Respiratory Therapy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5.
J Crit Care. 2012 Dec;27(6):556-63. doi: 10.1016/j.jcrc.2012.04.021. Epub 2012 Jul 2.
Mechanical ventilation protocols for treating intensive care unit (ICU) patients are often recommended to improve process of care and outcomes, but their composition may be variable and penetration into clinical practice may be incomplete. We sought to ascertain ICU and hospital characteristics associated with adoption of mechanical ventilation (MV) protocols in Ontario, Canada.
We surveyed respiratory therapy leaders in all 97 Ontario hospitals capable of providing MV in an ICU.
We received responses from 70 hospitals (72.2%). Two-thirds (46/67; 68.7%) of hospitals reported having a respiratory therapist on duty 24 hours/7 days per week. Mechanical ventilation protocols were present in most hospitals (47/67; 70.2%), but low tidal volume ventilation was incorporated into only half of these protocols (24/44; 54.5%). Factors associated with reported use of MV protocols were intensivist-staffing model (89.3% vs 56.4%; odds ratio [OR], 6.44; [95% confidence interval {CI}, 1.66-25.0; P = .007]), presence of daily multidisciplinary rounds (84.4% vs 42.9%; OR, 7.24 [95% CI, 2.22-23.6; P = .001]), and presence of 24 hour/7 days per week respiratory therapist coverage (87.0% vs 36.4%; OR, 11.7 [95% CI, 3.44-39.6; P < .001]). The likelihood of having an MV protocol also increased with increasing patient-to-physician ratio (OR for each increase of 1 patient, 1.17 [95% CI, 1.01-1.35; P = .034] and increasing ICU size (OR for each additional ICU bed, 1.05 [95% CI, 1.00-1.10; P = .04]).
Most surveyed hospitals reported the presence of a protocol for MV, but only half of these incorporated low tidal volume ventilation. Several organizational factors were associated with adoption of protocols, and therefore, these should also be considered when evaluating the impact of protocols on clinical outcomes.
为了改善治疗效果和结果，重症监护病房（ICU）患者的机械通气治疗方案通常被推荐使用，但这些方案的组成可能存在差异，并且在临床实践中的应用可能并不完整。我们旨在确定与加拿大安大略省机械通气（MV）方案采用相关的 ICU 和医院特征。
我们对安大略省所有 97 家能够在 ICU 中提供 MV 的医院的呼吸治疗负责人进行了调查。
我们收到了 70 家医院（72.2%）的回复。三分之二（46/67；68.7%）的医院报告说每周 7 天每天 24 小时都有呼吸治疗师值班。大多数医院（47/67；70.2%）都有机械通气方案，但这些方案中只有一半（24/44；54.5%）纳入了低潮气量通气。与 MV 方案使用报告相关的因素包括：重症监护医师配备模式（89.3%比 56.4%；优势比[OR]，6.44；[95%置信区间{CI}，1.66-25.0；P=.007]）、每日多学科查房（84.4%比 42.9%；OR，7.24 [95% CI，2.22-23.6；P=.001]）和每周 7 天每天 24 小时呼吸治疗师覆盖（87.0%比 36.4%；OR，11.7 [95% CI，3.44-39.6；P<.001]）。MV 方案的可能性随着患者与医师比例的增加而增加（每增加 1 名患者的 OR，1.17 [95% CI，1.01-1.35；P=.034]）和 ICU 规模的增加（每增加 1 张 ICU 床位的 OR，1.05 [95% CI，1.00-1.10；P=.04]）。
大多数接受调查的医院报告称存在 MV 方案，但只有一半的方案纳入了低潮气量通气。一些组织因素与方案的采用相关，因此，在评估方案对临床结果的影响时，也应考虑这些因素。
