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Projects | In Progress

Implementing Nudges to Promote Utilization of Low Tidal Volume Ventilation (INPUT) Study

Research Areas

PAIR Center Research Team

Headshot of Meeta Prasad Kerlin
MD, MSCE

Meeta Prasad Kerlin

Headshot of Scott Halpern
MD, PhD

Scott Halpern

MS

Stefania Scott

PhD

Wei Wang

Headshot of Elizabeth Levy
MD

Elizabeth Levy

MD

Jennifer Ginestra

Headshot of Aerielle Belk
BS

Aerielle Belk

MPH

Jasmine Silvestri

Headshot of Michael Harhay
PhD, MPH

Michael Harhay

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.

  • Diagram showing the study design: 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.
    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.
  • Conceptual model diagram showing the relationships under study
    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.
  • 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)

Related Publications

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