Feasibility of implementing Extubation Advisor , a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study.

Objectives: Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extubation decision support (CDS) tool.
Design: Phase I mixed-methods observational study.
Setting: Two Canadian intensive care units (ICUs).
Participants: We included patients on mechanical ventilation for ≥24 hours and clinicians (respiratory therapists and intensivists) responsible for extubation decisions.
Interventions: Components included a predictive model assessment, feasibility evaluation, questionnaires and interviews with clinicians.
Results: We enrolled 117 patients, totalling 151 SBTs and 80 extubations. The incidence of extubation failure was 11% in low-risk patients and 21% in high-risk patients stratified by the predictive model; 38% failed extubation when both the model and clinical impression were at high risk. The tool was well rated: 94% and 75% rated the data entry and EA report as average or better, respectively. Interviews (n=15) revealed favourable impressions regarding its user interface and functionality, but unexpectedly, also concerns regarding EA's potential impact on respiratory therapists' job security.
Conclusions: EA implementation was feasible, and users perceived it to have potential to support extubation decision-making. This study helps to understand bedside implementation of CDS tools in a multidisciplinary ICU.
Trial Registration Number: NCT02988167.
Competing Interests: Competing interests: AJES is the Founder and Board Chair of Therapeutic Monitoring Systems (TMS); TMS is developing and commercialising waveform-based variability-derived clinical decision support tools in order to improve care for patients at risk for or with existing critical illness. Both AJES and CLH are co-inventors on patents related to physiological waveform assessment and variability analysis. All remaining authors have disclosed that they do not have any potential conflicts of interest.
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