Abstract
Background:
Management of the ventilator is historically done by the ICU provider at the bedside and uses software that ships with the ventilator that do not integrate with other sources of patient data like sedation levels, arterial blood gas analysis or patient’s presenting conditions. Advancement in the field of clinical informatics and critical care device integrations allows for better integration between the ventilator and the EMR. Moreover, multiple clinical targets for management of mechanically ventilated patients were previously proposed like sedation management based on patient ventilator asynchrony and assessment of bronchodilator response based on ventilatory circuit pressure changes among many others. We investigate the feasibility and applicability of a custom-built software that is embedded into the EMR and presenting integrated data from the ventilator along with chart events to the treating provider in the ICU.
Methods:
The ventilator was connected via the serial interface to transfer breath level data as well as current modes and settings, patient respiratory mechanics. Our software also connects to the EMR to collect admission events including labs and medication doses. The software is customizable to display trends of any selected values but three main areas of interest were designed. (1) A view that allows continuous visualization of exhaled tidal volume, generated ventilatory ratio using PaCO2 levels (Figure 1). (2) A view for paired exhaled tidal volumes and patient frequency with sedation levels and RASS scores (Figure 2). (3) A view to visualize administered inhaled bronchodilators with measured airway pressures from the mechanical ventilator including peak and plateau airway pressure.
Results:
We successfully connected a custom-built software to the mechanical ventilator as well as collected EMR data. When maintaining appropriate date and time indices, the data can be visualized throughout the whole admission. Data was collected for 25 mechanically ventilated patients. A total of 82.5 days (2.84 million breaths) were collected.
Conclusions:
Current technologies allow integration of data from the mechanical ventilator with other sources of information including data collected in the EMR. Our platform not only offers superior insights on the current clinical state of the mechanically ventilated patient but also lays the infrastructure needed to assess and prospectively validate a number integrated clinical targets proposed for management of ICU patients.
Figure 01 Figure 02
Get full access to this article
View all access options for this article.