重症监护病房专业人员识别患者-呼吸机不同步的能力：一项多中心横断面分析研究。

Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study.

作者信息

Enríquez Popayán Andrés Mauricio, Ramírez Iván Ignacio, Zúñiga Juan Felipe, Gutierrez-Arias Ruvistay, Jiménez Pérez Mayda Alejandra, Parada-Gereda Henry Mauricio, Pardo Cocuy Luis Fernando, Colmenares Ana Lucia Rangel, Castro Chaparro Nubia, Pinza Ortega Ana, Martínez Díaz Jorge, Hurtado Laverde Johanna, Henao Cruz Joismer Alejandro

机构信息

Departamento de Fisioterapia en Cuidado Intensivo, GyO Medical, Yopal, Colombia; Departamento de Fisioterapia en Cuidado Intensivo, Clínica SIMALINK, Yopal, Colombia.

Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile; INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Diego Portales, Santiago, Chile.

出版信息

J Crit Care Med (Targu Mures). 2025 Apr 30;11(2):157-163. doi: 10.2478/jccm-2025-0017. eCollection 2025 Apr.

DOI:10.2478/jccm-2025-0017

PMID:40386701

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12080533/

Abstract

INTRODUCTION

Patient-ventilator asynchrony (PVA) is frequent in intensive care. Its presence is associated with prolonged days of mechanical ventilation and may lead to increased mortality in the intensive care unit (ICU) and hospital. Little is known about the ability of Colombian intensive care professionals to identify asynchronies, and the factors associated with their correct identification are not apparent.

AIM OF THE STUDY

To describe the ability of Colombian intensive care professionals to identify patient-ventilator asynchronies (PVA) using waveform analysis. In addition, to define the characteristics associated with correctly detecting PVA.

MATERIAL AND METHODS

We conducted a multicenter, cross-sectional, national survey-based study between January and August 2024. Colombian physiotherapists, respiratory therapists, nurses and intensive care physicians from 24 departments participated in the study. An online survey was used. They were asked to identify six different PVAs presented as videos. The videos were displayed using pressure/time and flow/time waveform of a Puritan Bennett 840 ventilator.

RESULTS

We recruited 900 participants, 60% female, most of whom were physiotherapists (53%). Most professionals had specialty training in critical care (42%), and 32% reported having specific PVA training. Double triggering was the most frequently identified PVA (75%). However, only 3.67% of participants recognized all six PVAs. According to multiple logistic regression analysis, working in a mixed unit (OR 2.59; 95% CI 1.19 - 5.54), caring for neonates (OR 5.19; 95% CI 1.77 - 15.20), and having specific training (OR 2.38; 95% CI 1.16 - 4.76) increases the chance of correctly recognizing all PVAs.

CONCLUSION

In Colombia, a low percentage of professionals recognize all PVAs. Having specific training in this topic, working in mixed ICUs and neonatal intensive care was significantly associated with identifying all PVAs.

摘要

引言

患者 - 呼吸机不同步（PVA）在重症监护中很常见。其存在与机械通气天数延长相关，并可能导致重症监护病房（ICU）和医院的死亡率增加。对于哥伦比亚重症监护专业人员识别不同步的能力知之甚少，且与其正确识别相关的因素尚不明确。

研究目的

描述哥伦比亚重症监护专业人员使用波形分析识别患者 - 呼吸机不同步（PVA）的能力。此外，确定与正确检测PVA相关的特征。

材料与方法

我们在2024年1月至8月期间进行了一项基于全国性调查的多中心横断面研究。来自24个部门的哥伦比亚物理治疗师、呼吸治疗师、护士和重症监护医生参与了该研究。采用在线调查。要求他们识别以视频形式呈现的六种不同的PVA。视频使用伟康840呼吸机的压力/时间和流量/时间波形显示。

结果

我们招募了900名参与者，其中60%为女性，大多数是物理治疗师（53%）。大多数专业人员接受过重症监护方面的专业培训（42%），32%报告接受过特定的PVA培训。双重触发是最常被识别的PVA（75%）。然而，只有3.67%的参与者识别出了所有六种PVA。根据多因素逻辑回归分析，在混合病房工作（比值比2.59；95%置信区间1.19 - 5.54）、护理新生儿（比值比5.19；95%置信区间1.77 - 15.20）以及接受特定培训（比值比2.38；95%置信区间1.16 - 4.76）会增加正确识别所有PVA的机会。