Determinants of Implementation Success Coordinating Ventilator, Early Ambulation and Rehabilitation Efforts in the ICU (DISCOVER-ICU) study

ICU 中协调呼吸机、早期下床活动和康复工作的实施成功的决定因素 (DISCOVER-ICU) 研究

• 批准号: 10159121
• 负责人: Michele Christina Balas
• 金额: $ 37.56万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159121
• 关键词: Admission activity; Adopted; Adoption; Adult; Agitation; Anxiety; Attitude; Beds; Biometry; Body mass index; Caring; Characteristics; Clinical; Clinical Medicine; Clinical Practice Guideline; Clinical Research; Cognitive; Collaborations; Communities; Consolidated Framework for Implementation Research; Critical Care; Critical Illness; Data; Data Collection; Delirium; Development; Diagnosis; Disease; Dissemination and Implementation; Early Ambulation; Elderly; Excision; Exhibits; Face; Family; Future; Guidelines; Health; Heart Diseases; Hematological Disease; Hospitals; Hybrids; Impaired health; Impairment; Institutionalization; Intensive Care Units; Intervention; Knowledge; Lead; Light; Lung diseases; Mechanical ventilation; Medicine; Mental Depression; Methods; Modeling; National Heart, Lung, and Blood Institute; Neurocognitive Deficit; Outcome; Outpatients; Pain; Pain management; Patients; Pattern; Perception; Performance; Post-Traumatic Stress Disorders; Practice Management; Process; Protocols documentation; Provider; Psyche structure; Public Health; Randomized; Recommendation; Rehabilitation therapy; Reporting; Research; Resources; Risk; Sedation procedure; Self Efficacy; Severity of illness; Societies; Structure; Surveys; Testing; Variant; Ventilator; Vulnerable Populations; Work; adult obesity; clinical practice; concept mapping; data de-identification; demographics; design; effectiveness implementation trial; evidence base; experience; flexibility; functional decline; implementation determinants; implementation framework; implementation outcomes; implementation research; implementation science; implementation strategy; improved; improved outcome; innovation; interest; member; professional atmosphere; residence; skills; success; survivorship; symptom management

There is a fundamental gap between the discovery of proven-effective intensive care unit (ICU) sedation, mechanical ventilation, mobility, and symptom management strategies and approaches that can equip ICU providers with the skills necessary to reliably adopt these interventions in everyday practice. Until this gap is filled, the millions of patients with heart, lung, and blood disorders admitted to ICUs annually will remain at risk for avoidable physical, mental, and cognitive health impairments that may persist for months to years after hospital discharge. In the proposed study, we will continue our partnership with the Society of Critical Care Medicine's (SCCM's) ICU Liberation Collaborative; a national quality improvement network comprised of 68 academic, community, and federal ICUs. Guided by the Consolidated Framework for Implementation Research, the overall objective of the Determinants of Implementation Success Coordinating Ventilator, Early Ambulation and Rehabilitation Efforts in the ICU (DISCOVER-ICU) study is to develop multilevel implementation strategies to enhance sustainable adoption of the ABCDEF bundle in routine ICU practice. The ABCDEF bundle is an evidence-based, multicomponent ICU management strategy that incorporates many of the SCCM's Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. Using a multiphase, sequential, mixed-methods design, this study has three specific aims: 1) estimate the effects of patient-level characteristics on ABCDEF bundle adoption; 2) examine unit-level variation in ABCDEF bundle adoption and associated provider- and organization-level characteristics; and 3) determine which implementation strategies result in the greatest adoption of the ABCDEF bundle. We will use existing deidentified data obtained from >15,000 patients, >5,000 interprofessional ICU team members, and 68 hospitals participating in the ICU Liberation Collaborative to achieve specific aims 1 and 2. For specific aim 3, we will extend data collection using interprofessional ICU team surveys, a modified Delphi process, and concept mapping to achieve greater understanding of implementation strategies that prove most effective for ABCDEF bundle adoption. Our focus on high- and low-ABCDEF bundle-performing units will allow us to select and tailor potential ABCDEF bundle implementation strategies to meet specific local contextual needs. This approach in innovative because it: capitalizes on existing data from a large, nationally representative network of ICUs; includes units with already known and highly variable ABCDEF bundle performance rates and implementation strategies; and allows for the examination of actual versus perceived ABCDEF Bundle performance. Results of this work will directly lead to the development of implementation strategies that are adaptable, responsive to community needs, and account for the cultural and organizational factors necessary to increase ABCDEF bundle adoption. These implementation strategies will then be tested in a future cluster randomized hybrid II implementation- effectiveness trial.

事实证明，重症监护病房 (ICU) 镇静剂的有效性与发现之间存在根本性差距， 可以装备 ICU 的机械通气、活动能力和症状管理策略和方法 提供者具有在日常实践中可靠地采用这些干预措施所需的技能。直到这个间隙 每年入住 ICU 的数百万患有心脏、肺和血液疾病的患者仍将面临风险 对于可避免的身体、精神和认知健康损害，这些损害可能会在术后持续数月至数年 出院。在拟议的研究中，我们将继续与重症监护协会的合作伙伴关系 医学 (SCCM) ICU 解放协作组织；国家质量改进网络由 68 学术、社区和联邦 ICU。在实施研究综合框架的指导下， 实施成功的决定因素的总体目标 协调呼吸机、早期下床活动 ICU 中的康复工作（DISCOVER-ICU）研究旨在制定多层次的实施策略 加强 ABCDEF 捆绑包在 ICU 常规实践中的可持续采用。 ABCDEF 捆绑包是 基于证据的多组成部分 ICU 管理策略，融合了 SCCM 的许多临床经验 ICU 成人患者疼痛、躁动和谵妄管理实践指南。使用 多相、顺序、混合方法设计，本研究有三个具体目标：1）估计 ABCDEF 捆绑包采用的患者层面特征； 2) 检查 ABCDEF 包中单元级别的变化 采用以及相关的提供商和组织级别的特征； 3）确定哪个实施 策略导致 ABCDEF 捆绑包得到最大程度的采用。我们将使用获得的现有去识别化数据 来自超过 15,000 名患者、超过 5,000 名跨专业 ICU 团队成员以及参与 ICU 的 68 家医院 Liberation Collaborative 实现具体目标 1 和 2。对于具体目标 3，我们将使用以下方式扩展数据收集 跨专业 ICU 团队调查、改进的德尔菲流程和概念图，以实现更大的目标 了解对于 ABCDEF 捆绑包采用最有效的实施策略。我们的重点 高和低 ABCDEF 捆绑表现单元将使我们能够选择和定制潜在的 ABCDEF 捆绑 以满足当地具体情况需求的实施策略。这种方法具有创新性，因为它： 利用来自具有全国代表性的大型重症监护室网络的现有数据；包括已经有的单位 已知且高度可变的 ABCDEF 捆绑包性能率和实施策略；并允许 检查实际与感知的 ABCDEF Bundle 性能。这项工作的成果将直接导致 制定适应性强、响应社区需求并考虑到的实施战略 增加 ABCDEF 捆绑包采用所需的文化和组织因素。这些 然后，实施策略将在未来的集群随机混合 II 实施中进行测试 - 有效性试验。

项目成果

Factors Associated With Spontaneous Awakening Trial and Spontaneous Breathing Trial Performance in Adults With Critical Illness: Analysis of a Multicenter, Nationwide, Cohort Study.

与成人危重病患者自主觉醒试验和自主呼吸试验表现相关的因素：多中心、全国范围队列研究分析。

• DOI: 10.1016/j.chest.2022.01.018
• 发表时间: 2022
• 期刊: Chest
• 影响因子: 9.6
• 作者: Balas,MicheleC;Tan,Alai;Mion,LorraineC;Pun,Brenda;Jun,Jin;Brockman,Audrey;Mu,Jinjian;Ely,EWesley;Vasilevskis,EduardE
• 通讯作者: Vasilevskis,EduardE

Delirium in critical illness: clinical manifestations, outcomes, and management.

• DOI: 10.1007/s00134-021-06503-1
• 发表时间: 2021-10
• 期刊: Intensive care medicine
• 影响因子: 38.9
• 作者: Stollings JL;Kotfis K;Chanques G;Pun BT;Pandharipande PP;Ely EW
• 通讯作者: Ely EW

COVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic?

• DOI: 10.5114/ait.2020.95164
• 发表时间: 2020
• 期刊: Anaesthesiology intensive therapy
• 影响因子: 1.7
• 作者: Kotfis K;Williams Roberson S;Wilson J;Pun B;Ely EW;Jeżowska I;Jezierska M;Dabrowski W
• 通讯作者: Dabrowski W

Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis.

• DOI: 10.1056/nejmoa2024922
• 发表时间: 2021-04-15
• 期刊: The New England journal of medicine
• 作者: Hughes CG;Mailloux PT;Devlin JW;Swan JT;Sanders RD;Anzueto A;Jackson JC;Hoskins AS;Pun BT;Orun OM;Raman R;Stollings JL;Kiehl AL;Duprey MS;Bui LN;O'Neal HR Jr;Snyder A;Gropper MA;Guntupalli KK;Stashenko GJ;Patel MB;Brummel NE;Girard TD;Dittus RS;Bernard GR;Ely EW;Pandharipande PP;MENDS2 Study Investigators
• 通讯作者: MENDS2 Study Investigators

Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation.

• DOI: 10.4037/ajcc2022768
• 发表时间: 2022-01-01
• 期刊: American journal of critical care : an official publication, American Association of Critical-Care Nurses