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Maximizing Extubation Outcomes Through Educational and Organizational Research (METEOR) Trial: protocol for a
Niall T Prendergast1, Jeremy M Kahn2, Derek C Angus2
1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA prendergastnt@upmc.edu.
BMJ Open
|October 23, 2025
Summary
Interprofessional education (IPE) and clinical protocols improve the use of non-invasive ventilation (NIV) and high-flow nasal cannula oxygen (HFNC) after mechanical ventilation, reducing patient mortality. This approach enhances respiratory support and patient outcomes in intensive care units (ICUs).
Area of Science:
- Critical Care Medicine
- Implementation Science
- Respiratory Therapy
Background:
- Extubation failure, requiring reintubation, is common in patients with acute respiratory failure.
- Non-invasive ventilation (NIV) and high-flow nasal cannula oxygen (HFNC) are evidence-based interventions to prevent extubation failure.
- Implementation of these interventions is limited due to complex care coordination needs in intensive care units (ICUs).
Purpose of the Study:
- To evaluate the effectiveness of interprofessional education (IPE) in increasing the implementation of preventive postextubation respiratory support.
- To assess if pairing IPE with a clinical protocol enhances the benefits of preventive respiratory support.
- To determine the impact of preventive postextubation NIV and HFNC on in-hospital mortality compared to conventional oxygen therapy.
Main Methods:
- A batched, stepped-wedge, cluster-randomised trial involving 24 ICU clusters in a US multihospital health system.
- Comparison of traditional online education (OE) with IPE, with or without a clinical protocol.
- Randomisation of half the clusters to targeted NIV/HFNC education and the other half to universal HFNC education for eligible mechanically ventilated patients.
Main Results:
- The primary implementation endpoint is the rate of NIV or HFNC use postextubation.
- The primary clinical endpoint is in-hospital mortality, assessed up to 60 days post-intubation.
- The trial will test hypotheses regarding IPE, clinical protocols, and the comparative effectiveness of NIV/HFNC strategies.
Conclusions:
- Interprofessional education, especially when combined with a clinical protocol, has the potential to improve the adoption of evidence-based postextubation respiratory support.
- Targeted or universal HFNC and NIV strategies may reduce in-hospital mortality in patients recovering from mechanical ventilation.
- This hybrid trial design addresses both the implementation and effectiveness of critical care interventions.
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