Efficacy of ventilator waveforms observation in detecting patient-ventilator asynchrony
Efficacy of ventilator waveforms observation in detecting patient-ventilator asynchrony
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DOI：
10.1097/ccm.0b013e318225753c
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发表时间：
2011-11-01
影响因子：
8.8
通讯作者：
Navalesi, Paolo
中科院分区：
文献类型：
--
作者：
Colombo, Davide;Cammarota, Gianmaria;Navalesi, Paolo
目标：目视检查呼吸机波形在检测重症监护病房患者与呼吸机异步性方面的价值从未得到系统评估。本研究旨在评估重症监护病房医生通过呼吸机波形识别患者与呼吸机不同步的能力。设计：前瞻性观察研究。设置：大学医院的重症监护病房。患者：24 名因急性呼吸衰竭接受机械通气的患者。干预：由 10 名专家和 10 名非专家（即住院医师、重症监护室患者）评估 43 份 5 分钟报告，显示流量时间和气道压力时间追踪护理单位的医生。将专家和非专家确定的异步性与三名独立检查员确定的异步性进行比较，这三名独立检查员评估了显示膈肌电活动轨迹的相同报告。测量和主要结果：根据逐次呼吸分析和总体报告分析检查数据。确定敏感性、特异性以及阳性和阴性预测值。逐次呼吸分析的敏感性和阳性预测值非常低（分别为 22% 和 32%），而报告分析的敏感性和阳性预测值则相当高（分别为 55% 和 44%）。相反，逐次呼吸分析的特异性和阴性预测值较高（分别为 91% 和 86%），报告分析的特异性和阴性预测值略低（分别为 76% 和 82%）。对于逐次呼吸分析，专家的灵敏度明显高于非专家（28% vs. 16%，p
Objectives: The value of visual inspection of ventilator waveforms in detecting patient-ventilator asynchronies in the intensive care unit has never been systematically evaluated. This study aims to assess intensive care unit physicians' ability to identify patient-ventilator asynchronies through ventilator waveforms.Design: Prospective observational study.Setting: Intensive care unit of a University Hospital.Patients: Twenty-four patients receiving mechanical ventilation for acute respiratory failure.Intervention: Forty-three 5-min reports displaying flow-time and airway pressure-time tracings were evaluated by 10 expert and 10 nonexpert, i.e., residents, intensive care unit physicians. The asynchronies identified by experts and nonexperts were compared with those ascertained by three independent examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity.Measurements and Main Results: Data were examined according to both breath-by-breath analysis and overall report analysis. Sensitivity, specificity, and positive and negative predictive values were determined. Sensitivity and positive predictive value were very low with breath-by-breath analysis (22% and 32%, respectively) and fairly increased with report analysis (55% and 44%, respectively). Conversely, specificity and negative predictive value were high with breath-by-breath analysis (91% and 86%, respectively) and slightly lower with report analysis (76% and 82%, respectively). Sensitivity was significantly higher for experts than for nonexperts for breath-by-breath analysis (28% vs. 16%, p