Performance of Computerized Protocols for the Management of Arterial Oxygenation in an Intensive Care Unit

  • Susan Henderson
  • Robert O. Crapo
  • C. Jane Wallace
  • Thomas D. East
  • Alan H. Morris
  • Reed M. Gardner
Part of the Computers and Medicine book series (C+M)


Adult respiratory distress syndrome (ARDS) is a form of respiratory failure characterized clinically by severe hypoxemia, diffuse infiltrates on chest radiograph, and decreased lung compliance. In its most severe form it has a survival of about 10%. In 1984, Gattinoni et al. reported a 77% survival in this subset of ARDS patients using a new form of therapy [1]. The new therapy included pressure controlled inverse ratio ventilation (PCIRV) and low frequency positive pressure ventilation with extracorporeal CO2 removal (ECC02R). Its goal was to reduce the peak and average pressures applied to the lungs by mechanical ventilators. The extraordinary survival reported with this new therapy and the fact that it was the result of an uncontrolled trial led to the design of a prospective randomized controlled clinical trial comparing PCIRV and ECC02R with traditional positive pressure ventilatory support. The trial was executed at the LDS Hospital from 1987 to 1991. During the design phase of this trial it became obvious that the novelty of extracorporeal support could cause increased interest among the clinical staff, resulting in a difference in the intensity of care between patients receiving ECC02R and patients receiving traditional ventilatory care. This created the possibility that differences in the intensity of therapy would bias the outcome of the study. To assure equivalency of care in both the control and new therapy limbs of the study, protocols were developed to control the management of arterial oxygenation in all study patients [2-4].


Clinical Staff Adult Respiratory Distress Syndrome Computerize Protocol Total Instruction Therapy Instruction 
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  1. 1.
    Gattinoni L, Pesenti A, Caspani ML, Pelizzola A, Mascheroni D, et al. The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment. Intensive Care Med 1984; 10:121–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Sittig DF, Pace NL, Gardner RM, Beck E, Morris AH. Implemention of a computerized patient advice system using the HELP clinical information system. Comp Biomed Res 1989; 22:474–87.CrossRefGoogle Scholar
  3. 3.
    Henderson S, East TD, Morris AH, Gardner RM. Performance evaluation of computerized clinical protocols for management of artierial hypoxemia in ARDS patients. Proc Thirteenth Symp Comput Appl Med Care. New York: IEEE Comput Soc Press, 1989: 588–92.Google Scholar
  4. 4.
    Henderson S, Crapo RO, East TD, Morris AH, Gardner RM. Computerized clinical protocols in an intensive care unit: How well are they followed? Proc Fourteenth Annual Symp Comput Appl Med Care. New York: IEEE Comput Soc Press, 1900:284–8.Google Scholar
  5. 5.
    Gardner RM. Computerized management of intensive care patients. MD Comput 1986; 3(1):36–51.PubMedGoogle Scholar
  6. 6.
    Pryor TA. the HELP medical reasearch system. MD Comput 1988; 5(5):22–3.PubMedGoogle Scholar
  7. 7.
    Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Systems 1983; 7:87–102.CrossRefGoogle Scholar
  8. 8.
    Hawley WL, Tariq H, Gardner RM. Clinical implementation of automated Medical Information Bus in an intensive care unit. SCAMC 1988; 12;621–4.Google Scholar
  9. 9.
    Gardner RM, Tariq H, Hawley WL, East TD. Medical Information Bus: The key to future integrated monitoring [editorial]. Int J Clin Monit Comput 1989; 6:205–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Shabot MM. Standardized acquisition of bedside data; The IEEE P1073 medical information Bus. Int J Clinc Monit Comput 1989; 6:197–204.CrossRefGoogle Scholar
  11. 11.
    Morris AH, Wallace CJ, Clemmer TP. Orme JF Jr, Weaver LK, et al. Extracorporeal CO2 removal therapy for adult respiratory distress syndrome patients. Resp Care 1990; 35:234–31.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1994

Authors and Affiliations

  • Susan Henderson
  • Robert O. Crapo
  • C. Jane Wallace
  • Thomas D. East
  • Alan H. Morris
  • Reed M. Gardner

There are no affiliations available

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