Mechanical ventilation of patients with acute respiratory distress syndrome (ARDS) should balance lung and diaphragm protective principles, challenging to achieve in routine clinical practice. This interventional non blinded pilot study was aimed to determine whether computerized decision support–based protocol is feasible to implement, resulting in the improvised acceptance for the diaphragm and lung-protective ventilation improving the clinical outcomes over historical controls, through a Phase I clinical trial.
Thirty-two mechanically ventilated children with ARDS were included. Acceptance of protocol recommendations was over 75%. The real-time effort-driven ventilator management was associated with more than six days devoid of ventilation, lesser duration until the primary spontaneous breathing trial, and three or fewer days on mechanical ventilation amongst survivors than historical controls while maintaining no difference in the reintubation rate. Cumulatively throughout the study, 76% of protocol recommendations were followed by bedside providers. In the acute phase, 75% oxygenation recommendations (PEEP and Fio2) and 75% ventilation recommendations (ΔP and ventilatory rate) were accepted. During the weaning phase, 84% of the recommendations (pressure support) were accepted.
In conclusion, a CDS-based protocol targeting lung- and diaphragm-protective ventilation, including esophageal manometry, can achieve high protocol adherence rates in children with ARDS. It was associated with more lung-protective ventilation and better clinical outcomes than historical control patients.
