Agreement Between Pediatric ICU Providers and Software Recommendations Regarding Ventilator Weaning in Pediatric Patients With Acute Hypoxemic Respiratory Failure

Abstract

Background:

There is evidence for ventilator weaning protocols providing benefit to children receiving mechanical ventilation but many protocols do not include explicit instruction to decreasing ventilator support from maximal settings. We evaluated provider and respiratory therapist (RT) opinion on ventilator weaning recommendations from a computerized decision support tool that could be used to predictably wean the ventilator.

Methods:

Institution Review Board approval was received for this study. Pediatric ICU attendings, fellows, nurse practitioners (collectively ICU providers), and RTs answered a brief survey about recommendations from a computer decision tool based on the ARDSnet protocol and modified for children. Data entered by RTs into the software from patients currently receiving mechanical ventilation for acute hypoxemic respiratory failure. The survey asked how reasonable the recommendations were and if recommendations could be implemented.

Results:

RTs completed 99 surveys and ICU providers completed 96 surveys based on data from 10 patients. RTs found 63.9% of recommendations reasonable. ICU providers found 65. 3% of recommendations reasonable. There were 5 instances of disagreement between RTs and ICU providers. The percent of recommendations RTs thought could be implemented was 29.9% and ICU providers 26.3%. There was 1 instance of disagreement. Free text responses indicated that many RTs and ICU providers were concerned about patient stability and low tidal volumes.

Conclusions:

We did not find the computer decision support tool highly acceptable to RTs and providers in our pediatric ICU. The main barriers to use of this computer decision support tool were ease of data entry, familiarity with the intricacies of computer software algorithm, and perception of stability.