McKinley B A, Moore F A, Sailors R M, Cocanour C S, Marquez A, Wright R K, Tonnesen A S, Wallace C J, Morris A H, East T D
Department of Anesthesiology, University of Texas-Houston Medical School, Houston, Texas 77030, USA.
J Trauma. 2001 Mar;50(3):415-24; discussion 425. doi: 10.1097/00005373-200103000-00004.
Variability and logistic complexity of mechanical ventilatory support of acute respiratory distress syndrome, and need to standardize care among all clinicians and patients, led University of Utah/LDS Hospital physicians, nurses, and engineers to develop a comprehensive computerized protocol. This bedside decision support system was the basis of a multicenter clinical trial (1993-1998) that showed ability to export a computerized protocol to other sites and improved efficacy with computer- versus physician-directed ventilatory support. The Memorial Hermann Hospital Shock Trauma intensive care unit (ICU) (Houston, TX; a Level I trauma center and teaching affiliate of The University of Texas Houston Medical School) served as one of the 10 trial sites and recruited two thirds of the trauma patients. Results from the trauma patient subgroup at this site are reported to answer three questions: Can a computerized protocol be successfully exported to a trauma ICU? Was ventilator management different between study groups? Was patient outcome affected?
Sixty-seven trauma patients were randomized at the Memorial Hermann Shock Trauma ICU site. "Protocol" assigned patients had ventilatory support directed by the bedside respiratory therapist using the computerized protocol. "Nonprotocol" patients were managed by physician orders.
Of the 67 trauma patients randomized, 33 were protocol (age 40 +/- 3; Injury Severity Score [ISS] 26 +/- 3; 73% blunt) and 34 were nonprotocol (age 38 +/- 2; ISS 25 +/- 2; 76% blunt). For the protocol group, the computerized protocol was used 96% of the time of ventilatory support and 95% of computer-generated instructions were followed by the bedside respiratory therapist. Outcome measures (i.e., survival, ICU length of stay, morbidity, and barotrauma) were not significantly different between groups. Fio2 > or = 0.6 and Pplateau > or = 35 cm H2O exposures were less for the protocol group.
A computerized protocol for bedside decision support was successfully exported to a trauma center, and effectively standardized mechanical ventilatory support of trauma-induced acute respiratory distress syndrome without adverse effect on patient outcome.
急性呼吸窘迫综合征机械通气支持的变异性和逻辑复杂性，以及在所有临床医生和患者中规范护理的必要性，促使犹他大学/lds医院的医生、护士和工程师开发了一种全面的计算机化方案。这个床边决策支持系统是一项多中心临床试验（1993 - 1998年）的基础，该试验表明能够将计算机化方案导出到其他地点，并且与医生指导的通气支持相比，计算机指导的通气支持疗效有所提高。纪念赫尔曼医院休克创伤重症监护病房（德克萨斯州休斯顿；一级创伤中心和德克萨斯大学休斯顿医学院的教学附属医院）作为10个试验地点之一，招募了三分之二的创伤患者。报告该地点创伤患者亚组的结果以回答三个问题：计算机化方案能否成功导出到创伤重症监护病房？研究组之间的呼吸机管理是否不同？患者结局是否受到影响？
67名创伤患者在纪念赫尔曼休克创伤重症监护病房进行随机分组。“方案组”患者由床边呼吸治疗师使用计算机化方案指导通气支持。“非方案组”患者由医生医嘱管理。
在随机分组的67名创伤患者中，33名属于方案组（年龄40±3岁；损伤严重度评分[ISS]26±3；73%为钝性伤），34名属于非方案组（年龄38±2岁；ISS 25±2；76%为钝性伤）。对于方案组，计算机化方案在通气支持时间的96%被使用，床边呼吸治疗师遵循了95%的计算机生成指令。两组之间的结局指标（即生存率、重症监护病房住院时间、发病率和气压伤）没有显著差异。方案组的Fio2≥0.6和平台压≥35 cm H2O暴露情况较少。
用于床边决策支持的计算机化方案成功导出到一个创伤中心，并有效规范了创伤性急性呼吸窘迫综合征的机械通气支持，且对患者结局没有不良影响。
