Raurell-Torredà M, Argilaga-Molero E, Colomer-Plana M, Ródenas-Francisco A, Garcia-Olm M
Escuela de Enfermería, Facultad Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
Enferm Intensiva (Engl Ed). 2019 Jan-Mar;30(1):21-32. doi: 10.1016/j.enfi.2018.04.006. Epub 2018 Jun 25.
To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences.
Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]).
Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment.
There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.
评估不同环境下护士和医生的无创通气知识与技能：设备及环境影响因素。
对4家医院（3家大学附属医院，1家社区医院）的4个重症监护病房（ICU）（1个外科ICU，3个内科 - 外科ICU）、1个术后恢复病房、2个急诊科（ED）和3个普通病房的407名专业人员进行横断面描述性研究。采用在该环境下验证过的包含13个条目的调查问卷（Kappa指数为0.97（95%可信区间[0.965 - 0.975]））。
护士的应答率为63.7%；医生的应答率为39%。正确回答的总体百分比为50%。评分从1到5，分数越低表示知识越丰富，护士的得分分别为3.27±0.5，医生为2.62±0.5（平均差异为0.65（95%可信区间：0.48 - 0.82，P <.001））。医院或科室之间无差异（P = 0.07和P = 0.09）。相当比例的受访者错误地将患者 - 呼吸机同步策略识别为“盖住呼气端口”（故意漏气）以及将面罩紧贴患者面部（无意漏气）（ICU为28.2%，ED为22.5%，术后复苏病房为8.3%，普通病房为61.5%），护士和医生之间无差异（27.9%对23.4%，P = 0.6））。只有50%的护士受访者正确回答了关于测量面罩尺寸的问题；只有11.7%的护士知道“两指贴合”调整方法。
在所研究的环境中，护士和医生的知识水平没有差异。无创通气治疗知识的欠缺取决于所接受的培训和可用的材料。为减少故意漏气和无意漏气之间现有的混淆，建议使用单一类型的无创通气设备并为护士提供适当水平的培训。
