Potential acceptability of a pediatric ventilator management computer protocol

Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design: Survey/questionnaire. Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants: One hundred twenty-two physicians (attendings and fellows). Interventions: None. Measurements and Main Results: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for Fio2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

Original languageEnglish (US)
Pages (from-to)1027-1034
Number of pages8
JournalPediatric Critical Care Medicine
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Mechanical Ventilators
Pediatrics
Positive-Pressure Respiration
Adult Respiratory Distress Syndrome
Pressure
High-Frequency Ventilation
Critical Care
Consensus
Physicians
Research
Surveys and Questionnaires

Keywords

  • Acute lung injury
  • Clinical decision support
  • Guideline adherence
  • Mechanical ventilation
  • Pediatric acute respiratory distress syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) (2017). Potential acceptability of a pediatric ventilator management computer protocol. Pediatric Critical Care Medicine, 18(11), 1027-1034. https://doi.org/10.1097/PCC.0000000000001331
Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). / Potential acceptability of a pediatric ventilator management computer protocol. In: Pediatric Critical Care Medicine. 2017 ; Vol. 18, No. 11. pp. 1027-1034.
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abstract = "Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design: Survey/questionnaire. Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants: One hundred twenty-two physicians (attendings and fellows). Interventions: None. Measurements and Main Results: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80{\%} of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83{\%}, pressure-regulated volume control 82{\%}, pressure control 75{\%}; p = 0.002) and variable adjusted (ranging from 88{\%} for peak inspiratory pressure and 86{\%} for Fio2 changes to 69{\%} for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.",
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author = "{Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)} and Sward, {Katherine A.} and Newth, {Christopher J.L.} and Khemani, {Robinder G.} and Kent Page and Meert, {Kathleen L.} and Carcillo, {Joseph A.} and Shanley, {Thomas Patrick} and Moler, {Frank W.} and Pollack, {Murray M.} and Dalton, {Heidi J.} and Wessel, {David L.} and Berger, {John T.} and Berg, {Robert A.} and Harrison, {Rick E.} and Allan Doctor and Dean, {J. Michael} and Richard Holobkov and Jenkins, {Tammara L.} and Nicholson, {Carol E.}",
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Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) 2017, 'Potential acceptability of a pediatric ventilator management computer protocol', Pediatric Critical Care Medicine, vol. 18, no. 11, pp. 1027-1034. https://doi.org/10.1097/PCC.0000000000001331

Potential acceptability of a pediatric ventilator management computer protocol. / Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN).

In: Pediatric Critical Care Medicine, Vol. 18, No. 11, 01.11.2017, p. 1027-1034.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Potential acceptability of a pediatric ventilator management computer protocol

AU - Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)

AU - Sward, Katherine A.

AU - Newth, Christopher J.L.

AU - Khemani, Robinder G.

AU - Page, Kent

AU - Meert, Kathleen L.

AU - Carcillo, Joseph A.

AU - Shanley, Thomas Patrick

AU - Moler, Frank W.

AU - Pollack, Murray M.

AU - Dalton, Heidi J.

AU - Wessel, David L.

AU - Berger, John T.

AU - Berg, Robert A.

AU - Harrison, Rick E.

AU - Doctor, Allan

AU - Dean, J. Michael

AU - Holobkov, Richard

AU - Jenkins, Tammara L.

AU - Nicholson, Carol E.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design: Survey/questionnaire. Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants: One hundred twenty-two physicians (attendings and fellows). Interventions: None. Measurements and Main Results: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for Fio2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

AB - Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design: Survey/questionnaire. Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants: One hundred twenty-two physicians (attendings and fellows). Interventions: None. Measurements and Main Results: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for Fio2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

KW - Acute lung injury

KW - Clinical decision support

KW - Guideline adherence

KW - Mechanical ventilation

KW - Pediatric acute respiratory distress syndrome

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Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). Potential acceptability of a pediatric ventilator management computer protocol. Pediatric Critical Care Medicine. 2017 Nov 1;18(11):1027-1034. https://doi.org/10.1097/PCC.0000000000001331