Interaction of Critical Care Practitioners With a Decision Support Tool for Weaning Mechanical Ventilation in Children

• Published in: Respiratory care Vol. 65; no. 3; pp. 333 - 340
• Main Authors: Hartmann, Silvia M, Farris, Reid Wd, Yanay, Ofer, DiBlasi, Robert M, Kearney, Christine N, Zimmerman, Joe D, Carlin, Kristen, Zimmerman, Jerry J
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01-03-2020
• Subjects: Adolescent; Child; Clinical Protocols; Cohort Studies; Critical Care - methods; Decision Support Systems, Clinical; Female; Health Personnel; Humans; Intensive Care Units, Pediatric; Male; Medical research; Nurse practitioners; Nurses; Pediatrics; Prospective Studies; Respiration, Artificial; Respiratory insufficiency; Respiratory Insufficiency - therapy; Setting (Literature); Surveys and Questionnaires; Tidal Volume; Time; Ventilator Weaning - methods; Ventilators, Mechanical; United Kingdom; acute hypoxemic respiratory failure; mechanical ventilation; protocols; weaning; pediatric
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.06877

There is evidence that ventilator weaning protocols provide benefit to children receiving mechanical ventilation, but many protocols do not include explicit instructions for decreasing ventilator support from maximal settings. We evaluated care provider opinions on ventilator weaning recommendations made by a computerized decision support tool.
Recommendations for ventilator adjustment were generated using a computerized decision support tool based on the ARDSNet protocol using data from children with acute hypoxemic respiratory failure admitted to the pediatric ICU (PICU). Attending physicians, fellows, nurse practitioners, and respiratory therapists (RTs) caring for these patients answered a brief survey to assess whether recommendations were reasonable and whether the practitioner believed they could be implemented.
RTs completed 99 surveys and ICU providers completed 96 surveys based on data from 10 patients. RTs and ICU providers found 63.9% and 65.3% of recommendations reasonable, respectively. There were 5 instances of disagreement between RTs and ICU providers. The percent of recommendations that RTs thought could be implemented was 29.9%, whereas this figure for ICU providers was 26.3%, with 4 instances of disagreement. Free-text responses indicated that many RTs and ICU providers were concerned about disrupting current patient stability and low tidal volumes.
On initial evaluation, the decision support tool did not appear to be highly acceptable to RTs and ICU providers in our setting because recommendations were rarely implemented. In addition, acceptability did not increase over time as patients generally improved. Most respondents preferred to make no ventilator changes and felt the recommendations were too aggressive. The notable barrier to use was a perception of potential patient instability with weaning.