Researchers at Intermountain Healthcare have received a $4.6 million grant from the National Institutes of Health to study the best ways to implement recognized standards of care to determine when ICU patients on mechanical ventilators, including those being treated for severe COVID illness, should be taken off the ventilators to resume breathing on their own.
Mechanical ventilators are life-saving devices that help patients with critical illness breath until their lungs are strong enough to operate on their own again. However, this kind of treatment comes with its own risks, including infection, lung and vocal cord damage, ventilator-associated pneumonia, and delirium due to heavy sedation required for their use.
Mechanical ventilators are commonly used for severely-ill COVID patients in the ICU, whose lungs have been ravaged by the virus, and who are unable to breath on their own.
“We know how to test if patients can breathe on their own, but that requires coordination from multiple members of the care team, who are all stretched thin right now given the high number of COVID-19 patients in our ICUs,” said Colin K. Grissom, MD, senior medical director of critical care for Intermountain Healthcare and co-principal Investigator of the grant.
“Through our already established telehealth platform and giving real time feedback on meeting those care standards, we know we can reduce the time patients are on ventilators. This grant will help us study the best way to do that,” he added.
Determining whether a patient needs continued mechanical ventilation is done through a process that involves coordinating a spontaneous awakening trial (when sedation is stopped) and a spontaneous breathing trial. Known as a C-SAT/SBT, this requires testing a patient’s ability to breath with little to no assistance and requires multiple members of the critical care team to coordinate care to be done safely.
The Society of Critical Care Medicine recommends a C-SAT/SBT be done once a day, in the morning, for patients who pass an initial safety screen. When done successfully, this protocol can reduce the number of days a patient remains on a ventilator, and in the hospital overall.
In a previous study, Intermountain Healthcare researchers implemented a protocol in three ICUs called TEACH, which stands for Telehealth Enabled Real-Time Audit and Feedback for Clinical Adherence protocol and found that it improved adherence to lung protective mechanical ventilation best practices to more than 90%.
“We now want to use the TEACH protocol to improve performance on C-SAT/SBT for mechanically ventilated patients,” said Dr. Grissom.
As part of the TEACH protocol, tele-critical care providers — critical care physicians, respiratory therapists, nurse practitioners, and critical care nurses — remotely monitor patients to determine if they are ready for C-SAT/SBT, nudge the on-site care team to prepare the patient for the C-SAT/SBT if they haven’t already, and then assist in performing and assessing the results.
Then in real time, versus through monthly or weekly reports, the hospital and ICU can see how they are doing in meeting the standard of care.
This new NIH grant, which runs through August 2026, will help implement these adherence strategies to 14 other Intermountain Healthcare ICUs across the system.
“We’ll learn whether this telehealth enabled-audit and feedback process is something that improves adherence with best practices for effective and sustainable strategies for C-SAT/SBT implementation,” said Dr. Raj Srivastava, senior medical executive director of the Healthcare Delivery Institute at Intermountain Healthcare and co-principal Investigator of the grant.
If successful, these techniques can be expanded to help scale up this kind of telehealth-enabled, central monitoring of critical aspects of care for ICU patients, which Dr. Grissom added is critical now given the vulnerability of ICU staff to potential COVID-19 exposure.