@article{1e55396bda234180ac4681ff53532853,
title = "Potential acceptability of a pediatric ventilator management computer protocol",
abstract = "Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design: Survey/questionnaire. Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants: One hundred twenty-two physicians (attendings and fellows). Interventions: None. Measurements and Main Results: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for Fio2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.",
keywords = "Acute lung injury, Clinical decision support, Guideline adherence, Mechanical ventilation, Pediatric acute respiratory distress syndrome",
author = "{Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)} and Sward, {Katherine A.} and Newth, {Christopher J.L.} and Khemani, {Robinder G.} and Kent Page and Meert, {Kathleen L.} and Carcillo, {Joseph A.} and Shanley, {Thomas P.} and Moler, {Frank W.} and Pollack, {Murray M.} and Dalton, {Heidi J.} and Wessel, {David L.} and Berger, {John T.} and Berg, {Robert A.} and Harrison, {Rick E.} and Allan Doctor and Dean, {J. Michael} and Richard Holobkov and Jenkins, {Tammara L.} and Nicholson, {Carol E.}",
note = "Funding Information: Supported, in part, by the following cooperative agreements and awards from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health Funding Information: and Human Services: U10HD050012 (to Dr. Newth), U10HD050096 (to Dr. Meert), U10HD049983 (to Dr. Carcillo), U10HD063106 (to Dr. Shan-ley), U10HD063114 (to Dr. Pollack/Dalton), U10HD049981 (to Dr. Wessel), U10HD063108 (to Dr. Berg), and U01HD049934 (to Dr. Dean), and R21HD061870 awarded to Drs. Newth and Sward for the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Drs. Sward, Newth, Page, Meert, Carcillo, Shanley, Moler, Pollack, Dalton, Wessel, Berger, Berg, Harrison, Doctor, Dean, Holobkov, Jenkins, and Nich-olson received support for article research from the National Institutes of Health (NIH). Drs. Sward, Page, Carcillo, Dalton, Berg, and Dean{\textquoteright}s institutions received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Drs. Newth, Meert, Shanley, Pollack, Wessel, Harrison, and Holobkov{\textquoteright}s institutions received funding from the NIH. Dr. Newth received funding from Philips Medical Research North America and Covidien. Dr. Shanley received funding from International Pediatric Research Foundation, Springer Publishing, and Clore and Assoc{\textquoteright}s. Dr. Moler{\textquoteright}s institution received funding from the NICHD and the National Heart, Lung, and Blood Institute. Dr. Dalton received funding from Maquet (speaker honorarium) and Innovative ECMO Concepts Inc. (consultant). Dr. Berger{\textquoteright}s institution received funding from the NIH and the Association for Pediatric Pulmonary Hypertension. Dr. Doctor{\textquoteright}s institution received funding from the NIH, the Department of Defense, and Children{\textquoteright}s Discovery Institute. Dr. Holobkov received funding from Pfizer (Data and Safety Monitoring Board [DSMB]), Mediummune (DSMB), and Arma-ron Bio (DSMB), and he disclosed other support from the American Burn Association (DSMB), St. Judge Medical (biostatistical consulting), and Physicians Committee for Responsible Medicine (biostatistical consulting). Drs. Jenkins and Nicholson disclosed government work. Dr. Khemani disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: kathy.sward@nurs.utah.edu Publisher Copyright: Copyright {\textcopyright} 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",
year = "2017",
month = nov,
doi = "10.1097/PCC.0000000000001331",
language = "English",
volume = "18",
pages = "1027--1034",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
number = "11",
}