Bierer Gregory B, Soo Hoo Guy W
University of California Los Angeles Olive View Medical Center, Sylmar, CA, USA.
Respir Care. 2009 Oct;54(10):1313-20.
The utilization of noninvasive ventilation (NIV) in the Veterans Affairs health-care system is not well characterized. A survey of physicians and respiratory therapists was conducted to better understand its use.
Three hospitals in each of 21 Veterans Affairs networks were selected based on severity of patient mix, level of staffing and workload. A request was sent via e-mail to Veterans Affairs respiratory therapists and critical care physicians at these hospitals to complete a 41-question survey using an Internet-based survey site.
A total of 192/882 (22%) responses were received from a survey of about half (63/128) of the Veterans Affairs intensive care units (ICUs). Previous experience and training in NIV was limited. NIV is reported to be widely available and applied in both monitored (ICU, step-down, emergency department) and unmonitored (ward) settings. NIV was identified as a first-line option for COPD and CHF, but perceived use was less. Sixty-four percent of respiratory therapists felt NIV was used <50% of the time when indicated, compared to 29% of physicians (P<.001). Reported NIV use varied, with 45% treating 0-4 patients a month and 23% with >10 patients a month. Larger ICUs reported more frequent use of NIV (>10 patients a month) than smaller ICUs (P=.02). Written guidelines were noted by 65%, but only 27% had titration guidelines. The perceived efficacy of NIV was low, with a success rate of >50% noted by only 29% of respondents.
The perception of NIV use in the Veterans Affairs hospitals varies significantly. This survey revealed a wide range of training and experience, location of use, presence of written guidelines, and methods of delivery. Notable perceptual differences exist between respiratory therapists and physicians. Underutilization of NIV and low rates of perceived efficacy are major findings.
退伍军人事务医疗系统中无创通气（NIV）的使用情况尚无充分描述。我们开展了一项针对医生和呼吸治疗师的调查，以更好地了解其使用情况。
根据患者病情严重程度、人员配备水平和工作量，从21个退伍军人事务医疗网络中各选取3家医院。通过电子邮件向这些医院的退伍军人事务呼吸治疗师和重症监护医生发送请求，要求他们使用基于互联网的调查网站完成一项包含41个问题的调查。
在对约一半（63/128）的退伍军人事务重症监护病房（ICU）进行的调查中，共收到192/882（22%）份回复。此前在无创通气方面的经验和培训有限。据报告，无创通气在监测环境（ICU、逐步降级病房、急诊科）和非监测环境（普通病房）中都广泛可用且得到应用。无创通气被确定为慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）的一线治疗选择，但实际使用较少。64%的呼吸治疗师认为无创通气在有指征时的使用时间<50%，而医生的这一比例为29%（P<0.001）。报告的无创通气使用情况各不相同，45%的人每月治疗0 - 4名患者，23%的人每月治疗>10名患者。规模较大的ICU报告无创通气的使用频率（每月>10名患者）高于规模较小的ICU（P = 0.02）。65%的人提到有书面指南，但只有27%的人有滴定指南。无创通气的实际疗效较低，只有29%的受访者指出成功率>50%。
退伍军人事务医院对无创通气使用的认知存在显著差异。本次调查揭示了在培训和经验、使用地点、书面指南的存在情况以及实施方法等方面存在广泛差异。呼吸治疗师和医生之间存在明显的认知差异。无创通气使用不足和实际疗效较低是主要发现。
