Projects | In Progress
Implementing Nudges to Promote Utilization of Low Tidal Volume Ventilation (INPUT) Study
Research Areas
PAIR Center Research Team
Topics
Overview
Over a million Americans undergo invasive mechanical ventilation each year. Mechanical ventilation can be life-saving but can also be harmful, sometimes leading to direct lung injury with artificially delivered breaths. A growing body of evidence has demonstrated that a specific strategy of “lung-protective ventilation,” defined by setting low tidal volumes and limiting plateau pressures, can improve outcomes of mechanically ventilated patients; the strategy is best suited for patients with acute respiratory distress syndrome (ARDS). Despite the wealth of literature demonstrating clear benefits to LPV in ARDS and possible benefit and at least no harm from LPV in other mechanically ventilated patients, many patients who undergo mechanical ventilation do not receive this life-saving therapy. The goal of this research is to develop implementation strategies to improve the utilization of LPV and the outcomes of patients who undergo mechanical ventilation. Through semi-structured interviews with clinicians, we will assess the perceived benefits and burdens of different EHR-based strategies grounded in behavioral economic theory. These findings will provide preliminary data to inform a future pragmatic trial of how such strategies may increase LPV utilization among all mechanically ventilated patients.
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Stepped wedge roll-out of three strategies to promote the use of lung-protective ventilation. Strategy A is a default order panel for mechanical ventilation that is auto-populated with lung-protective settings. Strategy B is an order panel that includes accountable justification requiring a user to provide a reason when LPV settings are not entered. Strategy C is an accountable justification strategy embedded in the flowsheet documentation. -
The diagram maps the relationships under study. Dashed -arrows show factors that may interact with the implementation strategies with respect to implementation and effectiveness outcomes. Aim 1 will test implementation outcomes, aim 2 will test effectiveness outcomes.
Partnering Health Systems
University of Pennsylvania Health System
Sponsors
National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI)