Deployment, Adoption, And Clinical Impact Of A Real-Time Ventilator Management Dashboard

RATIONALE: Exposure to high tidal volumes is associated with increased mortality for patients undergoing invasive mechanical ventilation (IMV), but adherence to lung protective ventilation (LPV, ≤8cc/kg ideal body weight [IBW]) is suboptimal.Presented here is the evaluation of a real-time ventilator management dashboard to communicate synthesized ventilator information and improve LPV adherence.METHODS: The Respiratory Insights Dashboard (RID) displays key real-time patient and ventilator data.Variables include: respiratory support modality, IBW, airway pressures, set and measured tidal volumes (Vt), and arterial blood gases.Out-of-range values are highlighted in red; summary count of patients with currently set Vt >8cc/kg IBW in each ICU is placed above patient-level data.The RID was piloted in the Neurosciences ICU (NSICU) with daily review jointly by respiratory therapists and neuro-intensivists embedded into the ICU workflow.The primary outcome was duration with ventilator settings >8cc/kg IBW for all NSICU patients in the pre-implementation (12/1/2019-3/4/2020) and post-implementation (6/14-2020-12/1/2020) periods.Secondary outcomes included duration with measured expiratory Vt >8cc/kg IBW per patient, hourly percent adherence with Vt set ≤8cc/kg IBW, duration of MV before ventilator set ≤8cc/kg IBW, and number of views of the dashboard.RESULTS: In the preintervention period, 139 NSICU patients received MV, and 240 in the post-intervention period.Patient cohorts were not significantly different between pre-and post-intervention periods in terms of age (60 ± 17 vs.62 ±15 years), IBW (62 ± 12 vs.63 ± 10 kg), SOFA score (4.42 ± 2.44 vs. 4.47 ± 2.92), and total MV duration (117 ± 149 vs. 99 ± 120 hours).Duration of mechanical ventilation >8cc/kg IBW decreased from a mean 10 ± 37 to 1 ± 5 hours (p=0.003)(See Figure ).Duration with measured Vt >8cc/kg decreased from 38 ±70 to 22 ± 39 hours (p=0.006).Hourly adherence with Vt setting ≤8cc/kg rose from 89 ± 28% to 96 ± 16%, (p=0.004).Mean duration from first mechanical ventilation in NSICU to reaching goal Vt settings fell from mean 4.61 hours (range 0-203.15hours) to 0.34 (range 0-21.93 hours) (p=0.016).The dashboard was viewed 1058 times in the 170day study period, averaging 6.22 views/day.CONCLUSION: A real-time ventilator management dashboard clinically and statistically significantly improved LPV adherence, enabled rapid correction of suboptimal ventilator settings, and was viewed more frequently than required by the pilot design.Further initiatives with the dashboard may optimize other aspects of ventilator management.