Computerized weaning of childhood respiratory failure

Update Item Information
Publication Type dissertation
School or College School of Medicine
Department Biomedical Informatics
Author Maloney, Christopher Gerard
Title Computerized weaning of childhood respiratory failure
Date 2007-05
Description Acute respiratory failure (ARF) is a major reason for admission to a pediatric intensive care unit. Endotracheal intubation and mechanical ventilation is a method of life support for ARF. Mechanical ventilation is intended to be a temporary measure with an ultimate goal of extubation and a return by the patient to natural breathing. Weaning is the process of slowly removing ventilator support in order to achieve this goal. A standardized process for weaning children from mechanical ventilation does not exist. This dissertation describes how use of a computerized pediatric ventilator weaning protocol is safe and efficient. Standardization of process reduces variation in clinical practice and results in improved outcomes. Protocols provide standardized medical decision making. Computerized protocols are the most robust form of protocols and can assist clinicians at the point of care by providing patient-specific instructions. A paper-based protocol to wean children with ARF was developed by a group of pediatric critical care clinicians. Protocol knowledge content was derived from outcomes in the medical literature and local practice. The protocol consisted of eight flow charts executed in series. Sixteen data elements were required to execute the entire protocol. Within a flow chart, time-sensitive, patient-specific instructions were provided. Following development and validation, the paper-based pediatric ventilator weaning protocol was computerized. Each flow chart was broken down into specific states corresponding to computerized if-then-else" logic statements. A commercially available rules engine was integrated with a web-browser based decision-support infrastructure to continually monitor patient specific data elements and deliver explicit instructions to clinicians. Upon completion of the computerized pediatric ventilator weaning protocol a prospective randomized controlled trial was conducted to compare the protocol to a typical-physician approach to weaning children from mechanical ventilation. Children in the protocol group were weaned significantly faster than children in the control group (8 hours vs. 28.5 hours p < 0.002). No complications of mechanical ventilation occurred in either group. These studies demonstrate that a pediatric ventilator weaning protocol can be developed, computerized and implemented to safely and efficiently assist clinicians in weaning children from mechanical ventilation. Standardizing processes for the delivery of healthcare can improve outcomes.
Type Text
Publisher University of Utah
Subject Respirators; Medical Equipment; Children
Subject MESH Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Automatic Data Processing
Dissertation Institution University of Utah
Dissertation Name PhD
Language eng
Relation is Version of Digital reproduction of "Computerized weaning of childhood respiratory failure." Spencer S. Eccles Health Sciences Library. Print version of "Computerized weaning of childhood respiratory failure." available at J. Willard Marriott Library Special Collection. RJ25.5 2007 .M34.
Rights Management © Christopher Gerard Maloney.
Format Medium application/pdf
Format Extent 2,062,892 bytes
Identifier undthes,4650
Source Original: University of Utah Spencer S. Eccles Health Sciences Library (no longer available).
Master File Extent 2,062,983 bytes
ARK ark:/87278/s61r6s97
Setname ir_etd
ID 191071
Reference URL https://collections.lib.utah.edu/ark:/87278/s61r6s97