Ventilator setting discordance with computerized physician orders in a pediatric ICU: A human factors perpective

The prevalence of mechanical ventilation in Pediatric Intensive Care Units (PICU) has been reported to be between 20–45%. Patients might require mechanical ventilation for different reasons that include neurologic disease, heart disease, and respiratory disease. While mechanical ventilation in children is a very effective way to support respiration, it might also produce harm. Indeed, optimal ventilator settings for good gas exchange and preventing harm have been the subject of much study in the last 20 years. Not having the intended ventilator settings could potentially lead to patient harm. Based on incident reporting in our PICU, we know that there are times where ventilator settings do not match orders for these settings. However, it is likely that incident reporting underestimates the scope of the problem. Furthermore, there are no studies in the medical literature reporting its prevalence, nor is there literature describing the relationship between computerized physician order entry and the use of the ventilator as a therapeutic device.