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专项培训可改善患者-呼吸机不同步的检测与管理。

Specific Training Improves the Detection and Management of Patient-Ventilator Asynchrony.

作者信息

Ramírez Iván I, Gutiérrez-Arias Ruvistay, Damiani L Felipe, Adasme Rodrigo S, Arellano Daniel H, Salinas Francisco A, Roncalli Angelo, Núñez-Silveira Juan, Santillán-Zuta Milton, Sepúlveda-Barisich Patrick, Gordo-Vidal Federico, Blanch Lluís

机构信息

Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile.

Faculty of Health Sciences, Diego Portales University, Santiago, Chile.

出版信息

Respir Care. 2024 Jan 24;69(2):166-175. doi: 10.4187/respcare.11329.

Abstract

BACKGROUND

Patient-ventilator asynchrony is common in patients undergoing mechanical ventilation. The proportion of health-care professionals capable of identifying and effectively managing different types of patient-ventilator asynchronies is limited. A few studies have developed specific training programs, but they mainly focused on improving patient-ventilator asynchrony detection without assessing the ability of health-care professionals to determine the possible causes.

METHODS

We conducted a 36-h training program focused on patient-ventilator asynchrony detection and management for health-care professionals from 20 hospitals in Latin America and Spain. The training program included 6 h of a live online lesson during which 120 patient-ventilator asynchrony cases were presented. After the 6-h training lesson, health-care professionals were required to complete a 1-h training session per day for the subsequent 30 d. A 30-question assessment tool was developed and used to assess health-care professionals before training, immediately after the 6-h training lecture, and after the 30 d of training (1-month follow-up).

RESULTS

One hundred sixteen health-care professionals participated in the study. The median (interquartile range) of the total number of correct answers in the pre-training, post-training, and 1-month follow-up were significantly different (12 [8.75-15], 18 [13.75-22], and 18.5 [14-23], respectively). The percentages of correct answers also differed significantly between the time assessments. Study participants significantly improved their performance between pre-training and post-training ( < .001). This performance was maintained after a 1-month follow-up ( = .95) for the questions related to the detection, determination of cause, and management of patient-ventilator asynchrony.

CONCLUSIONS

A specific 36-h training program significantly improved the ability of health-care professionals to detect patient-ventilator asynchrony, determine the possible causes of patient-ventilator asynchrony, and properly manage different types of patient-ventilator asynchrony.

摘要

背景

患者与呼吸机不同步在接受机械通气的患者中很常见。能够识别并有效处理不同类型患者与呼吸机不同步的医护人员比例有限。一些研究已制定了特定的培训项目,但主要侧重于改善患者与呼吸机不同步的检测,而未评估医护人员确定可能原因的能力。

方法

我们为来自拉丁美洲和西班牙20家医院的医护人员开展了一项为期36小时的关于患者与呼吸机不同步检测及管理的培训项目。该培训项目包括6小时的在线直播课程,期间展示了120例患者与呼吸机不同步的病例。在这6小时的培训课程之后,医护人员在随后的30天里每天需要完成1小时的培训课程。开发了一个包含30个问题的评估工具,用于在培训前、6小时培训课程结束后即刻以及培训30天后(1个月随访)对医护人员进行评估。

结果

116名医护人员参与了该研究。培训前、培训后以及1个月随访时正确答案总数的中位数(四分位间距)有显著差异(分别为12[8.75 - 15]、18[13.75 - 22]和18.5[14 - 23])。在不同时间评估之间,正确答案的百分比也有显著差异。研究参与者在培训前和培训后之间的表现有显著改善(P <.001)。对于与患者与呼吸机不同步的检测、原因确定及管理相关的问题,在1个月随访后该表现得以维持(P =.95)。

结论

一个特定的36小时培训项目显著提高了医护人员检测患者与呼吸机不同步、确定患者与呼吸机不同步可能原因以及妥善处理不同类型患者与呼吸机不同步的能力。

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