Clinical Decision Support for Neonatal Mechanical Ventilation

Abstract

Mechanical Ventilation (MV) in the Neonatal Intensive Care Unit (NICU) is a life-saving therapy that is associated with multiple comorbidities. Compared to pressure-limited ventilation volume-targeted ventilation (VTV) is associated with improved outcomes. However, there has been slow clinical adoption of VTV, which may be due to clinicians lack of knowledge of appropriate initial tidal volumes (VT) for a patient’s weight and disease. A clinical decision support (CDS) tool was designed and implemented for both clinicians and respiratory therapists. A prospective interrupted time series study was performed to evaluate compliance with recommended initial VT settings after incremental CDS implementation. Our CDS interventions showed little improvement in the compliance of recommended initial VTs. A contextual inquiry survey of clinicians and respiratory therapists revealed that most chose an initial VT prior to viewing the CDS. Improvement ideas discussed by survey participants included a pop-up reminder, pre-populated orders, or CDS directly on the ventilator.