The Maximizing Extubation Outcomes Through Educational and Organizational Research (METEOR) Trial (METEOR)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
- Behavioral: Traditional online education
- Other: Risk-stratified preventive post-extubation noninvasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC)
- Behavioral: Interprofessional education
- Behavioral: Clinical protocol
- Other: Preventive post-extubation high-flow nasal cannula oxygen (HFNC)
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Nicole Toney, MPH, CPH
- Phone Number: 412-648-0608
- Email: nat88@pitt.edu
Study Locations
-
-
Pennsylvania
-
Carlisle, Pennsylvania, United States, 17015
- UPMC Carlisle
-
Hanover, Pennsylvania, United States, 17331
- UPMC Hanover
-
Harrisburg, Pennsylvania, United States, 17101
- UPMC Harrisburg
-
Harrisburg, Pennsylvania, United States, 17109
- UPMC Community Osteopathic
-
Mechanicsburg, Pennsylvania, United States, 17050
- UPMC West Shore
-
Monroeville, Pennsylvania, United States, 15146
- UPMC East
-
New Castle, Pennsylvania, United States, 16105
- UPMC Jameson
-
Pittsburgh, Pennsylvania, United States, 15213
- University of Pittsburgh
-
Pittsburgh, Pennsylvania, United States, 15219
- UPMC Mercy
-
Pittsburgh, Pennsylvania, United States, 15213
- UPMC Presbyterian
-
Pittsburgh, Pennsylvania, United States, 15232
- UPMC Shadyside
-
Pittsburgh, Pennsylvania, United States, 15215
- UPMC St. Margaret
-
Pittsburgh, Pennsylvania, United States, 15237
- UPMC Passavant
-
Pittsburgh, Pennsylvania, United States, 15213
- UPMC Magee-Womens Hospital
-
Seneca, Pennsylvania, United States, 16346
- UPMC Northwest
-
Williamsport, Pennsylvania, United States, 17701
- UPMC Williamsport
-
York, Pennsylvania, United States, 17408
- UPMC Memorial
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- All adults treated with invasive mechanical ventilation >24 hours in participating ICUs
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Online education about risk-stratified post-extubation NIV/HFNC
During this period, ICU providers receive traditional online education that demonstrates the evidence supporting use of preventive post-extubation respiratory support (NIV or HFNC) over conventional post-extubation oxygen and supports the implementation of risk-stratified, preventive post-extubation NIV/HFNC.
|
A 30-60 minute, online, interactive, educational video that is customized to each provider type and offered with provider-specific continuing education credits
Preventive post-extubation NIV for high-risk patients and preventive post-extubation HFNC for low-risk patients
|
|
Active Comparator: Interprofessional education about risk-stratified post-extubation NIV/HFNC
During this period, ICU providers receive interprofessional education that demonstrates the evidence supporting use of preventive post-extubation respiratory support (NIV or HFNC) over conventional post-extubation oxygen and supports the implementation of risk-stratified, preventive post-extubation NIV/HFNC.
|
Preventive post-extubation NIV for high-risk patients and preventive post-extubation HFNC for low-risk patients
Interprofessional education (IPE) consists of both classroom-based IPE and just-in-time IPE.
In classroom-based IPE, a trained physician educator with content expertise who works in the ICU leads a 60-to-90-minute, in-person, IPE workshop consisting of a 30-minute didactic session and a 30-to-60-minute small group session, during which participants work together to apply the content to authentic cases.
The workshops, which are designed according to modern principles of adult learning and IPE, present the rationale and evidence supporting the preventive, post-extubation therapies.
They are specifically designed to foster authenticity, reinforce role identity, and relate the content to life experience.
In just-in-time IPE, trained local champions meet with the interprofessional ICU team each morning to identify eligible patients and, as needed, briefly review the evidence supporting proper use of the assigned preventive, post-extubation strategy.
|
|
Active Comparator: Clinical protocol about risk-stratified post-extubation NIV/HFNC
During this period, ICU providers deploy a clinical protocol that supports the implementation of risk-stratified, preventive post-extubation NIV/HFNC.
|
Preventive post-extubation NIV for high-risk patients and preventive post-extubation HFNC for low-risk patients
An "adequately explicit" protocol provides specific rules for use of the preventive, post-extubation therapy based on patient data.
A "ready-to-customize" version of the protocol with instructions to work with key local stakeholders to revise the protocol, accounting for local needs and resources, is provided.
After local customization, a local champion then disseminates the protocol based on local practices.
|
|
Active Comparator: Interprofessional education plus clinical protocol about risk-stratified post-extubation NIV/HFNC
During this period, ICU providers receive interprofessional education and use a clinical protocol that supports the implementation of risk-stratified, preventive post-extubation NIV/HFNC.
|
Preventive post-extubation NIV for high-risk patients and preventive post-extubation HFNC for low-risk patients
Interprofessional education (IPE) consists of both classroom-based IPE and just-in-time IPE.
In classroom-based IPE, a trained physician educator with content expertise who works in the ICU leads a 60-to-90-minute, in-person, IPE workshop consisting of a 30-minute didactic session and a 30-to-60-minute small group session, during which participants work together to apply the content to authentic cases.
The workshops, which are designed according to modern principles of adult learning and IPE, present the rationale and evidence supporting the preventive, post-extubation therapies.
They are specifically designed to foster authenticity, reinforce role identity, and relate the content to life experience.
In just-in-time IPE, trained local champions meet with the interprofessional ICU team each morning to identify eligible patients and, as needed, briefly review the evidence supporting proper use of the assigned preventive, post-extubation strategy.
An "adequately explicit" protocol provides specific rules for use of the preventive, post-extubation therapy based on patient data.
A "ready-to-customize" version of the protocol with instructions to work with key local stakeholders to revise the protocol, accounting for local needs and resources, is provided.
After local customization, a local champion then disseminates the protocol based on local practices.
|
|
Active Comparator: Online education about post-extubation HFNC
During this period, ICU providers receive traditional online education that demonstrates the evidence supporting use of preventive post-extubation respiratory support (NIV or HFNC) over conventional post-extubation oxygen and supports the implementation of preventive post-extubation HFNC for all eligible patients.
|
A 30-60 minute, online, interactive, educational video that is customized to each provider type and offered with provider-specific continuing education credits
Preventive post-extubation HFNC for all eligible patients (without risk stratification)
|
|
Active Comparator: Interprofessional education about post-extubation HFNC
During this period, ICU providers receive interprofessional education that demonstrates the evidence supporting use of preventive post-extubation respiratory support (NIV or HFNC) over conventional post-extubation oxygen and supports the implementation of preventive post-extubation HFNC for all eligible patients.
|
Interprofessional education (IPE) consists of both classroom-based IPE and just-in-time IPE.
In classroom-based IPE, a trained physician educator with content expertise who works in the ICU leads a 60-to-90-minute, in-person, IPE workshop consisting of a 30-minute didactic session and a 30-to-60-minute small group session, during which participants work together to apply the content to authentic cases.
The workshops, which are designed according to modern principles of adult learning and IPE, present the rationale and evidence supporting the preventive, post-extubation therapies.
They are specifically designed to foster authenticity, reinforce role identity, and relate the content to life experience.
In just-in-time IPE, trained local champions meet with the interprofessional ICU team each morning to identify eligible patients and, as needed, briefly review the evidence supporting proper use of the assigned preventive, post-extubation strategy.
Preventive post-extubation HFNC for all eligible patients (without risk stratification)
|
|
Active Comparator: Clinical protocol about post-extubation HFNC
During this period, ICU providers deploy a clinical protocol that supports the implementation of preventive post-extubation HFNC for all eligible patients.
|
An "adequately explicit" protocol provides specific rules for use of the preventive, post-extubation therapy based on patient data.
A "ready-to-customize" version of the protocol with instructions to work with key local stakeholders to revise the protocol, accounting for local needs and resources, is provided.
After local customization, a local champion then disseminates the protocol based on local practices.
Preventive post-extubation HFNC for all eligible patients (without risk stratification)
|
|
Active Comparator: Interprofessional education plus clinical protocol about post-extubation HFNC
During this period, ICU providers receive interprofessional education and use a clinical protocol that supports the implementation of preventive post-extubation HFNC for all eligible patients.
|
Interprofessional education (IPE) consists of both classroom-based IPE and just-in-time IPE.
In classroom-based IPE, a trained physician educator with content expertise who works in the ICU leads a 60-to-90-minute, in-person, IPE workshop consisting of a 30-minute didactic session and a 30-to-60-minute small group session, during which participants work together to apply the content to authentic cases.
The workshops, which are designed according to modern principles of adult learning and IPE, present the rationale and evidence supporting the preventive, post-extubation therapies.
They are specifically designed to foster authenticity, reinforce role identity, and relate the content to life experience.
In just-in-time IPE, trained local champions meet with the interprofessional ICU team each morning to identify eligible patients and, as needed, briefly review the evidence supporting proper use of the assigned preventive, post-extubation strategy.
An "adequately explicit" protocol provides specific rules for use of the preventive, post-extubation therapy based on patient data.
A "ready-to-customize" version of the protocol with instructions to work with key local stakeholders to revise the protocol, accounting for local needs and resources, is provided.
After local customization, a local champion then disseminates the protocol based on local practices.
Preventive post-extubation HFNC for all eligible patients (without risk stratification)
|
|
No Intervention: Usual care
During this period, ICU providers receive no structured education about preventive, post-extubation respiratory support therapies
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of use of post-extubation NIV or HFNC among eligible participants (primary implementation outcome)
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined the number of participants who received post-extubation NIV or HFNC divided by the number of participants eligible for post-extubation NIV or HFNC
|
60 days after initiating invasive mechanical ventilation
|
|
In-hospital mortality truncated at 60 days from intubation (primary clinical outcome)
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined as the number of participants who died during hospitalization
|
60 days after initiating invasive mechanical ventilation
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of eligible participants receiving care from providers who completed an implementation intervention
Time Frame: Up to 3 years
|
Defined as the total number of participants who received care from ICU providers (physicians, nurses, and/or respiratory therapists) who completed an implementation intervention (traditional online education, interprofessional education, and/or clinical protocol)
|
Up to 3 years
|
|
Use of post-extubation NIV or HFNC among eligible participants 6 months after the implementation intervention (IPE plus protocol) is fully deployed
Time Frame: 6 months after the implementation intervention (IPE plus protocol) is fully deployed
|
Defined the number of participants who received post-extubation NIV or HFNC divided by the number of participants eligible for post-extubation NIV or HFNC during the one-month period beginning 6 months after the implementation intervention (IPE plus protocol) is fully deployed
|
6 months after the implementation intervention (IPE plus protocol) is fully deployed
|
|
90-day survival
Time Frame: 90 days after initiating invasive mechanical ventilation
|
Defined as time from initiating invasive mechanical ventilation to the date of death from any cause or last known follow-up (censored)
|
90 days after initiating invasive mechanical ventilation
|
|
ICU length of stay
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined as time from the time of initiating invasive mechanical ventilation to successful discharge from the ICU, where "successful" indicates that discharge was followed by at least 48 hours alive without ICU readmission
|
60 days after initiating invasive mechanical ventilation
|
|
Hospital length of stay
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined as time from the time of initiating invasive mechanical ventilation to successful hospital discharge, where "successful" indicates that discharge was followed by at least 48 hours alive without hospital readmission
|
60 days after initiating invasive mechanical ventilation
|
|
Post-extubation respiratory failure
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined as reintubation and resumption of invasive mechanical ventilation during the 48 hours after extubation
|
60 days after initiating invasive mechanical ventilation
|
|
Duration of mechanical ventilation
Time Frame: 60 days after initiating invasive mechanical ventilation
|
Defined as time from the time of initiating invasive mechanical ventilation to successful extubation, where "successful" indicates that extubation was followed by at least 48 hours alive without reintubation
|
60 days after initiating invasive mechanical ventilation
|
|
28-day ventilator-free days (VFDs)
Time Frame: 28 days after initiating invasive mechanical ventilation
|
Defined as the number of days a participant was breathing without assistance from the day they of intubation (initiating invasive mechanical ventilation) to 28 days later, where "breathing without assistance" indicates that discontinuation of assisted breathing was followed by at least 48 hours alive without reintubation
|
28 days after initiating invasive mechanical ventilation
|
|
Ventilator-associated events (VAEs)
Time Frame: Up to 60 days after initiating invasive mechanical ventilation
|
Defined as the number of participants who have a VAE according to Centers of Disease Control and Prevention (CDC) criteria divided by the number of participants who received invasive mechanical ventilation
|
Up to 60 days after initiating invasive mechanical ventilation
|
|
Organ failure (daily SOFA)
Time Frame: Up to 60 days after initiating invasive mechanical ventilation
|
Defined as mean daily sequential organ failure assessment (SOFA) score from initiating invasive mechanical ventilation to up to 60 days later
|
Up to 60 days after initiating invasive mechanical ventilation
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Timothy D Girard, MD, MSCI, University of Pittsburgh
Publications and helpful links
General Publications
- Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, Alhazzani W, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong MN, Hough CL, Mehta S, Nanchal R, Pawlik AJ, Schweickert WD, Sessler CN, Strom T, Kress JP. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation. Chest. 2017 Jan;151(1):166-180. doi: 10.1016/j.chest.2016.10.036. Epub 2016 Nov 3.
- Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P Members Of The Steering Committee, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S Members Of The Task Force. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426. doi: 10.1183/13993003.02426-2016. Print 2017 Aug.
- Granton D, Chaudhuri D, Wang D, Einav S, Helviz Y, Mauri T, Mancebo J, Frat JP, Jog S, Hernandez G, Maggiore SM, Hodgson CL, Jaber S, Brochard L, Trivedi V, Ricard JD, Goligher EC, Burns KEA, Rochwerg B. High-Flow Nasal Cannula Compared With Conventional Oxygen Therapy or Noninvasive Ventilation Immediately Postextubation: A Systematic Review and Meta-Analysis. Crit Care Med. 2020 Nov;48(11):e1129-e1136. doi: 10.1097/CCM.0000000000004576.
- Sang L, Nong L, Zheng Y, Xu Y, Chen S, Zhang Y, Huang Y, Liu X, Li Y. Effect of high-flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation for preventing reintubation: a Bayesian network meta-analysis and systematic review. J Thorac Dis. 2020 Jul;12(7):3725-3736. doi: 10.21037/jtd-20-1050.
- Fernando SM, Tran A, Sadeghirad B, Burns KEA, Fan E, Brodie D, Munshi L, Goligher EC, Cook DJ, Fowler RA, Herridge MS, Cardinal P, Jaber S, Moller MH, Thille AW, Ferguson ND, Slutsky AS, Brochard LJ, Seely AJE, Rochwerg B. Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis. Intensive Care Med. 2022 Feb;48(2):137-147. doi: 10.1007/s00134-021-06581-1. Epub 2021 Nov 25.
- Argote L, Miron-Spektor E. Organizational learning: From experience to knowledge. Organization Science 2011;22:1123-37.
- Kasza J, Bowden R, Hooper R, Forbes AB. The batched stepped wedge design: A design robust to delays in cluster recruitment. Stat Med. 2022 Aug 15;41(18):3627-3641. doi: 10.1002/sim.9438. Epub 2022 May 21.
- Prendergast NT, Kahn JM, Angus DC, Argote L, Barnes B, Chang CH, Graff S, Hess DR, Onyemekwu CA, Rak KJ, Russell JL, Seaman JB, Toth KM, Girard TD. Maximizing Extubation Outcomes Through Educational and Organizational Research (METEOR) Trial: protocol for a batched, stepped-wedge, cluster-randomised, type 2 hybrid effectiveness-implementation trial. BMJ Open. 2025 Oct 23;15(10):e108956. doi: 10.1136/bmjopen-2025-108956.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Respiratory Tract Diseases
- Respiration Disorders
- Respiratory Insufficiency
- Health Care Quality, Access, and Evaluation
- Therapeutics
- Health Care Evaluation Mechanisms
- Quality of Health Care
- Airway Management
- Respiratory Therapy
- Respiration, Artificial
- Epidemiologic Study Characteristics
- Clinical Protocols
- Noninvasive Ventilation
Other Study ID Numbers
Other Study ID Numbers
- STUDY20100469
- U01HL159882 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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