Skip to main content
PMC home page
Proceedings of the AMIA Symposium logoLink to Proceedings of the AMIA Symposium
. 1999:251–255.

Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.

T D East 1, L K Heermann 1, R L Bradshaw 1, A Lugo 1, R M Sailors 1, L Ershler 1, C J Wallace 1, A H Morris 1, B McKinley 1, A Marquez 1, A Tonnesen 1, L Parmley 1, W Shoemaker 1, P Meade 1, P Thaut 1, T Hill 1, M Young 1, J Baughman 1, M Olterman 1, V Gooder 1, B Quinn 1, W Summer 1, V Valentine 1, J Carlson 1, K Steinberg 1, et al.
PMCID: PMC2232746  PMID: 10566359

Abstract

200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.

Full text

PDF
251

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barie P. S., Hydo L. J., Fischer E. A prospective comparison of two multiple organ dysfunction/failure scoring systems for prediction of mortality in critical surgical illness. J Trauma. 1994 Oct;37(4):660–666. doi: 10.1097/00005373-199410000-00022. [DOI] [PubMed] [Google Scholar]
  2. Bell R. C., Coalson J. J., Smith J. D., Johanson W. G., Jr Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983 Sep;99(3):293–298. doi: 10.7326/0003-4819-99-3-293. [DOI] [PubMed] [Google Scholar]
  3. Conway S. P., Pond M. N., Bowler I., Smith D. L., Simmonds E. J., Joanes D. N., Hambleton G., Hiller E. J., Stableforth D. E., Weller P. The chest radiograph in cystic fibrosis: a new scoring system compared with the Chrispin-Norman and Brasfield scores. Thorax. 1994 Sep;49(9):860–862. doi: 10.1136/thx.49.9.860. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. East T. D., Morris A. H., Wallace C. J., Clemmer T. P., Orme J. F., Jr, Weaver L. K., Henderson S., Sittig D. F. A strategy for development of computerized critical care decision support systems. Int J Clin Monit Comput. 1991;8(4):263–269. doi: 10.1007/BF01739127. [DOI] [PubMed] [Google Scholar]
  5. Henderson S., Crapo R. O., Wallace C. J., East T. D., Morris A. H., Gardner R. M. Performance of computerized protocols for the management of arterial oxygenation in an intensive care unit. Int J Clin Monit Comput. 1991;8(4):271–280. doi: 10.1007/BF01739128. [DOI] [PubMed] [Google Scholar]
  6. Jacobs S., Zuleika M., Mphansa T. The Multiple Organ Dysfunction Score as a descriptor of patient outcome in septic shock compared with two other scoring systems. Crit Care Med. 1999 Apr;27(4):741–744. doi: 10.1097/00003246-199904000-00027. [DOI] [PubMed] [Google Scholar]
  7. Miller P. L. Goal-directed critiquing by computer: ventilator management. Comput Biomed Res. 1985 Oct;18(5):422–438. doi: 10.1016/0010-4809(85)90020-5. [DOI] [PubMed] [Google Scholar]
  8. Montgomery A. B., Stager M. A., Carrico C. J., Hudson L. D. Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis. 1985 Sep;132(3):485–489. doi: 10.1164/arrd.1985.132.3.485. [DOI] [PubMed] [Google Scholar]
  9. Morris A. H., Wallace C. J., Menlove R. L., Clemmer T. P., Orme J. F., Jr, Weaver L. K., Dean N. C., Thomas F., East T. D., Pace N. L. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):295–305. doi: 10.1164/ajrccm.149.2.8306022. [DOI] [PubMed] [Google Scholar]
  10. Petty T. L. ARDS: refinement of concept and redefinition. Am Rev Respir Dis. 1988 Sep;138(3):724–724. doi: 10.1164/ajrccm/138.3.724. [DOI] [PubMed] [Google Scholar]
  11. Rutledge G., Thomsen G., Farr B., Tovar M., Sheiner L., Fagan L. VentPlan: a ventilator-management advisor. Proc Annu Symp Comput Appl Med Care. 1991:869–871. [PMC free article] [PubMed] [Google Scholar]
  12. Suchyta M. R., Clemmer T. P., Orme J. F., Jr, Morris A. H., Elliott C. G. Increased survival of ARDS patients with severe hypoxemia (ECMO criteria). Chest. 1991 Apr;99(4):951–955. doi: 10.1378/chest.99.4.951. [DOI] [PubMed] [Google Scholar]
  13. Thomsen G. E., Pope D., East T. D., Morris A. H., Kinder A. T., Carlson D. A., Smith G. L., Wallace C. J., Orme J. F., Jr, Clemmer T. P. Clinical performance of a rule-based decision support system for mechanical ventilation of ARDS patients. Proc Annu Symp Comput Appl Med Care. 1993:339–343. [PMC free article] [PubMed] [Google Scholar]
  14. Weatherly M. R., Palmer C. G., Peters M. E., Green C. G., Fryback D., Langhough R., Farrell P. M. Wisconsin cystic fibrosis chest radiograph scoring system. Pediatrics. 1993 Feb;91(2):488–495. [PubMed] [Google Scholar]
  15. Wong E. B., Regnis J., Shnier R. C., Bye P. T., Stewart M. E. The relationship between tests of lung function and three chest radiological scoring systems in patients with cystic fibrosis. Australas Radiol. 1993 Aug;37(3):265–269. doi: 10.1111/j.1440-1673.1993.tb00070.x. [DOI] [PubMed] [Google Scholar]

Articles from Proceedings of the AMIA Symposium are provided here courtesy of American Medical Informatics Association

RESOURCES