Some ICU patients require prolonged mechanical ventilation. The process of liberating a patient from mechanical ventilation is termed “weaning”. Like many aspects of physical training, there is no universally accepted formula for weaning and it is part of the overall rehabilitation process in ICU. To best understand the factors affecting the weaning process for patients, it is first and foremost necessary to ensure that weaning-associated data, including ventilatory support and respiratory pattern parameters, supported by information illustrating decision-making processes, are recorded accurately and are easy to interpret. It is proposed that a prototype electronic version of the paper weaning chart, termed the “Digitally Enhanced Liberation from VEntilation” or “DELVE” system could allow clinical prescription of the weaning plan and an accurate record of patient performance and adherence to the weaning plan.

Method

This is feasibility study will collect data to support the development of a future clinical trial. This study will be a mixed-methods feasibility study of the introduction of the DELVE system to the ICU over a 9 month period. Quantitative data collection on patient recruitment and device usage will be supported by qualitative methods to assess user acceptance and experience, where the users are members of the multidisciplinary clinical team on the ICU. This study follows the guidance on developing and evaluating complex interventions provided by the Medical Research Council. During the study, the DELVE system will be used in parallel with standard care, including the paper-based “Weaning Chart” and patient records. This study will directly compare the usability, benefits and potential limitations of the DELVE system compared to current practice of weaning prescription and record of progress.

Pain is an expected and appropriate experience that usually follows a traumatic injury. By contrast, chronic pain and disability are unhelpful but common sequelae of trauma-related injuries. Gaining an understanding of why some people develop chronic and disabling post-traumatic pain is, therefore, a priority for individual patients, the military and society at large. The mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are not fully understood. Such knowledge would facilitate the development and implementation of a clinical pathway of care that matches interventions to the projected risk of poor recovery, with the aim of preventing poor long-term outcomes.

Method

The research team are recruiting two temporally staggered cohorts of patients with trauma. The first cohort will facilitate the development of the prediction model to inform the screening tool, and the second will enable validation of the prediction model through an evaluation of the predictive performance of the model and tool.

Self-reported and physical assessment predictive data will be collected at baseline over a period of up to 14 days, which commences immediately following recruitment. Biomarker data collection occurs throughout the same baseline period. The outcome data will be collected at 6 months post-injury, the point of evaluation of an individual’s absolute risk of poor outcome. In addition, selected data will be measured at 3 and 12 months post-injury to explore the clinical course of recovery following injury in shorter and longer terms.