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Potential Acceptability of a Pediatric Ventilator Management Computer Protocol

Katherine A Sward1, Christopher J L Newth, Robinder G Khemani

  • 11University of Utah College of Nursing, Salt Lake City, UT. 2Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 5Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 9Department of Pediatrics, University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 12Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 13Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 14Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 15Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD. 16Formerly Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|September 20, 2017
PubMed

Insights

Physicians found ventilator management protocol recommendations acceptable overall, but disagreed on the specific size of ventilator setting adjustments for children with pediatric acute respiratory distress syndrome.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Clinical Protocol Development

Background:

  • Pediatric acute respiratory distress syndrome (PARDS) requires mechanical ventilation.
  • Optimizing ventilator settings is crucial but complex.
  • Standardized protocols may improve care but require clinician acceptance.

Purpose of the Study:

  • To assess the acceptability and preferred granularity of ventilator management recommendations for PARDS.
  • To inform the development of effective ventilator management protocols.

Main Methods:

  • Online questionnaire administered to 122 physicians in eight Pediatric Intensive Care Units (PICUs).
  • Physicians evaluated 50 clinical scenarios with protocol recommendations.
  • Acceptability was measured based on scenario recommendations and provider characteristics.

Main Results:

  • Overall, 80% of ventilator management recommendations were accepted.
  • Acceptance varied by ventilator mode (e.g., HFOV 83%, PRVC 82%, PC 75%) and adjusted variable (e.g., PIP 88%, FiO2 86%, PEEP 69%).
  • No significant variation in acceptance based on child size or age; preference for smaller PEEP changes noted.

Conclusions:

  • While overall acceptance of PARDS ventilator management recommendations was high, consensus on the specific granularity of setting adjustments was lacking.
  • A well-defined protocol could facilitate the evaluation of ventilator management strategies.
  • Further research is needed to link protocol adherence to improved patient outcomes.
Abstract

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