The Maximizing Extubation outcomes Through Educational and Organizational Research (METEOR) Trial

通过教育和组织研究 (METEOR) 试验最大限度地提高拔管效果

• 批准号: 10314540
• 负责人: Timothy D Girard
• 金额: $ 62.12万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10314540
• 关键词: Acute respiratory failure; Address; Adoption; Adult; Area; Breathing; Cannulas; Caring; Cessation of life; Clinical; Clinical Protocols; Clinical Trials; Critical Care; Data; E-learning; Education; Educational Intervention; Effectiveness; Evidence based practice; Funding; Grant; Hospital Mortality; Hospitals; Inpatients; Intervention; Interview; Learning; Life; Link; Mechanical ventilation; Medical; Memory; Morbidity - disease rate; Nature; Nose; Outcome; Oxygen; Patient risk; Patients; Persons; Population; Preventive; Process; Protocols documentation; Provider; Qualitative Evaluations; Randomized; Randomized Controlled Trials; Recurrence; Research; Respiratory Failure; Respiratory Therapy; Risk; Role; Series; Surveys; Testing; Transact; Tube; United States; Work; active control; base; clinical center; compare effectiveness; contextual factors; design; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; face mask; high risk; implementation strategy; implementation tool; improved outcome; innovation; insight; member; mortality; novel; patient oriented; prevent; respiratory; theories; therapy design; ventilation

PROJECT SUMMARY Nearly one million patients require invasive mechanical ventilation for acute respiratory failure in the United States each year. Most of these patients will recover to the point of extubation, yet even those who are extubated remain vulnerable to complications and poor outcomes. Multiple high-profile randomized controlled trials have shown that two preventive post-extubation respiratory therapies— noninvasive ventilation (NIV) and high-flow nasal cannula oxygen (HFNC)—can prevent recurrent respiratory failure, reintubation, and death in this population. Despite this evidence, however, these therapies remain severely underutilized, leading to preventable morbidity and mortality. To address this implementation gap, we propose to conduct the Maximizing Extubation outcomes Through Educational and Organizational Research (METEOR) Trial, a cluster-randomized, stepped-wedge, type 2 hybrid effectiveness-implementation trial of interprofessional education about preventive post-extubation NIV and HFNC with and without clinical protocols. We designed the METEOR Trial based on extensive preliminary studies, during which we identified barriers to adoption of preventive post-extubation respiratory care and pilot tested interprofessional education as an implementation strategy in the ICU. These studies revealed that a major barrier to implementation is the lack of a shared understanding about the value of these therapies within the interprofessional ICU team; a theory-based interprofessional education intervention designed to create a shared understanding and support “transactive memory” among team members is both feasible and acceptable; and interprofessional education can be strengthened by linking it with a clinical protocol. During the METEOR Trial, we will randomize ICUs to one of four implementation strategies: an active control, protocol-directed care, interprofessional education, or a combination of protocol-directed care and interprofessional education. In parallel, we will randomize ICUs to one of two clinical strategies, one emphasizing either post- extubation NIV or HFNC based on patient risk vs. one emphasizing post-extubation HFNC for all patients. The specific aims of the trial are to (1) test the effectiveness of interprofessional education on the implementation of preventive, post-extubation therapies, (2) compare the effectiveness of two preventive, post-extubation therapies (NIV and HFNC) on patient-centered clinical outcomes, and (3) perform a comprehensive qualitative evaluation of the trial processes and outcomes in order to better understand mechanism, identify what worked and what didn’t, and set the stage for broader dissemination of the study findings. Together these aims will provide critical insight into the role of interprofessional education as an implementation strategy in hospital settings, leading to improved outcomes for hundreds of thousands of patients with acute respiratory failure.

项目摘要 近一百万患者需要侵入性的机械通气，以使其急性呼吸衰竭 每年美国。这些患者中的大多数都会恢复到拔管的地步，甚至 被拔管的人仍然容易发生并发症和不良结果。多个高调 随机对照试验表明，两种预防性后拔管后呼吸疗法 - 无创通气（NIV）和高流量鼻套管氧（HFNC） - 可以防止复发 该人群中的呼吸衰竭，重新输出和死亡。尽管有这些证据，这些 疗法仍然严重充分利用，导致可预防的发病率和死亡率。解决这个问题 实施差距，我们建议通过教育进行最大化的拔管结果 和组织研究（Meteor）试验，一项群集随机，阶梯式，2型混合动力 跨专业教育的有效性实施试验有关预防性肠道内NIV 具有和没有临床方案的HFNC。我们设计了基于广泛的流星试验 初步研究，在此期间，我们确定了采用预防后采用的障碍 呼吸护理和试点跨专业教育作为ICU中的实施策略。 这些研究表明，实施的主要障碍是缺乏共同的理解 关于这些疗法在跨专业ICU团队中的价值；基于理论的 专业教育干预措施旨在建立共同的理解和支持 团队成员之间的“交易记忆”既可行又可以接受。和专业 可以通过将其与临床方案联系起来来加强教育。在流星试验期间，我们将 将ICU随机为四种实施策略之一：主动控制，协议指导的护理， 跨专业教育或协议指导的护理和跨专业教育的结合。 同时，我们将随机将ICU随机为两种临床策略之一，强调这两种策略 基于患者风险与一个强调所有人的肠道脱水HFNC的拔管NIV或HFNC 患者。试验的具体目的是（1）测试跨专业教育的有效性 实施预防性，拔管后疗法，（2）比较两个的有效性 预防性，静读后疗法（NIV和HFNC）在以患者为中心的临床结果和（3） 对试验过程和结果进行全面的定性评估，以便更好 了解机制，确定什么有效和无效，并为更广泛的舞台奠定了基础 研究结果的传播。这些目标共同将对角色的作用提供批判性的见解 专业教育作为医院环境中的实施策略，导致改善 成千上万的急性呼吸衰竭患者的结局。