Implementation of Nudges to Promote Utilization of Low Tidal Volume Ventilation (INPUT) Study (INPUT)
ARDS, Critical Illness, Acute Respiratory Distress Syndrome
About this trial
This is an interventional health services research trial for ARDS focused on measuring mechanical ventilation, lung-protective ventilation
Eligibility Criteria
Inclusion Criteria:
- Aged 18 and over; AND
- Admission to 1 of the 12 participating ICUs; AND
- Undergoing mechanical ventilation
Exclusion Criteria:
- The episode of MV lasts less than 12 hours, because we believe that the evidence-based practice may not apply to these patients nor alter their outcomes.
- The patient is on minimal settings for the entirety of MV, defined as a spontaneous mode (e.g., pressure support ventilation) with pressure support <10 Centimeters of Water Column (cmH2O), AND positive end-expiratory pressure (PEEP) <8 cmH20, AND fraction of inspired oxygen (FiO2) <50%, because the clinical significance of spontaneous tidal volumes is unknown and low tidal volumes may not be beneficial or desirable.
- Goals of care are documented as comfort measures only (as identified through their "code status" field in the EHR) during the first 72 hours during episode of MV, because mechanical ventilation is managed differently during care focused exclusively on comfort and low tidal volume ventilation may not be appropriate, nor would it likely influence clinical outcomes.
- There is no height documented in the EHR at the time of initiation of MV, because we will be unable to estimate ideal body weight, a necessary parameter to calculate the primary outcome, and because they will not receive the interventions.
- The height documented is less than 4 feet, because the formula for ideal body weight does not hold true below this height.
Sites / Locations
- Princeton Medical CenterRecruiting
- Hospital of the University of PennsylvaniaRecruiting
- Penn Presbyterian Medical CenterRecruiting
- Pennsylvania HospitalRecruiting
- Chester County HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Active Comparator
Active Comparator
Active Comparator
Placebo Comparator
Active Comparator
Default order set
Physician-targeted accountable justification
Default order set + physician-targeted accountable justification
Standard of Care
Physician-targeted accountable justification + RT-targeted accountable justification
This arm will have the default order set implementation strategy
This arm will have the physician-targeted accountable justification implementation strategy
This arm will have the default order set and physician-targeted accountable justification
This arm will have no interventions and standard of care practices will be in place.
This arm will have the default order set and respiratory therapist-targeted accountable justification