title: Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score.
abstract: BACKGROUND
  The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance.
  
  
  METHODS
  This study was composed of 3 phases: a retrospective observational phase (baseline) followed by 2 prospective sequential interventions. Phase I intervention comprised daily goal establishment of mechanical ventilation. Phase II intervention was the setting and monitoring of daily goals of mechanical ventilation with a web-based data visualization system (T3). A single score of mechanical ventilation was developed to evaluate the outcome.
  
  
  RESULTS
  The baseline phase evaluated 130 subjects, phase I enrolled 31 subjects, and phase II enrolled 36 subjects. There were no differences in demographic characteristics between cohorts. A total of 171 verbalizations of goals of mechanical ventilation were completed in phase I. The use of T3 increased by 87% from phase I. Mechanical ventilation score improved by 8.4% in phase I and 11.3% in phase II from baseline (P= .032). The largest effect was in the low risk VTcategory, with a 40.3% improvement from baseline in phase I, which was maintained at 39% improvement from baseline in phase II (P= .01). mechanical ventilation score was 9% higher on average in those who survived.
  
  
  CONCLUSIONS
  Daily goal formation and computer-enhanced visualization of mechanical ventilation variance were associated with an improvement in goal attainment by evidence of an improved mechanical ventilation score. Further research is needed to determine whether improvements in mechanical ventilation score through a targeted, process-oriented intervention will lead to improved patient outcomes. (ClinicalTrials.gov registration NCT02184208.).
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Walsh
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Craig
authors.initials: C
authors.lastname: Smallwood
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jordan
authors.initials: J
authors.lastname: Rettig
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, and Respiratory Care Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: John H
authors.initials: JH
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006040:Goals; D006801:Humans; D007223:Infant; D020407:Internet; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D012984:Software; D016896:Treatment Outcome
keywords: ICU; computer decision support; critical care; health-care quality; mechanical ventilation; quality; safety; visualization of data