This proposal will test the feasibility of implementing an assist volume control ventilation protocol in patients receiving mechanical ventilation in the medical intensive care unit. The trial will consist of a before-and-after trial design of block assignment to either adaptive pressure control (baseline) or assist volume control . This is a feasibility study looking at the management of patients in the ventilator.
Over the course of 6 weeks, a before-and-after trial design of adaptive pressure control and assist volume control will be conducted. Pre-trial planning phase: study protocols will be reviewed with key stakeholders (respiratory therapy providers and medical teams) Weeks 1-2: data will be collected on our current adaptive pressure control ventilator protocol. Week 3: The investigators will implement an assist volume control protocol. . Patients already on mechanical ventilation will be converted to assist volume control; however, these patients will not be included in the primary analysis.In accordance with the Consolidated Framework For Implementation Research (CFIR) approach, after 1 week of assist volume control the investigators will engage in quantitative and qualitative feedback with care providers to identify facilitators and barriers of assist volume control implementation. Week 4-6: If the investigators identify substantial barriers, the investigators will pause and alter the protocol. If not, the investigators will continue assist volume control for an additional 2 weeks.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
139
Adaptive Pressure Control mechanical ventilation is a dual controlled mode that is designed to auto-control flow and minimize inspiratory pressure while delivering a provider-determined tidal volume. Assist Volume Control mechanical ventilation is a mode in which the respiratory care provider determines patient tidal volume and flow.
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States
Percentage of patients receiving Assist Volume Control
The primary outcome for the PIVOT-1 pilot is feasibility of Assist Volume Control implementation. We define feasibility in this study as 80% of patients receiving Assist Volume Control within 1 hour of initiation of intensive care unit mechanical ventilation
Time frame: 1 hour
assist volume control duration
A secondary feasibility outcome will be \>70% of ventilated time on Assist Volume Control during the first 24 hours of mechanical ventilation.
Time frame: 24 hours
Percentage of mode crossover
A secondary feasibility outcome will include \<10% crossover to the alternative mode
Time frame: 2 weeks
exhaled tidal volume
exhaled tidal volume will be compared between modes using data extracted from the critical care data capsule.
Time frame: 2 weeks
Number of ventilator free days
vent free days will be compared between the modes using data from the critical care data analytics platform
Time frame: 28 days
intensive care length of stay
intensive care unit length of stay will be compared between the modes using data from the critical care data analytics platform
Time frame: 28 days
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