Setting and Study Design
This prospective cohort study took place at a 640-bed (62 intensive care
unit (ICU) beds) quaternary care center and enrolled 250 adult
inpatients between December 2013 and March 2015. All intubated ICU
patients who had provided consent for use of their electronic health
record data for research purposes were screened for eligibility by a
research nurse. Patients were excluded if they were intubated solely for
airway protection, had a history of pleurodesis, pneumonectomy, or
video-assisted thoracoscopic surgery, had been extubated or had been
intubated for > 24 hours before a first PU , had been
transitioned to comfort care, or were imminently dying (Figure 1). Due
to physician availability, daily enrollment was limited to the 3 most
recently intubated patients each morning. The protocol was approved by
an institutional review board (Schulman Associates IRB, Inc. Approval
No. 4080-2E).