1 Division of Pulmonary and Critical Care Medicine.
Ann Am Thorac Soc. 2014 Feb;11(2):182-5. doi: 10.1513/AnnalsATS.201307-222OC.
Predictions of duration of mechanical ventilation are frequently made by intensivists and influence clinical decisions.
We aimed to measure the accuracy of these clinical early predictions.
One hundred fifty-five patients within 48 hours of initiation of mechanical ventilation on a general intensive care unit had clinical data prospectively collected and were followed to determine actual duration of mechanical ventilation. Intensivists, after evaluating patients in the first 2 consecutive days, predicted each duration of mechanical ventilation by selecting between less than 3, 4 to 7, 8 to 14, or more than 14 days. Accuracy of predictions was evaluated by comparisons between predicted and actual durations.
Raw agreement (95% confidence interval) between predicted and actual durations, classified into the four categories, was 37% (29-45%). Predictions of duration of more than 7 and more than 14 days showed raw agreements of 59% (51-66%) and 83% (76-88%); sensitivities of 40% (28-54%) and 29% (13-51%); specificities of 71% (61-80%) and 93% (87-97%); positive predictive values of 48% (34-63%) and 44% (20-70%); and negative predictive values of 64% (54-73%) and 87% (81-92%), respectively.
The accuracy of intensivists' early clinical predictions of duration of mechanical ventilation is limited, particularly for identifying patients who will require prolonged mechanical ventilation.
机械通气时间的预测通常由重症监护医师进行，并影响临床决策。
旨在评估这些临床早期预测的准确性。
在综合重症监护病房机械通气开始后 48 小时内的 155 例患者前瞻性地收集临床数据，并随访以确定实际的机械通气时间。在评估患者的前 2 天中，重症监护医师通过选择机械通气时间少于 3、4-7、8-14 或超过 14 天来预测每位患者的机械通气时间。通过比较预测和实际持续时间来评估预测的准确性。
将预测和实际持续时间分为四类，原始一致性（95%置信区间）为 37%（29-45%）。预测 7 天以上和 14 天以上的持续时间的原始一致性分别为 59%（51-66%）和 83%（76-88%）；敏感性分别为 40%（28-54%）和 29%（13-51%）；特异性分别为 71%（61-80%）和 93%（87-97%）；阳性预测值分别为 48%（34-63%）和 44%（20-70%）；阴性预测值分别为 64%（54-73%）和 87%（81-92%）。
重症监护医师早期对机械通气持续时间的临床预测准确性有限，特别是对于识别需要长时间机械通气的患者。
