Evaluating trends and implementation determinants of post-pandemic sedation practices in the intensive care unit

Active Project Grant Awarded Last action

Award ID
F32HL188860
Recipient
Awarding agency
Obligated
$92,154

Award facts

Assistance listing
93.837 Cardiovascular Diseases Research
Completion date 0% complete
Place of performance
Philadelphia, PA 19104, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Approximately 800,000 critically ILL adult patients with acute respiratory failure require invasive mechanical ventilation (IMV) every year, accounting for 20-40% of intensive care unit (ICU) admissions in the US. Nearly all of these patients receive sedatives to treat anxiety, reduce emotional distress, prevent agitation-related harm, and facilitate synchrony with the ventilator. However, certain sedative medications as well as differential depths of sedation confer variable risks of harm to the patient, and - for this reason - clinical practice guidelines recommend against the use of benzodiazepines and deep levels of sedation, which is defined as a richmond agitation-sedation scale score of -3 to -5. While several multidisciplinary implementation strategies successfully improved adherence to these guidelines before the covid-19 pandemic, emerging data suggest post-pandemic ICU sedation practices are less guideline-adherent. This F32 award seeks to rigorously evaluate contemporary trends in ICU sedation practices and identify current implementation determinants of guideline-recommended sedation management. To achieve these goals, the specific aims of this proposal are: (1) identify perceived barriers and facilitators of adherence to guideline-recommended ICU sedation practices in the post-covid ERA, and (2) evaluate longitudinal trends in (a) benzodiazepine use and (b) sedation depth among IMV patients before, during, and after the covid-19 pandemic. These aims utilize novel qualitative and quasi-experimental epidemiologic approaches to fill specific training and knowledge gaps that are foundational for generating novel implementation strategies that RE-align bedside ICU sedation practices with evidence- based guidelines. Aim 1 utilizes semi-structured multidisciplinary focus group interviews that will be analyzed via directed content analysis mapped onto implementation frameworks. Aim 2 will employ an interrupted time series analysis of benzodiazepine use and early sedation depth before, during, and after the covid-19 pandemic within a retrospective cohort of >14,000 IMV patients across five hospitals and 14 icus. These studies and their associated skillset development will inform a k-series career development award application focused on the development of novel implementation strategies through the integration of human factors engineering, human-centered design, and implementation mapping. These strategies will then be tested in a future R01 award for a pragmatic clinical trial, thereby positioning the principal investigator to become an independently funded physician scientist who improves adherence to evidence-based sedation practices and promotes improved clinical outcomes for patients with acute respiratory failure receiving IMV.

Quick answers

Who received award F32HL188860?

F32HL188860 was awarded to The Trustees Of The University Of Pennsylvania by National Heart Lung and Blood Institute (National Institutes of Health) on March 1, 2027.

How much is award F32HL188860 worth?

$92,154 has been obligated on F32HL188860.

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