Jabaley Craig S, Groff Robert F, Sharifpour Milad, Raikhelkar Jayashree K, Blum James M
Division of Critical Care Medicine, Department of Anesthesiology, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
Division of Critical Care Medicine, Anesthesiology Service Line, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
BMC Res Notes. 2018 Jul 3;11(1):425. doi: 10.1186/s13104-018-3534-z.
As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming approaches could be readily identified. We conducted an exploratory retrospective observational database study of routinely recorded mechanical ventilation parameters between January 1, 2010 and December 31, 2016 from 12 intensive care units. Mode epoch count proportions were examined using Chi squared and Fisher exact tests as appropriate on an inter-unit basis with outlier detection for two test cases via post hoc pairwise analyses of a binomial regression model.
Final analysis included 559,734 mode epoch values. Significant heterogeneity was demonstrated between individual units (P < 0.05 for all comparisons). One unit demonstrated heightened utilization of high-frequency oscillatory ventilation, and three units demonstrated frequent synchronized intermittent mandatory ventilation utilization. Assist control ventilation was the most commonly recorded mode (51%), followed by adaptive support ventilation (23.1%). Volume-controlled modes were about twice as common as pressure-controlled modes (64.4% versus 35.6%). Our methodology provides a means by which to characterize the epidemiology of mechanical ventilation approaches and identify nonconforming practices. The observed variability warrants further clinical study about contributors and the impact on relevant outcomes.
由于缺乏循证指南来帮助临床医生选择机械通气模式，我们试图描述某大学医疗系统内机械通气模式的流行病学特征，并假设可以很容易地识别出不符合规范的方法。我们对2010年1月1日至2016年12月31日期间12个重症监护病房常规记录的机械通气参数进行了一项探索性回顾性观察数据库研究。在单位间基础上，使用卡方检验和Fisher精确检验（视情况而定）检查模式时段计数比例，并通过二项式回归模型的事后成对分析对两个测试案例进行异常值检测。
最终分析纳入了559,734个模式时段值。各单位之间存在显著异质性（所有比较的P值均<0.05）。一个单位高频振荡通气的使用率较高，三个单位同步间歇指令通气的使用频率较高。辅助控制通气是记录最常见的模式（51%），其次是自适应支持通气（23.1%）。容量控制模式的常见程度约为压力控制模式的两倍（64.4%对35.6%）。我们的方法提供了一种描述机械通气方法流行病学特征并识别不符合规范做法的手段。观察到的变异性值得对影响因素及其对相关结果的影响进行进一步的临床研究。
