The following is a summary of a thematic poster presentation conducted by our team for the American Thoracic Society 2021 International Conference, which took place May 14-19, 2021. For more information, visit https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2021.203.1_MeetingAbstracts.A2815.
Deployment, Adoption, and Clinical Impact of a Real-Time Ventilator Management Dashboard
P. Tandon1, K. Nguyen2, M. Rajendran2, K. S. Mathews3, M. Crow2, R. Freeman2, P. Timsina2, C. A. Powell1, M.Levin4; 1Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,United States, 2Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY,United States, 3Div of Pulm Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,United States, 4Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Corresponding author’s email: pranai.tandon@mountsinai.org
RATIONALE: Exposure to high tidal volumes is associated with increased mortality for patients undergoing
invasive mechanical ventilation (IMV), but adherence to lung protective ventilation (LPV, ≤8cc/kg ideal body
weight [IBW]) is suboptimal. Presented here is the evaluation of a real-time ventilator management dashboard to
communicate synthesized ventilator information and improve LPV adherence. METHODS: The Respiratory
Insights Dashboard (RID) displays key real-time patient and ventilator data. Variables include: respiratory support
modality, IBW, airway pressures, set and measured tidal volumes (Vt), and arterial blood gases. Out-of-range
values are highlighted in red; summary count of patients with currently set Vt >8cc/kg IBW in each ICU is placed
above patient-level data. The RID was piloted in the Neurosciences ICU (NSICU) with daily review jointly by
respiratory therapists and neuro-intensivists embedded into the ICU workflow. The primary outcome was
duration with ventilator settings >8cc/kg IBW for all NSICU patients in the pre-implementation (12/1/2019-
3/4/2020) and post-implementation (6/14-2020-12/1/2020) periods. Secondary outcomes included duration with
measured expiratory Vt >8cc/kg IBW per patient, hourly percent adherence with Vt set ≤8cc/kg IBW, duration
of MV before ventilator set ≤8cc/kg IBW, and number of views of the dashboard. RESULTS: In the pre-
intervention period, 139 NSICU patients received MV, and 240 in the post-intervention period. Patient cohorts
were not significantly different between pre- and post-intervention periods in terms of age (60 ± 17 vs. 62 ±15
years), IBW (62 ± 12 vs. 63 ± 10 kg), SOFA score (4.42 ± 2.44 vs. 4.47 ± 2.92), and total MV duration (117 ±
149 vs. 99 ± 120 hours). Duration of mechanical ventilation >8cc/kg IBW decreased from a mean 10 ± 37 to 1
± 5 hours (p=0.003) (See Figure). Duration with measured Vt >8cc/kg decreased from 38 ±70 to 22 ± 39
hours (p=0.006). Hourly adherence with Vt setting ≤8cc/kg rose from 89 ± 28% to 96 ± 16%, (p=0.004). Mean
duration from first mechanical ventilation in NSICU to reaching goal Vt settings fell from mean 4.61 hours (range
0-203.15 hours) to 0.34 (range 0-21.93 hours) (p=0.016). The dashboard was viewed 1058 times in the 170-
day study period, averaging 6.22 views/day. CONCLUSION: A real-time ventilator management dashboard
clinically and statistically significantly improved LPV adherence, enabled rapid correction of suboptimal ventilator
settings, and was viewed more frequently than required by the pilot design. Further initiatives with the
dashboard may optimize other aspects of ventilator management.
