背景:使用重症监护医师(CCP)的波形分析改善患者-呼吸机异步(PVA)识别可能会改善患者预后。本研究旨在评估CCP使用波形分析以及与此能力相关的因素来识别不同类型的PVAs的能力。
方法:我们调查了突尼斯12所大学附属医疗ICU(MICU)。在这些MICU中练习的CCP被要求在视觉上识别4例临床病例,每个对应于不同的PVA。我们收集了关于CCP的以下特征:科学等级,多年的经验,之前的机械通气培训,先前暴露于波形分析,以及他们实践的MICUs的特征。根据受访者正确识别PVAs的能力(定义为正确识别4例PVA中至少3例),将受访者分为2组。进行单变量分析以确定与正确识别PVA相关的因素。
结果:在136个包含的CCP中,72人(52.9%)回答了本次调查。受访者包括59名(81.9%)居民,和13名(18.1%)高级医师。Further,50名(69.4%)受访者曾参加过机械通气培训。此外,21(29.2%)的受访者可以正确识别PVAs。双触发是最常见的PVA类型,43(59.7%),其次是自动触发,36(50%);过早骑自行车,28(38.9%);努力不力,25(34.7%)。单因素分析表明,高级医师比居民具有更好的正确识别PVAs的能力(7[53.8%]vs14[23.7%],P=.044)。
结论:本研究揭示了在MICUs的CCP中准确视觉识别PVAs的显著缺陷。与居民相比,高级医师在正确识别PVAs方面表现出明显的优越才能。
BACKGROUND: Improved patient-ventilator asynchrony (PVA) identification using waveform analysis by critical care physicians (CCPs) may improve patient outcomes. This study aimed to assess the ability of CCPs to identify different types of PVAs using waveform analysis as well as factors related to this ability.
METHODS: We surveyed 12 university-affiliated medical ICUs (MICUs) in Tunisia. CCPs practicing in these MICUs were asked to visually identify 4 clinical cases, each corresponding to a different PVA. We collected the following characteristics regarding CCPs: scientific grade, years of experience, prior training in mechanical ventilation, prior exposure to waveform analysis, and the characteristics of the MICUs in which they practice. Respondents were categorized into 2 groups based on their ability to correctly identify PVAs (defined as the correct identification of at least 3 of the 4 PVA cases). Univariate analysis was performed to identify factors related to the correct identification of PVA.
RESULTS: Among 136 included CCPs, 72 (52.9%) responded to the present survey. The respondents comprised 59 (81.9%) residents, and 13 (18.1%) senior physicians. Further, 50 (69.4%) respondents had attended prior training in mechanical ventilation. Moreover, 21 (29.2%) of the respondents could correctly identify PVAs. Double-triggering was the most frequently identified PVA type, 43 (59.7%), followed by auto-triggering, 36 (50%); premature cycling, 28 (38.9%); and ineffective efforts, 25 (34.7%). Univariate analysis indicated that senior physicians had a better ability to correctly identify PVAs than residents (7 [53.8%] vs 14 [23.7%], P = .044).
CONCLUSIONS: The present study revealed a significant deficiency in the accurate visual identification of PVAs among CCPs in the MICUs. When compared to residents, senior physicians exhibited a notably superior aptitude for correctly recognizing PVAs.