title: Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.
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.
authors.affiliation: Department of Medical Informatics, Cottonwood Hospital, Salt Lake City, Utah 84107, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: East
authors.forename: L K
authors.initials: LK
authors.lastname: Heermann
authors.forename: R L
authors.initials: RL
authors.lastname: Bradshaw
authors.forename: A
authors.initials: A
authors.lastname: Lugo
authors.forename: R M
authors.initials: RM
authors.lastname: Sailors
authors.forename: L
authors.initials: L
authors.lastname: Ershler
authors.forename: C J
authors.initials: CJ
authors.lastname: Wallace
authors.forename: A H
authors.initials: AH
authors.lastname: Morris
authors.forename: B
authors.initials: B
authors.lastname: McKinley
authors.forename: A
authors.initials: A
authors.lastname: Marquez
authors.forename: A
authors.initials: A
authors.lastname: Tonnesen
authors.forename: L
authors.initials: L
authors.lastname: Parmley
authors.forename: W
authors.initials: W
authors.lastname: Shoemaker
authors.forename: P
authors.initials: P
authors.lastname: Meade
authors.forename: P
authors.initials: P
authors.lastname: Thaut
authors.forename: T
authors.initials: T
authors.lastname: Hill
authors.forename: M
authors.initials: M
authors.lastname: Young
authors.forename: J
authors.initials: J
authors.lastname: Baughman
authors.forename: M
authors.initials: M
authors.lastname: Olterman
authors.forename: V
authors.initials: V
authors.lastname: Gooder
authors.forename: B
authors.initials: B
authors.lastname: Quinn
authors.forename: W
authors.initials: W
authors.lastname: Summer
authors.forename: V
authors.initials: V
authors.lastname: Valentine
authors.forename: J
authors.initials: J
authors.lastname: Carlson
authors.forename: K
authors.initials: K
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D020000:Decision Support Systems, Clinical; D006801:Humans; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D013813:Therapy, Computer-Assisted