169: Optimizing Mechanical Ventilation Lung-Protective Strategy: Systems Engineering to the Rescue

INTRODUCTION: Approximately 20% of patients with COVID-19 need hospitalization and 5% require ICU level care with respiratory support for ARDS The LUNG-SAFE study reports a third of patients with ARDS not ventilated with protective strategy This is due to multiple factors including complex pathology, lack of data integration and absent real-time decision support Existing challenges in following evidenced based practice are likely to worsen during pandemics when critical care resources become strained Systems engineering can provide the solution University Hospitals (UH) partnered with Talis Clinical, LLC to demonstrate the feasibility of deploying a technology platform based on systems engineering principles to improve ICU care METHODS: After institutional approval, RemoteView™ ICU, a cloud-based application, was implemented across the UH system A Talis Medical Device Integration (MD-iQ™) appliance was installed in each ICU room to collect discrete and waveform data from monitors and ventilators Admission, Discharge, Transfer and laboratory data were integrated using existing hospital interfaces Collected data were continuously processed by a cloud-based engine Real-time decision support and patient views were delivered to clinicians on their mobile devices and enterprise dashboards ICU view included location, demographic, disease-specific data and highlighted alerts Patient view included medical device data with trending historical values RESULTS: UH health system has 11 community based ICU and 6 subspecialty units in one tertiary academic medical center Thus far 3 community ICU and 2 subspecialty units have implemented RV-ICU In this early phase, RVICU is used to determine census, COVID-19 status and mechanically ventilated patients Real-time decision support is being used to identify severity of ARDS using PaO2:FiO2 as per Berlin criteria and evaluate compliance with protective ventilation best practice as defined by Tidal Volume/predicted body weight, Plateau pressure and PEEP Any impact of on hemodynamics is identified immediately CONCLUSIONS: Systems engineering approach to mechanical ventilation management was successfully deployed and used Our preliminary results indicate a tremendous opportunity for this methodology to augment ICU care, assure safety and improve outcomes