Clinical Decision Support for ventilating ARDS patients is not a new idea; however,
Vent Navigator is the first ARDS CDS software widely available for patient use.
Recent Research on Clinical Decision Support for ARDS:
2020 Nov – Hotz et al. provide results from implementing ARDS CDS software that was the
direct precursor to Vent Navigator in pediatric ARDS patients. The research team matched 32
“CDS” patients with 128 historical control patients who had similar age, initial oxygenation index
and immune compromise percentage. They found that patients treated with the help of the CDS
software:
- Received lower ΔP and Vₜ
- Received higher PEEP when FiO2 > 0.60
- Had 6 more vent-free days
- Had a shorter duration until first spontaneous breathing trial
- Had 3 fewer days on MV amongst survivors
- Did not have an increase in reintubation rate
Hotz JC, Bornstein D, Kohler K, Smith E, Suresh A, Klein M, Bhalla A, Newth CJ, Khemani RG. Real-time effort driven ventilator management: a pilot study. Pediatr Crit Care Med. 2020;21(11):933-940.
Early Research on Clinical Decision Support for ARDS:
1999 – East et al. evaluated Vent CDS efficacy in a multi-center randomized trial involving 200
patients at 10 medical centers. They found a significant reduction in morbidity (based on MODS
score) and significantly lower incidence and severity of overdistension lung injury. CDS
protocols were active for 1335 patient days and generated 38k instructions, of which 94% were
followed.
East TD, Heermann LK, Bradshaw RL, Lugo A, Sailors RM, Ershler L, Wallace CJ, Morris AH, McKinley
B, Marquez A, Tonnesen A, Parmley L, Shoemaker W, Meade P, Thaut P, Hill T, Young M, Baughman J,
Olterman M, Gooder V, Quinn B, Summer W, Valentine V, Carlson J, Steinberg K, et al. Efficacy of
computerized decision support for mechanical ventilation: results of a prospective multi-center
randomized trial. Proc AMIA Symp. 1999:251-5. PMID: 10566359; PMCID: PMC2232746.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232746/
2001 – McKinley et al. evaluated results of their ARDS CDS software in a multi-center
randomized trial involving 67 trauma patients at 10 trauma ICUs. In the CDS cohort, they found
lower rates of FiO2 >= 0.6 and Pplat >= 35 cm H2O.
McKinley BA, Moore FA, Sailors RM, Cocanour CS, Marquez A, Wright RK, Tonnesen AS, Wallace CJ,
Morris AH, East TD. Computerized decision support for mechanical ventilation of trauma induced ARDS:
results of a randomized clinical trial. J Trauma. 2001 Mar;50(3):415-24; discussion 425. doi:
10.1097/00005373-200103000-00004. PMID: 11265020.
https://pubmed.ncbi.nlm.nih.gov/11265020/
1993 – Thomsen et al. evaluated a CDS system for ARDS used on 40 patients. 93% of
ventilation protocol instructions were followed; 60% of patients survived.
Thomsen GE, Pope D, East TD, et al. Clinical performance of a rule-based decision support system for
mechanical ventilation of ARDS patients. Proc Annu Symp Comput Appl Med Care. 1993;339-343.