Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshopitalet, Oslo University Hospital, Oslo, Norway.
Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 2023 Nov;67(10):1383-1394. doi: 10.1111/aas.14317. Epub 2023 Sep 22.
When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.
We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.
The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.
The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.
在为患有急性低氧性呼吸衰竭（AHRF）的机械通气成人患者提供护理时，临床医生面临着在允许自主呼吸的通气模式与完全由通气机控制的通气模式之间进行不确定的选择。管理此类患者的临床医生的偏好，以及促使他们选择通气模式的因素，在很大程度上是未知的。为了更好地了解临床医生的偏好如何可能影响对 AHRF 患者通气支持的选择，我们向国际重症监护病房（ICU）研究人员网络发布了一项调查。
我们分发了一份在线调查，其中包含 32 个广泛相似且相互关联的问题，这些问题涉及在不同严重程度的 AHRF 情况下，临床医生如何优先考虑自主或控制通气，以及哪些因素决定了他们的选择。
该调查分发给 12 个国家的 1337 名收件人。其中，415 人（31%）完成了调查，要么完全完成（52%），要么部分完成（48%）。大多数受访者被认定为医学专家（87%）或正在接受培训的医生（11%）。在轻度 AHRF 中，允许自主通气的模式被认为更可取，而在中度和重度 AHRF 中，控制通气被认为越来越重要。在受访者中，强烈支持（90%）在中度 AHRF 患者中进行比较自主通气和控制通气的随机临床试验。
这项国际调查的回应表明，在中度 AHRF 患者中，对于首选通气模式存在临床平衡。我们发现强烈支持在中度 AHRF 患者中比较通气模式的随机试验。
