Patients who experience lung injury are often placed on a ventilator to help them heal; however, if the ventilator volume settings are too high, it can cause additional lung injury. It is proven that using lower ventilator volume settings improves outcomes. In patients with acute brain injury, it is proven that maintaining a normal partial pressure of carbon dioxide in the arterial blood improves outcomes. Mechanical ventilator settings with higher volumes and higher breathing rates are sometimes required to maintain a normal partial pressure of carbon dioxide. These 2 goals of mechanical ventilation, using lower volumes to prevent additional lung injury but maintaining a normal partial pressure of carbon dioxide, are both important for patients with acute brain injury. The investigators have designed a computerized ventilator protocol in iCentra that matches the current standard of care for mechanical ventilation of patients with acute brain injury by targeting a normal partial pressure of carbon dioxide with the lowest ventilator volume required.
This is a quality improvement study with the purpose of observing and measuring the effects of implementation of a standard of care mechanical ventilation protocol for patients with acute brain injury in the iCentra electronic medical record system at Intermountain Medical Center. We hypothesize that implementation of a standardized neuro lung protective ventilation protocol will be feasible, will achieve a target normal partial pressure of carbon dioxide, will decrease tidal volumes toward the target 6 mL/kg predicted body weight, and will improve outcomes.
- Intracerebral Hemorrhage
- Traumatic Brain Injury
- Cerebral Edema
- Acute Brain Injury
- Anoxic Brain Injury
- Lung Protective Ventilation Procedure
Intervention Desc: Neuro lung protective ventilation for patients with acute brain injury is designed to target a normal partial pressure of arterial carbon dioxide and decrease initial tidal volumes toward a target 6 ml/kg predicted body weight PBW (range 6 to 8 ml/kg PBW) ARM 1: Kind: Experimental Label: Lung Protective Ventilation Description: Subjects with acute brain injury (traumatic brain injury and non-traumatic brain injury) will receive neuro lung protective ventilation which targets a normal arterial partial pressure of carbon dioxide with the lowest tidal volume possible (6 to 8 ml/kg predicted body weight). Protocols for oxygenation and weaning from the ventilator will also be followed.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Patient-Level Proportion of time on Mechanical Ventilation with a Tidal Volume <= 6.5 ml/kg PBW||Time of initiation of mechanical ventilation to time of cessation of mechanical ventilation, an average of 5 days|
|Secondary||Proportion of time with a target PaCO2 of 35 to 45 mm Hg||Time of initiation of mechanical ventilation to time of cessation of mechanical ventilation, an average of 5 days|
|Secondary||Average number of protocol deviations for all subjects (protocol compliance)||Time of initiation of mechanical ventilation to time of cessation of mechanical ventilation, an average of 5 days|
|Secondary||Hospital Discharge Disposition||Day of hospital discharge, an average of 10 days after admission|
|Secondary||Hospital, 28-Day, and 90-Day Mortality||Hospital admission through 90 days|
|Secondary||Ventilator-free days to day 28||Initiation of mechanical ventilation to day 28|
|Secondary||Time to First ICU Activity||Day of admission to day of first ICU activity, an average of 0.2 days|
|Secondary||Hospital, ICU Length of Stay||Day of admission to day of discharge, an average of 10 days|
|Secondary||Health Care Utilization||Day of admission to day of discharge, an average of 10 days|
|Secondary||Quality of Life||Day of admission until up to 1 year after day of discharge|
|Secondary||Costs of Care||Day of admission to day of discharge, an average of 10 days|
- Colin Grissom Lead