Educational strategies to promote post-extubation non-invasive ventilation in patients with acute respiratory failure

促进急性呼吸衰竭患者拔管后无创通气的教育策略

基本信息

批准号：
9764479
负责人：
Timothy D Girard
金额：
$ 51.87万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9764479
关键词：
Acute respiratory failure Adoption Adult Blood Breathing Cessation of life Clinical Clinical Practice Guideline Clinical Trials Critical Care Critical Illness Data Disease Education Educational Intervention Effectiveness Environmental air flow Evidence based practice Eye Failure Focus Groups Foundations Health system Healthcare Heart Hospitals Hour Hybrids Inpatients Interruption Interview Knowledge Lead Learning Life Lung Measures Mechanical ventilation Medical Care Team Morbidity - disease rate Multi-Institutional Clinical Trial Nature Outcome Patients Persons Preparation Protocols documentation Provider Randomized Controlled Trials Recommendation Recurrence Research Infrastructure Respiratory Failure Risk Role Series Site Sleep Speed Testing Time Transcript Tube United States Work arm base behavior change continuing medical education design experience face mask high risk implementation research implementation strategy implementation trial improved improved outcome innovation instrument learned behavior learning strategy mortality novel novel strategies response theories

项目摘要

PROJECT SUMMARY Nearly 800,000 patients require invasive mechanical ventilation for acute respiratory failure in the United States each year. Among those who recover to the point of extubation, a substantial proportion remain at high risk for extubation failure, i.e., recurrent respiratory failure requiring reintubation within 48 hours of extubation. For these vulnerable patients, extubation directly to noninvasive ventilation reduces the risk of recurrent respiratory failure, reintubation, and death. Based on evidence from multiple randomized controlled trials, post- extubation noninvasive ventilation among high-risk patients is strongly recommended in recent clinical practice guidelines. Yet, despite these recommendations, the use of this evidence-based practice remains limited, leading to preventable morbidity and mortality. Our long-term objective is to conduct a multicenter, hybrid effectiveness-implementation trial to identify the optimal strategy for promoting the use of post-extubation noninvasive ventilation among high-risk patients recovering from acute respiratory failure. In this application, we propose a series of studies that will culminate in our ability to successfully conduct this trial. Specifically, we plan to achieve the following aims: (1) qualitatively assess barriers and facilitators to the adoption of post- extubation noninvasive ventilation and evaluate the role of educational interventions in improving adoption; (2) develop and pilot test three strategies designed to speed implementation of post-extubation noninvasive ventilation: one control strategy (traditional online continuing medical education) and two novel strategies (interprofessional education and just-in-time education); and (3) finalize preparations for a four-arm, multicenter, hybrid effectiveness-implementation trial conducted within the UPMC Health System to identify the implementation strategy that best promotes use of post-extubation noninvasive ventilation, comparing control with interprofessional education, just-in-time education, and both. This work is important because it will lead directly to a major clinical trial with the potential to improve outcomes for hundreds of thousands of high-risk patients with acute respiratory failure, and it will provide foundational knowledge about the roles of interprofessional education and just-in-time education as implementation strategies in the hospital setting. This work is innovative because it is based on novel theories for organizational learning and behavior change that account for the interprofessional nature of critical care and the unique needs of the adult learner. This work is feasible in our hands because it builds off an existing research infrastructure developed by an accomplished study team with extensive experience conducting both implementation research and multicenter clinical trials in critically ill patients.

项目摘要近80万名患者需要侵入性的机械通气，以治疗联合的急性呼吸衰竭每年。在恢复到拔管点的人中，很大一部分仍在拔管故障的高风险，即需要在48小时内重新插管的复发性呼吸衰竭拔管。对于这些脆弱的患者，直接拔管非侵入性通气会降低风险复发性呼吸衰竭，重新输出和死亡。基于来自多个随机的证据对照试验，高危患者的拔管后无创通气是强烈的在最近的临床实践指南中推荐。但是，尽管有这些建议，但使用此建议循证实践仍然有限，导致可预防的发病率和死亡率。我们的长期目的是进行多中心，混合有效性 - 实现试验，以确定最佳促进高风险患者中使用后无创通气的策略从急性呼吸衰竭中恢复。在此应用程序中，我们提出了一系列研究最终使我们成功进行该试验的能力。具体来说，我们计划实现以下内容目的：（1）定性评估采用后无创的障碍和促进者通风和评估教育干预措施在改善采用方面的作用；（2）开发和飞行员测试三种策略，旨在加快肠道后无创通气的实施：一种控制策略（传统的在线持续医学教育）和两种新颖的策略（专业教育和即时教育）；（3）最终确定四臂的准备工作，在UPMC卫生系统内进行的多中心，混合有效性试验确定最能促进使用后无创通气使用的实施策略，将控制与跨专业教育，即时教育以及两者进行比较。这项工作是重要的是因为它将直接导致一项重大的临床试验，并有可能改善结果成千上万的高风险急性呼吸衰竭患者，它将提供基础关于跨专业教育和即时教育的作用的知识医院环境中的策略。这项工作具有创新性，因为它基于新颖的理论组织学习和行为改变重症监护的跨专业性质以及成人学习者的独特需求。这项工作在我们手中是可行的现有的研究基础设施由一支丰富经验的成就研究团队开发对重症患者进行实施研究和多中心临床试验。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Enhancing Implementation of Complex Critical Care Interventions through Interprofessional Education.

DOI：
10.34197/ats-scholar.2020-0169oc
发表时间：
2021-09
期刊：
ATS scholar
影响因子：
1.9
作者：
Rak KJ;Kahn JM;Linstrum K;Caplan EA;Argote L;Barnes B;Chang CH;George EL;Hess DR;Russell JL;Seaman JB;Angus DC;Girard TD
通讯作者：
Girard TD

Provider Perspectives on Preventive Postextubation Noninvasive Ventilation for High-Risk Intensive Care Unit Patients.

提供者对高危重症监护病房患者预防性拔管后无创通气的看法。