由呼吸治疗师驱动的目标导向性机械通气医嘱集的实施提高了机械通气最佳实践的依从性。

Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

机构信息

1 Department of Anesthesiology-Critical Care, Mayo Clinic, Rochester, MN, USA.

2 Department of Respiratory Care, Mayo Clinic, Rochester, MN, USA.

出版信息

J Intensive Care Med. 2019 Jul;34(7):550-556. doi: 10.1177/0885066617746089. Epub 2017 Dec 5.

DOI:10.1177/0885066617746089

PMID:29207907

Abstract

PURPOSE

Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice.

METHODS

We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs.

RESULTS

Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P < .001). Adherence to the PEEP/Fio table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P = .02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality.

CONCLUSIONS

A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio table.

摘要

目的

有关改善急性呼吸窘迫综合征（ARDS）患者结局的呼吸机管理策略的最佳实践数据已经很容易获得。然而，对于确保这些策略得到遵守的相关过程却知之甚少。我们开发了一个以目标为导向的机械通气医嘱集，其中包括医生指定的肺保护性通气和氧合目标，由呼吸治疗师（RT）来执行。我们主要研究目标是确定是否可以实施由 RT 驱动的包含预定义氧合和通气目标的医嘱集，并确定其与提高最佳实践的依从性相关。

方法

我们采用了对照前后研究设计，评估了在实施标准化、以目标为导向的机械通气医嘱集之前和之后的 1302 例接受有创机械通气的患者（1693 例有创机械通气的单独发作）。通过预设者选择患者的氧合动脉血氧分压（Pao ）、ARDS 网络[Net]呼气末正压（PEEP）/吸入氧分数（Fio ）表的特定目标（使用）和通气（pH 值，二氧化碳分压），并由 RT 来实施。