# The Maximizing Extubation outcomes Through Educational and Organizational Research (METEOR) Trial

> **NIH NIH U01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2021 · $621,164

## Abstract

PROJECT SUMMARY
Nearly one million patients require invasive mechanical ventilation for acute respiratory failure in the
United States each year. Most of these patients will recover to the point of extubation, yet even those
who are extubated remain vulnerable to complications and poor outcomes. Multiple high-profile
randomized controlled trials have shown that two preventive post-extubation respiratory therapies—
noninvasive ventilation (NIV) and high-flow nasal cannula oxygen (HFNC)—can prevent recurrent
respiratory failure, reintubation, and death in this population. Despite this evidence, however, these
therapies remain severely underutilized, leading to preventable morbidity and mortality. To address this
implementation gap, we propose to conduct the Maximizing Extubation outcomes Through Educational
and Organizational Research (METEOR) Trial, a cluster-randomized, stepped-wedge, type 2 hybrid
effectiveness-implementation trial of interprofessional education about preventive post-extubation NIV
and HFNC with and without clinical protocols. We designed the METEOR Trial based on extensive
preliminary studies, during which we identified barriers to adoption of preventive post-extubation
respiratory care and pilot tested interprofessional education as an implementation strategy in the ICU.
These studies revealed that a major barrier to implementation is the lack of a shared understanding
about the value of these therapies within the interprofessional ICU team; a theory-based
interprofessional education intervention designed to create a shared understanding and support
“transactive memory” among team members is both feasible and acceptable; and interprofessional
education can be strengthened by linking it with a clinical protocol. During the METEOR Trial, we will
randomize ICUs to one of four implementation strategies: an active control, protocol-directed care,
interprofessional education, or a combination of protocol-directed care and interprofessional education.
In parallel, we will randomize ICUs to one of two clinical strategies, one emphasizing either post-
extubation NIV or HFNC based on patient risk vs. one emphasizing post-extubation HFNC for all
patients. The specific aims of the trial are to (1) test the effectiveness of interprofessional education on
the implementation of preventive, post-extubation therapies, (2) compare the effectiveness of two
preventive, post-extubation therapies (NIV and HFNC) on patient-centered clinical outcomes, and (3)
perform a comprehensive qualitative evaluation of the trial processes and outcomes in order to better
understand mechanism, identify what worked and what didn’t, and set the stage for broader
dissemination of the study findings. Together these aims will provide critical insight into the role of
interprofessional education as an implementation strategy in hospital settings, leading to improved
outcomes for hundreds of thousands of patients with acute respiratory failure.

## Key facts

- **NIH application ID:** 10314540
- **Project number:** 1U01HL159882-01
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Timothy D Girard
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $621,164
- **Award type:** 1
- **Project period:** 2021-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10314540

## Citation

> US National Institutes of Health, RePORTER application 10314540, The Maximizing Extubation outcomes Through Educational and Organizational Research (METEOR) Trial (1U01HL159882-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10314540. Licensed CC0.

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