Barriers to providing lung-protective ventilation to patients with acute lung injury
Barriers to providing lung-protective ventilation to patients with acute lung injury
复制标题
DOI：
10.1097/01.ccm.0000127266.39560.96
复制
发表时间：
2004-06-01
影响因子：
8.8
通讯作者：
Hudson, LD
中科院分区：
文献类型：
--
作者：
Rubenfeld, GD;Cooper, C;Hudson, LD
目标。尚未有研究探讨急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）患者实施肺保护性通气的障碍。我们的目的是确定ALI/ARDS患者使用肺保护性通气的障碍。设计：问卷调查，内容分析开放式回答。地点：医疗中心。参与者：经验丰富的重症监护室护士和呼吸治疗师网络，通过有目的的抽样从ARDS网络（美国国立卫生研究院资助的研究联盟）的医院中确定。干预措施:调查。结果：收到了代表所有10个ARDS网络站点的55份调查。27名（49%）受访者为重症监护室护士，24名（44%）为呼吸治疗师，4名未注明职业。临床医生在20例（四分位数范围10-50例）ALI/ARDS患者中使用了肺保护性通气。受访者认为，医生是否愿意放弃对呼吸机的控制，医生对ALI/ARDS的认识，以及医生对低潮气量患者禁忌症的认识是启动肺保护性通气的重要障碍。对患者继续进行肺保护性通气的重要障碍是对患者不适和呼吸急促以及对高碳酸血症、酸中毒和低氧血症的担忧。确定了克服障碍的技术，包括具体的呼吸机设置建议，临床医生教育和评估患者不适的工具。结论：经验丰富的床边临床医生认识到实施肺保护性通气的重要障碍。增加肺保护性通气使用的成功策略应该针对这些障碍。
Objective. No studies have explored the barriers to implementing lung-protective ventilation in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Our objective was to identify barriers to using lung-protective ventilation in patients with ALI/ARDS.Design: Survey with content analysis of open-ended responses.Setting: Medical center.Participants: Experienced intensive care unit nurses and respiratory therapists network identified through purposive sampling at hospitals from the ARDS Network, a National Institutes of Health-sponsored research consortium.Interventions: Survey.Results: Fifty-five surveys representing all ten ARDS Network sites were received. Twenty-seven (49%) of the respondents were intensive care unit nurses, 24 (44%) were respiratory therapists, and four did not indicate their profession. Clinicians had used lung-protective ventilation in a median of 20 (interquartile range, 10-50) patients with ALI/ARDS. Respondents identified physician willingness to relinquish control of ventilator, physician recognition of ALI/ARDS, and physician perceptions of patient contraindications to low tidal volumes as important barriers to initiating lung-protective ventilation. Important barriers to continuing patients on lungprotective ventilation were concerns over patient discomfort and tachypnea and concerns over hypercapnia, acidosis, and hypoxemia. Techniques for overcoming barriers were identified including specific ventilator setup recommendations, clinician education, and tools to assess patient discomfort.Conclusions: Experienced bedside clinicians perceive important barriers to implementing lung-protective ventilation. Successful strategies to increase use of lung-protective ventilation should target these barriers.