Mechanical Ventilation Complication, Nurse Education, Patient-Ventilator Asynchrony
Conditions
Brief summary
A prospective cluster-randomized quality improvement trial was conducted to evaluate whether a structured nurse education program on ventilator waveform interpretation and alarm management reduces patient-ventilator asynchrony in the pediatric intensive care unit. Two PICU units within the same hospital were randomized to either an Education group or a Control group. Nurses in the Education group received multimodal training, reference cards, and support for real-time waveform review. The primary outcomes were asynchrony index (%) and ventilator alarm frequency (alarms/day). Secondary outcomes included ventilator days, cumulative sedation dose, withdrawal symptoms, nurse accuracy in identifying asynchrony, and nurse workload.
Detailed description
Patient-ventilator asynchrony (PVA) is common in mechanically ventilated children and is associated with impaired gas exchange, increased sedation exposure, prolonged mechanical ventilation, and higher morbidity. Recognition and management of asynchrony require real-time waveform interpretation, yet bedside nurses' ability to identify it varies widely. This prospective cluster-randomized quality improvement study was conducted in two pediatric intensive care units within the same tertiary children's hospital. The two PICUs were randomized 1:1 to either the Education group or the Control group. Children aged 1 month to 18 years who required at least 48 hours of invasive mechanical ventilation were eligible. In the Education group, bedside nurses participated in a structured, multimodal training program including face-to-face teaching, case-based waveform analysis, alarm management principles, and a mobile platform for sharing ventilator screenshots with an asynchrony review team. Reference pocket cards summarizing common asynchrony patterns and recommended responses were provided. Nurses performed routine waveform checks and communicated suspected asynchrony to the clinical team; ventilator settings were changed only by physicians. The Control group followed the existing standard of care without nurse-specific training. Asynchrony was quantified using 24-hour waveform recordings exported from the ventilator. Primary outcomes were asynchrony index (%) and total ventilator alarm frequency (alarms per ventilator day). Secondary outcomes included mechanical ventilation duration, cumulative sedation dose (mg/kg), withdrawal symptoms measured using the WAT-1 score, nurse accuracy before and after training, and nurse workload assessed using the NASA-TLX tool.
Interventions
BEHAVIORALNurse Education on Ventilator Waveform and Alarm Management
A structured multimodal education program delivered to bedside nurses, including face-to-face teaching, case-based ventilator waveform interpretation, recognition of common patient-ventilator asynchrony patterns, ventilator alarm management principles, reference pocket cards, and real-time waveform sharing with an asynchrony review team. Nurses performed routine waveform checks and reported suspected asynchrony to physicians; ventilator adjustments were performed only by physicians.
Sponsors
Dr. Behcet Uz Children's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Two pediatric intensive care units were randomized as clusters to Education vs Control groups.
Eligibility
Sex/Gender
ALL
Age
1 Months to 18 Years
Healthy volunteers
No
Inclusion criteria
* Age between 1 month and 18 years * Admission to the pediatric intensive care unit (PICU) * Receiving invasive mechanical ventilation for at least 48 hours (expected or actual) * Managed with ventilators capable of waveform monitoring and data export
Exclusion criteria
* Use of continuous neuromuscular blocking agents * Hemodynamic instability preventing study procedures * Expected duration of invasive mechanical ventilation \< 48 hours * Lack of informed consent (if applicable per ethics approval)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Asynchrony Index (%) | Within the first 24 hours of invasive mechanical ventilation | The proportion of asynchronous breaths divided by total breaths, expressed as a percentage. Asynchrony is quantified using 24-hour ventilator waveform recordings. |
| Ventilator Alarm Frequency (alarms/day) | Within the first 24 hours of invasive mechanical ventilation | The total number of ventilator alarms per ventilator day, including pressure, volume, and flow-related alarms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Mechanical Ventilation (days) | Up to 28 days or until discontinuation of invasive mechanical ventilation, whichever comes first. | Number of days from initiation of invasive mechanical ventilation to successful extubation or transition to noninvasive ventilation. |
| Cumulative Sedation Dose (mg/kg) | Up to 28 days or until discontinuation of invasive mechanical ventilation, whichever comes first. | Total cumulative dose of sedative medications administered during mechanical ventilation, normalized to patient weight. |
| Nurse Accuracy in Identifying Asynchrony (%) | Within the first 24 hours of invasive mechanical ventilation | Proportion of correctly identified asynchrony patterns on pre-training and post-training waveform tests. |
| Withdrawal Severity (WAT-1 Score) | Up to 48 hours after extubation following a period of mechanical ventilation. | Maximum Withdrawal Assessment Tool-1 (WAT-1) score recorded during mechanical ventilation and weaning. |
Countries
Turkey (Türkiye)
Outcome results
None listed