Optimizing Time-limited Trials of Mechanical Ventilation in Acute Respiratory Failure: A Mixed-Methods Study (TIME Study)

The American healthcare system often fails to uphold the prevailing preference of adults to avoid prolonged, invasive medical treatments near death. Time-limited trials (TLTs) are a structured model of patient care proposed by palliative care experts to better align care with patients’ goals. A TLT is a trial of life support with milestones and a timeline to help evaluate whether the patient is improving.

The primary objective of the TIME Study is to define the optimal care delivery processes of a TLT for adults who develop acute respiratory failure requiring mechanical ventilation. First, we will use an ethnographic approach to understand how TLTs are currently carried out in intensive care units (ICUs) across five hospitals by conducting direct observation of patient care and real-time interviews with surrogate decision-makers and ICU team members. Next, we will explore relationships between TLTs, how they are implemented, and end-of-life outcomes for patients, surrogates, and ICU teams using health record data, surveys, and interviews.

We hypothesize that optimal delivery of time-limited trials will reduce how long patients with acute respiratory failure stay in the ICU and improve experiences for their families and for ICU clinicians

University of Wisconsin
Northwestern University

National Institutes of Health
National Heart, Lung, and Blood Institute