Background
acute respiratory failure
ACUTE RESPIRATORY FAILURE
Although invasive mechanical ventilation is a lifesaving treatment for more than 400,000 US patients with acute respiratory failure each year [Spontaneous awakening and breathing trials during mechanical ventilation improve patient outcomes. Daily interruptions in sedation [spontaneous awakening trials (SATs)] decrease duration of mechanical ventilation and intensive care unit (ICU) length of stay without compromising patient comfort or safety [Spontaneous awakening and breathing trials are difficult to coordinate and face substantial implementation barriers. Initial SAT/SBT trials utilized relatively narrow inclusion/exclusion criteria and employed resource-intensive methods for ensuring high adherence and careful monitoring of strictly protocolized C-SAT/SBT. Subsequent implementation efforts have focused on multistep protocols driven by nurses who conduct SATs and respiratory therapists who conduct SBTs [C-SAT/SBT implementation requires a clear understanding of protocol steps and tight coordination of difficult-to-execute sequencing between nurses and respiratory therapists [Telehealth-enabled remote care, and specifically tele-critical care, has the potential to overcome these barriers and improve C-SAT/SBT use. Tele-critical care enables proactive high-risk patient monitoring, surveillance, and real-time assistance — through central audit and feedback — to front-line ICU teams [Emerging literature suggests remote monitoring and prompting to improve C-SAT/SBT are feasible and effective. One pre/post study deployed a web-based electronic dashboard with information on SBT readiness, depth of sedation, and sedative infusions. A text message alert system notified respiratory therapists and nurses of patient readiness for SAT and SBT. After implementation, mechanical ventilation days and ICU length of stay decreased by 2.2 and 2.7 days respectively [We designed a cluster-randomized type II hybrid effectiveness-implementation clinical trial to determine whether adding 