Limiting ventilator-induced lung injury through individual electronic medical record surveillance
Limiting ventilator-induced lung injury through individual electronic medical record surveillance
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DOI：
10.1097/ccm.0b013e3181fa4184
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发表时间：
2011-01-01
影响因子：
8.8
通讯作者：
Gajic, Ognjen
中科院分区：
文献类型：
--
作者：
Herasevich, Vitaly;Tsapenko, Mykola;Gajic, Ognjen
背景：为了提高呼吸机护理的安全性，降低呼吸机致肺损伤的风险，我们设计并测试了一种结合患者特征和呼吸机设置的电子算法，允许近乎实时地通知床边提供者潜在的损伤性呼吸机设置。方法：在三个Mayo Clinic Rochester重症监护病房筛选连续接受有创呼吸机治疗的患者的电子病历。计算机系统通过文本寻呼通知提醒床边提供者有关可能有害的呼吸机设置。警报标准包括PaO(2)/FIO(2)比率为8毫升/公斤预计体重(基于患者性别和身高)，平台压力为>；30 cm H(2)O，以及呼吸道峰值压力为>；35 cm H(2)O。呼吸治疗师回答了一项简短的在线满意度调查。对引入呼吸机诱导肺损伤警报前后呼吸机所致肺损伤的风险进行了比较。结果：在接受有创呼吸机24小时的1159名患者中，急性肺损伤的发生率为42%(n=490)。该系统为80名患者发送了111个警报，阳性预测值为59%。暴露于潜在损伤呼吸机的时间从干预后的40.6+/-74.6小时减少到26.9+/-77.3小时(p=.004)。说明：对机械通气患者的电子病历监测准确地检测到潜在损伤的呼吸机设置，并能够以适中的成本影响床边实践。它的实施与减少患者暴露在潜在破坏性机械通风环境中有关。(Crit Care Med 2011；39：34-39)
Background: To improve the safety of ventilator care and decrease the risk of ventilator-induced lung injury, we designed and tested an electronic algorithm that incorporates patient characteristics and ventilator settings, allowing near-real-time notification of bedside providers about potentially injurious ventilator settings.Methods: Electronic medical records of consecutive patients who received invasive ventilation were screened in three Mayo Clinic Rochester intensive care units. The computer system alerted bedside providers via the text paging notification about potentially injurious ventilator settings. Alert criteria included a PaO(2)/FIO(2) ratio of 8 mL/kg predicted body weight (based on patient gender and height), a plateau pressure of >30 cm H(2)O, and a peak airway pressure of >35 cm H(2)O. Respiratory therapists answered a brief online satisfaction survey. Ventilator-induced lung injury risk was compared before and after the introduction of ventilator-induced lung injury alert.Findings: The prevalence of acute lung injury was 42% (n = 490) among 1,159 patients receiving >24 hrs of invasive ventilation. The system sent 111 alerts for 80 patients, with a positive predictive value of 59%. The exposure to potentially injurious ventilation decreased after the intervention from 40.6 +/- 74.6 hrs to 26.9 +/- 77.3 hrs (p = .004).Interpretations: Electronic medical record surveillance of mechanically ventilated patients accurately detects potentially injurious ventilator settings and is able to influence bedside practice at moderate costs. Its implementation is associated with decreased patient exposure to potentially injurious mechanical ventilation settings. (Crit Care Med 2011; 39:34-39)