Keenan S P, Montgomery J, Chen L M, Esmail R, Inman K J, Sibbald W J
Richard Ivey Critical Care Trauma Center, Victoria Hospital London, Ontario, Canada.
Intensive Care Med. 1998 Sep;24(9):946-52. doi: 10.1007/s001340050694.
To determine whether there is variability in the structure and process of ventilatory care in intensive care units (ICUs) of the hospitals of Southwestern Ontario.
Self-administered questionnaire-based survey.
ICUs of selected community and teaching hospitals of Southwestern Ontario.
Head of respiratory therapy service of respective hospitals; in those hospitals without respiratory therapists, the ICU nurse manager.
Self-administered questionnaire.
OUTCOME MEASURE(S): The availability of different models of ventilators and respiratory therapist and physician coverage were assessed. In addition, the use of clinical practice guidelines, respiratory therapists, and the nursing role in ventilatory care were determined.
In general, the structure of ventilatory care, including availability of different modes of ventilation, and coverage by respiratory therapists and physicians was more comprehensive in larger hospitals. However, the availability of some modes of ventilation varied more than expected among hospitals of comparable size. Similarly, variability in the process of ventilatory care, defined by the availability of clinical practice guidelines and the roles of respiratory therapists varied both within and among hospitals of different size.
The structure and process of ventilatory care in this sample of Southwestern Ontario ICUs was found to be variable. Not all this variability could be accounted for by hospital size, suggesting a potential for improvement in overall ventilatory care. Further study is required before any specific recommendations can be considered.
确定安大略省西南部医院重症监护病房（ICU）通气护理的结构和流程是否存在差异。
基于自我管理问卷的调查。
安大略省西南部选定的社区医院和教学医院的ICU。
各医院呼吸治疗服务负责人；在没有呼吸治疗师的医院，为ICU护士经理。
自我管理问卷。
评估不同型号呼吸机的可用性以及呼吸治疗师和医生的覆盖情况。此外，确定临床实践指南的使用、呼吸治疗师的作用以及护理在通气护理中的作用。
总体而言，通气护理的结构，包括不同通气模式的可用性以及呼吸治疗师和医生的覆盖情况，在较大的医院更为全面。然而，在规模相当的医院中，某些通气模式的可用性差异比预期的要大。同样，由临床实践指南的可用性和呼吸治疗师的作用所定义的通气护理流程的差异在不同规模的医院内部和之间都存在。
在安大略省西南部ICU的这个样本中，发现通气护理的结构和流程存在差异。并非所有这些差异都可以用医院规模来解释，这表明整体通气护理有改进的潜力。在考虑任何具体建议之前，需要进一步研究。
