Putting Implementation into Context to Advance the Management of Mechanically Ventilated Patients

Background

Each year, over one million people in the U.S. receive invasive mechanical ventilation (IMV) in intensive care units (ICUs). Some treatments have been shown to improve outcomes for these patients, such as reducing sedation, giving corticosteroids to certain patients, using low tidal volume ventilation, and placing patients with acute respiratory distress syndrome (ARDS) in a prone position. However, the way these treatments are used—and the results they produce—can vary widely between ICUs.

ICUs are complex environments where many different healthcare professionals work together, and we still don’t fully understand how the setting of each ICU affects how treatments are used. The COVID-19 pandemic brought a sudden increase in patients needing IMV and led to fast changes in how critical care was delivered. Some evidence-based practices became more common, while others were harder to use. New research, like the use of corticosteroids for COVID-19 and pneumonia, may have also changed how IMV patients are treated more broadly. Because of these major shifts, we now have a unique chance to learn more about how treatments are put into practice in different ICU settings.

Study Objective

The main goal of this project is to better understand how ICU environments and treatment features work together to affect care for IMV patients. Using research frameworks and advanced methods, we will:

1. Measure how often four proven treatments—sedation minimization, corticosteroid use, low tidal volume ventilation, and prone positioning—were used over time in IMV patients and specific groups.
2. Create a new model that shows how ICU conditions and other factors affect how treatments are used.
3. Develop flexible tools to help ICUs apply these treatments more effectively.

Study Design

We will study patients from over 30 ICUs in 16 hospitals who were admitted before, during, and after the peak of the COVID-19 pandemic. We’ll also use interviews and other qualitative methods and work with healthcare professionals and other stakeholders to design tools that help ICUs use these treatments in ways that fit their unique settings.

Study Impact

This project will improve how care is delivered in high-risk ICU settings by showing how treatment choices are shaped by the ICU environment. It will also provide important data for future studies that test ways to improve care for IMV patients. Finally, it will create a model that can be used to guide critical care in different ICUs across the country.

Johns Hopkins University
Colquitt Regional Medical Center
Penn State University

National Heart, Lung, and Blood Institute