Submitted By: Ali Abbasi MD- on behalf of the I-SPY COVID investigators / I-SPY COVID Trial Investigators | |
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Data Element Information | |
Use Case Description(s) | |
Use Case Description | The ventilator settings are crucial data elements both for clinical care, and also for research, pandemic preparedness, quality improvement. For clinical care, interoperability is crucial because critically ill patients are often transferred to tertiary or quaternary care centers when the complexity of their condition demands a higher level of care. These data elements are also really important in decision support systems in critical care that may require access to these data elements via an API. (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996182/). In terms of quality improvement, these data elements are key elements needed to assess the safety of treatments in critical care and to improve the quality, for example to reduce rates of healthcare acquired infections. This has been stressed in a previous submission (https://www.healthit.gov/isa/taxonomy/term/2551/level-0), which highlighted the public health needs for this data element. |
Estimate the breadth of applicability of the use case(s) for this data element | There are more than 5 million critical care admissions in the US annually [1] and about 40% of patients in the ICU are receiving mechanical ventilation at any given time [2]. Amongst patients receiving mechanical ventilation, mortality rates are as high as 50%. Therefore, there is a huge need for improving clinical care, quality of care, and clinical evidence in this patient population. Additionally, there are significant disparities in mortality of relevant conditions (e.g. COVID-19) by race/ethnicity, which highlights the need for additional research to address these disparities [1] https://www.sccm.org/Communications/Critical-Care-Statistics#:~:text=More%20than%205%20million%20patients,of%20comfort%20for%20dying%20patients. [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840149/) [3] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804391#:~:text=Results-,From%20March%201%2C%202020%2C%20through%20February%2028%2C%202022%2C,a%20mention%20of%20COVID%2D19. |
Link to use case project page | https://www.quantumleaphealth.org/portfolio/i-spy-covid |
ONC Priority |
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Maturity of Use and Technical Specifications for Data Element | |
Applicable Standard(s) | Airway type LOINC LL5542-7 PEEP LOINC 20077-4 Pressure support LOINC 20079-0 Plateau Pressure LOINC 76259-1 Tidal Volume LOINC 76221-1 Respiratory Rate LOINC 33438-3 https://loinc.org/LL5542-7 |
Additional Specifications | https://build.fhir.org/ig/HL7/fhir-saner/ValueSet-VentilatorObservations.html |
Current Use | (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer |
Extent of exchange | (Level 0) Limited environments, such as connectathons or pilots |
Supporting Artifacts |
ISPY COVID trial MIMIC data elements |
Potential Challenges | |
Restrictions on Standardization (e.g. proprietary code) | Standardization of this data element is likely to require some work on definitions around the measured parameters (peak inspiratory pressure and plateau pressure), because measurement is not standardized across ventilator devices. Ventilator settings (PEEP, PS, RR, Vt) are more standardized but it needs to be assured that these parameters are validated, rather than the raw data pulled directly from the ventilator (in most settings these are validated by the bedside nurse or respiratory thearpist). |
Restrictions on Use (e.g. licensing, user fees) | None |
Privacy and Security Concerns | None beyond usual health data |
Estimate of Overall Burden | Burden is likely to be moderate, given the need to standardize the data flow for extraction of this data element from the ventilator, verification by bedside providers, and storage in structured data field. |
An instrument, machine, appliance, implant, software or other article intended to be used for a medical purpose.
Data Element |
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Measured ventilator peak inspiratory pressure
Description
Measured peak inspiratory pressure if the patient is receiving mechanical ventilation |
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