Anica Law awarded R01 for improving mechanical ventilation plans
Congratulations to Assistant Professor Anica Law for receiving her first R01 from the NIH/NHLBI!
Every year, hundreds of thousands of patients with acute respiratory failure require invasive mechanical ventilation (IMV) in the US, and more than 10% progress to prolonged IMV (semi-permanent dependence on a ventilator to breathe). The pathway to prolonged IMV can sometimes occur not because it is within the patient’s goals, but because the usual process around shared decision-making with patients’ families and loved ones is fraught with inadequate and delayed exchange of information, inadequate time to consider information, and difficulty managing prognostic uncertainty. Time-limited trials (TLTs) are a promising alternative approach to traditional shared decision-making, which involves creating a collaborative plan with family members at the START of life-sustaining therapy to trial therapy for a defined period, after which the patient’s response to therapy during the trial period informs the decision to continue care focused on recovery, transition to comfort-focused care, or extend the trial’s duration to guide subsequent decision-making. However, major knowledge gaps limit the optimal use of TLTs, including patient selection for TLTs, length of TLTs, and optimal integration into clinical practice. This project will use a large national granular dataset and advanced time-varying prediction model techniques to (1) identify patients with high prognostic uncertainty who may benefit from TLTs, (2) model how certainty evolves during IMV to inform TLT duration, and (3) study how ICU physicians incorporate uncertainty estimates into decisions, ultimately supporting standardized, goal-concordant, patient-centered care.