Using a clinical decision support system to reduce excess driving pressure: the ALARM trial
Abstract Background Patients at need for ventilation often are at risk of acute respiratory distress syndrome (ARDS). Although lung-protective ventilation strategies, including low driving pressure settings, are well known to improve outcomes, clinical practice often diverges from these strategies....
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-025-03898-2 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832571619800776704 |
|---|---|
| author | Ursula Burger-Klepp Mathias Maleczek Robin Ristl Bettina Kroyer Marcus Raudner Claus G. Krenn Roman Ullrich |
| author_facet | Ursula Burger-Klepp Mathias Maleczek Robin Ristl Bettina Kroyer Marcus Raudner Claus G. Krenn Roman Ullrich |
| author_sort | Ursula Burger-Klepp |
| collection | DOAJ |
| description | Abstract Background Patients at need for ventilation often are at risk of acute respiratory distress syndrome (ARDS). Although lung-protective ventilation strategies, including low driving pressure settings, are well known to improve outcomes, clinical practice often diverges from these strategies. A clinical decision support (CDS) system can improve adherence to current guidelines; moreover, the potential of a CDS to enhance adherence can possibly be further increased by combination with a nudge type intervention. Methods A prospective cohort trial was conducted in patients at risk of ARDS admitted to an intensive care unit (ICU). Patients were assigned to control or intervention by their date of admission: First, the control group was included without changing anything in clinical practice. Next, the CDS was activated showing an alert in the patient data management system if driving pressure exceeded recommended values; additionally, data on the performance of the wards were sent to the healthcare professionals as the nudge intervention. The main hypothesis was that this combined intervention would lead to a significant decrease in excess driving pressure. Results The 472 included patients (230 in the control group and 242 in the intervention group) consisted of 33% females. The median age was 64 years; median Sequential Organ Failure Assessment score was 8. There was a significant reduction in excess driving pressure in the augmented ventilation modes (0.28 ± 0.67 mbar vs. 0.14 ± 0.45 mbar, p = 0.012) but not the controlled mode (0.37 ± 0.83 mbar vs. 0.32 ± 0.8 mbar, p = 0.53). However, there was no significant difference between groups in mechanical power, the number of ventilator-free days, or the percentage of patients showing progression to ARDS. Although there was no difference in progression to ARDS, 28-day mortality was higher in the intervention group. Notably, the mean overall driving pressure across both groups was low (12.02 mbar ± 2.77). Conclusions In a population at risk of ARDS, a combined intervention of a clinical decision support system and a nudge intervention was shown to reduce the excessive driving pressure above 15 mbar in augmented but not in controlled modes of ventilation. |
| format | Article |
| id | doaj-art-e244e43fbe10440c9e4f7f410505a35d |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-e244e43fbe10440c9e4f7f410505a35d2025-02-02T12:28:15ZengBMCBMC Medicine1741-70152025-01-012311810.1186/s12916-025-03898-2Using a clinical decision support system to reduce excess driving pressure: the ALARM trialUrsula Burger-Klepp0Mathias Maleczek1Robin Ristl2Bettina Kroyer3Marcus Raudner4Claus G. Krenn5Roman Ullrich6Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of ViennaCenter for Medical Data Science, Medical University of ViennaCenter for Medical Data Science, Medical University of ViennaDepartment of Radiology, Medical University of ViennaDepartment of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of ViennaAbstract Background Patients at need for ventilation often are at risk of acute respiratory distress syndrome (ARDS). Although lung-protective ventilation strategies, including low driving pressure settings, are well known to improve outcomes, clinical practice often diverges from these strategies. A clinical decision support (CDS) system can improve adherence to current guidelines; moreover, the potential of a CDS to enhance adherence can possibly be further increased by combination with a nudge type intervention. Methods A prospective cohort trial was conducted in patients at risk of ARDS admitted to an intensive care unit (ICU). Patients were assigned to control or intervention by their date of admission: First, the control group was included without changing anything in clinical practice. Next, the CDS was activated showing an alert in the patient data management system if driving pressure exceeded recommended values; additionally, data on the performance of the wards were sent to the healthcare professionals as the nudge intervention. The main hypothesis was that this combined intervention would lead to a significant decrease in excess driving pressure. Results The 472 included patients (230 in the control group and 242 in the intervention group) consisted of 33% females. The median age was 64 years; median Sequential Organ Failure Assessment score was 8. There was a significant reduction in excess driving pressure in the augmented ventilation modes (0.28 ± 0.67 mbar vs. 0.14 ± 0.45 mbar, p = 0.012) but not the controlled mode (0.37 ± 0.83 mbar vs. 0.32 ± 0.8 mbar, p = 0.53). However, there was no significant difference between groups in mechanical power, the number of ventilator-free days, or the percentage of patients showing progression to ARDS. Although there was no difference in progression to ARDS, 28-day mortality was higher in the intervention group. Notably, the mean overall driving pressure across both groups was low (12.02 mbar ± 2.77). Conclusions In a population at risk of ARDS, a combined intervention of a clinical decision support system and a nudge intervention was shown to reduce the excessive driving pressure above 15 mbar in augmented but not in controlled modes of ventilation.https://doi.org/10.1186/s12916-025-03898-2Decision support toolDriving pressureCritical careVentilation |
| spellingShingle | Ursula Burger-Klepp Mathias Maleczek Robin Ristl Bettina Kroyer Marcus Raudner Claus G. Krenn Roman Ullrich Using a clinical decision support system to reduce excess driving pressure: the ALARM trial BMC Medicine Decision support tool Driving pressure Critical care Ventilation |
| title | Using a clinical decision support system to reduce excess driving pressure: the ALARM trial |
| title_full | Using a clinical decision support system to reduce excess driving pressure: the ALARM trial |
| title_fullStr | Using a clinical decision support system to reduce excess driving pressure: the ALARM trial |
| title_full_unstemmed | Using a clinical decision support system to reduce excess driving pressure: the ALARM trial |
| title_short | Using a clinical decision support system to reduce excess driving pressure: the ALARM trial |
| title_sort | using a clinical decision support system to reduce excess driving pressure the alarm trial |
| topic | Decision support tool Driving pressure Critical care Ventilation |
| url | https://doi.org/10.1186/s12916-025-03898-2 |
| work_keys_str_mv | AT ursulaburgerklepp usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT mathiasmaleczek usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT robinristl usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT bettinakroyer usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT marcusraudner usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT clausgkrenn usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial AT romanullrich usingaclinicaldecisionsupportsystemtoreduceexcessdrivingpressurethealarmtrial |