A multicenter population-based effectiveness study of teleintensive care unit–directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality

Kalb, Thomas; Raikhelkar, Jayashree; Meyer, Shelley; Ntimba, Francis; Thuli, Jason; Gorman, Mary; Kopec, Isabelle; Scurlock, Corey

doi:10.1016/j.jcrc.2014.02.017

Cited by 41 publications

(18 citation statements)

References 17 publications

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“…Little formal investigation exists to describe and evaluate the effectiveness of PCUs ( 3 ). It is hypothesized that ICU services, bed utilization, and patient care outcomes may be positively impacted through use of PCUs ( 4 , 33 – 35 ); similarly Tele-ICU has shown to impact these factors positively ( 10 , 11 , 13 – 15 , 36 ) and therefore, Tele-PCU may also provide a distinct advantage. We found that PCU and hospital mortality rates were significantly lower for patients in TPCU group, compared with patients in NTPCUs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Armaignac

Saxena

Rubens

et al. 2018

Critical Care Medicine

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Objectives:To determine whether Telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients.Design:Retrospective observational.Setting:Large healthcare system in Florida.Patients:Adult patients admitted to progressive care unit (PCU) as their primary admission between December 2011 and August 2016 (n = 16,091).Interventions:Progressive care unit patients with telemedicine intervention (telemedicine PCU [TPCU]; n = 8091) and without telemedicine control (nontelemedicine PCU [NTPCU]; n = 8000) were compared concurrently during study period.Measurements and Main Results:Primary outcome was progressive care unit and hospital mortality. Secondary outcomes were hospital length of stay, progressive care unit length of stay, and mean direct costs. The mean age NTPCU and TPCU patients were 63.4 years (95% CI, 62.9–63.8 yr) and 71.1 years (95% CI, 70.7–71.4 yr), respectively. All Patient Refined-Diagnosis Related Group Disease Severity (p < 0.0001) and All Patient Refined-Diagnosis Related Group patient Risk of Mortality (p < 0.0001) scores were significantly higher among TPCU versus NTPCU. After adjusting for age, sex, race, disease severity, risk of mortality, hospital entity, and organ systems, TPCU survival benefit was 20%. Mean progressive care unit length of stay was lower among TPCU compared with NTPCU (2.6 vs 3.2 d; p < 0.0001). Postprogressive care unit hospital length of stay was longer for TPCU patients, compared with NTPCU (7.3 vs 6.8 d; p < 0.0001). The overall mean direct cost was higher for TPCU ($13,180), compared with NTPCU ($12,301; p < 0.0001).Conclusions:Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in progressive care unit settings. Our study showed that TPCU intervention significantly decreased mortality in progressive care unit and hospital and progressive care unit length of stay despite the fact patients in TPCU were older and had higher disease severity, and risk of mortality. Increased postprogressive care unit hospital length of stay and total mean direct costs inclusive of telemedicine costs coincided with improved survival rates. Telemedicine intervention decreased overall mortality and length of stay within progressive care units without substantial cost incurrences.

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Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Armaignac

Saxena

Rubens

et al. 2018

Critical Care Medicine

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“…Additional study characteristics are highlighted in e-Table 1 ( http://links.lww.com/CCX/A580 ). Seven of the included studies focused on the use of LTVV with definitions of LTVV varying by study ( 16 – 18 , 20 , 22 – 24 ). Two studies assessed the effect of an intervention on the use of prone positioning ( 19 , 20 ).…”

Section: Resultsmentioning

confidence: 99%

“…Seven of the included studies focused on the use of LTVV with definitions of LTVV varying by study ( 16 – 18 , 20 , 22 – 24 ). Two studies assessed the effect of an intervention on the use of prone positioning ( 19 , 20 ). Although all patients were mechanically ventilated, patient populations varied across studies as defined by the study authors including patients with primarily ARDS ( 18 , 19 , 21 ) or acute lung injury (ALI) ( 22 ), patients with ALI and ARDS ( 16 , 23 , 24 ), and patients with primary lung disease or complications of lung disease (including ARDS) ( 17 ) (e-Table 1, http://links.lww.com/CCX/A580 ).…”

Section: Resultsmentioning

confidence: 99%

“…Interventions involved trainees (residents and fellows) ( 17 , 23 , 24 ), intensivists, ( 16 – 18 , 20 , 23 , 24 ), respiratory therapists (RTs) ( 16 – 18 , 20 , 24 ), and critical care nurses ( 16 – 18 , 20 , 22 – 24 ) (Table 1 ). Several studies ( 17 , 18 ) proposed multicomponent interventions which combined targeted education on the merits of LTVV for physicians and nurses and protocol implementation (i.e., obtaining height to measure PBW and setting ventilation settings) by respiratory therapy.…”

Section: Resultsmentioning

confidence: 99%

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Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

Giovanni

Jennerich

Steel

et al. 2021

Critical Care Explorations

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OBJECTIVE: Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome. DATA SOURCES: PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. STUDY SELECTION: We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome. DATA EXTRACTION: Two authors independently performed study selection and data extraction using a standardized form. DATA SYNTHESIS: Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Measurements and Main Results: Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Conclusions: There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.

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“…), glycemic control, and compliance with a strategy of lung-protective ventilation. 12 – 15 The benefits in this domain are perhaps expected, given that the tele-ICU models consistently provide immediate access to experts, who reinforce the importance of and ensure compliance with such quality improvement bundles.…”

Section: Models Of Tele-icu Care and Impact On Patient-important Outcmentioning

confidence: 99%

Breaking Barriers to Reach Farther: A Call for Urgent Action on Tele-ICU Services

Ramakrishnan¹,

Vijayaraghavan²,

Venkataraman³

2020

Indian Journal of Critical Care Medicine

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A multicenter population-based effectiveness study of teleintensive care unit–directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality

Abstract: Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.

Cited by 41 publications

References 17 publications

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

Breaking Barriers to Reach Farther: A Call for Urgent Action on Tele-ICU Services

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