Evidence map›Paper›PMID 42098760›Full record

Trial reportImplementation science : IS2026

Nudging implementation of low tidal volume ventilation: a stepped wedge, cluster randomized trial.

Meeta Prasad Kerlin, Michael O Harhay, Fan Li, Dylan S Small, Yingying Lu, Wei Wang, Barry D Fuchs, Mark E Mikkelsen, Teresa Tran, Aerielle Belk and 9 more

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04663802 (Implementation of Nudges to Promote Utilization of Low Tidal Volume Ventilation), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04663802 nacompletednot on this map

Implementation of Nudges to Promote Utilization of Low Tidal Volume Ventilation (INPUT) Study

TypeinterventionalSponsorUniversity of PennsylvaniaRan2021 to 2023Enrolled7,342ConditionsARDS, Critical Illness, Acute Respiratory Distress Syndrome, Acute Respiratory FailureArmsDefault order set, Physician-targeted accountable justification, Respiratory therapist (RT)-targeted accountable justification
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Meeta Prasad KerlinPulmonary, Critical Care and Allergy Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine, 627 South Pavilion, Philadelphia, PA, 19104, USA. prasadm@pennmedicine.upenn.edu.ORCID http://orcid.org/0000-0002-3239-1443
Michael O HarhayPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Fan LiDepartment of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
Dylan S SmallDepartment of Statistics, The Wharton School at the University of Pennsylvania, Philadelphia, PA, USA.
Yingying LuPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Wei WangPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Barry D FuchsPulmonary, Critical Care and Allergy Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine, 627 South Pavilion, Philadelphia, PA, 19104, USA.
Mark E MikkelsenDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Teresa TranContinuous Improvement and Innovation, Seattle Children's Hospital, Seattle, WA, USA.
Aerielle BelkPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Jasmine A SilvestriPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Tamar KlaimanPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Stefania ScottPalliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Elizabeth LevyPulmonary, Critical Care and Allergy Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine, 627 South Pavilion, Philadelphia, PA, 19104, USA.
Michael W SjodingDepartment of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Rachel KohnPulmonary, Critical Care and Allergy Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine, 627 South Pavilion, Philadelphia, PA, 19104, USA.
Karsten J RobertsDepartment of Cardiovascular and Pulmonary Sciences, College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA.
Rinad S BeidasDepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Scott D HalpernPulmonary, Critical Care and Allergy Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine, 627 South Pavilion, Philadelphia, PA, 19104, USA.

Funding

Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patientsR01HL141608 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI KERLIN, MEETA PRASAD · 2019 to 2023
$3.7M
NHLBI NIH HHS R01 HL141608NIH/NHLBI R01HL141608
6 · The paper itself

Abstract

background"Nudges" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

methodsWe performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges.

resultsThe primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation.

conclusionsEHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU.

trial registrationClinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.

Indexed as

Respiration, ArtificialTidal VolumeElectronic Health RecordsFemaleHumansIntensive Care UnitsMaleRespiratory Therapists

Identifiers

PMID42098760
PMCPMC13321408

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.