Showing papers by "Alan H. Morris published in 1993"

Clinical performance of a rule-based decision support system for mechanical ventilation of ARDS patients.

Abstract: We developed a clinical decision support system—ventilation protocols—that managed tidal volume and ventilator rate settings during mechanical ventilation of patients with the Adult Respiratory Distress Syndrome (ARDS). We applied these protocols for a total of 10,903 hours in 40 ARDS patients. The clinical staff suspended the protocols for only 5% of the total application time due to medical procedures, surgeries, transient clinical problems not addressed by the protocols, or because of attending physician request. Of 3,148 instructions generated by the ventilation protocols, the clinical staff followed 2,932 (93%). The staff did not follow some instructions because of patient data errors, computer software and protocol logic errors, inability of the clinical staff to implement protocol instructions because of more pressing duties, and clinical staff objections to specific instructions. Sixty percent of the patients treated by the ventilation protocols survived. Our results demonstrate that the ventilation protocols provided a practical and safe decision support system for the mechanical ventilation of ARDS patients.

Protocol management of adult respiratory distress syndrome.

Abstract: Protocol control of severely ill ICU patients seems feasible. A satisfactory computer infrastructure makes protocol control practical. A reported four-fold survival rate increase associated with protocol control of ventilatory management of adult respiratory distress syndrome patients suggests that it is not harmful. Protocol control represents a medical decision-support approach for standardizing therapy. Computerized protocols might provide a solution to the nonuniformity of care in clinical ICU practice and investigation. My colleagues and I can envision a multicenter consortium of hospitals equipped to carry out computerized protocol-controlled care. Such a consortium could rapidly complete large, randomized, clinical trials under computerized protocol control. This arrangement could provide much more definitive results than are currently possible. Interpretation of outcomes research results should thereby be made easier and conclusions should be more credible and more likely to contribute to medical policy formulation.

Cost-benefit considerations in managing oxygenation failure.

Abstract: The evaluation of new therapy poses a formidable challenge in intensive care medicine. When therapy evaluation cannot be double-blinded, as in the evaluation of extracorporeal support, the problem becomes more difficult. The result of the extracorporeal clinical trial, like that of the ECMO trial in the 1970s, is a potent reminder of the importance of concurrent controls in such evaluations. We should view with caution ethical objections to controlled trials of therapies that are not supported by credible data. A stronger ethical argument may frequently be mounted in favor of a randomized, controlled clinical trial. This is particularly pertinent in the high-technology ICU environment in which information overload is intense. The establishment of ICU human laboratories should enable the medical community to make much needed progress and help us identify the useful elements in our therapeutic armamentarium.