Stress Index Can Be Accurately and Reliably Assessed by Visually Inspecting Ventilator Waveforms.
BACKGROUND: Stress index provides a noninvasive approach to detect injurious ventilation patterns and to personalize ventilator settings. Obtaining the stress index (SI), however, requires quantitatively analyzing the shape of pressure-time curve with dedicated instruments or a specific ventilator,...
| Publicado en: | Respiratory Care Vol. 63; no. 9; pp. 1094 - 1102 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | clinical trial pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Sep2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131514636&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131514636 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Sep2018 vid: 63 iid: 9 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 131514636 131514636 131514636 10.4187/respcare.06151 131514636 ppf: 1094 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Stress Index Can Be Accurately and Reliably Assessed by Visually Inspecting Ventilator Waveforms. aug: au: Xiu-Mei Sun Guang-Qiang Chen Kai Chen Yu-Mei Wang Xuan He Hua-Wei Huang Xu-Ying Luo Chun-Mei Wang Zhong-Hua Shi Ming Xu Lu Chen Eddy Fan Jian-Xin Zhou affil: Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China sug: subj: Respiration, Artificial Adverse Effects Ventilator-Induced Lung Injury Risk Factors Respiratory Mechanics Evaluation Stress, Physiological Evaluation Waveforms Human Female Male Descriptive Statistics Data Analysis Software kappa Statistic Confidence Intervals P-Value Clinical Trials Prospective Studies Observational Methods Hospitals Inpatients Two-Tailed Test Adult Middle Age APACHE (Acute Physiology and Chronic Health Evaluation) Questionnaires Funding Source Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: BACKGROUND: Stress index provides a noninvasive approach to detect injurious ventilation patterns and to personalize ventilator settings. Obtaining the stress index (SI), however, requires quantitatively analyzing the shape of pressure-time curve with dedicated instruments or a specific ventilator, which may encumber its clinical implementation. We hypothesized that the SI could be qualitatively determined through a visual inspection of ventilator waveforms. METHODS: Thirtysix adult subjects undergoing volume controlled ventilation without spontaneous breathing were enrolled. For each subject, 2 trained clinicians visually inspected the pressure-time curve directly from the ventilator screen. They then qualitatively categorized the shape of pressure-time curve as linear, a downward concavity, or an upward concavity at the bedside. We simultaneously recorded airway pressure and flow signals using a dedicated instrument. A quantitative off-line analysis was performed to calculate the SI using specific research software. This quantitative analysis of the SI served as the reference method for classifying the shape of the pressure-time curve (ie, linear, a downward concavity, or an upward concavity). We compared the SI categorized by visual inspection with that by the reference. RESULTS: We obtained 200 SI assessments of pressure-time curves, among which 125 (63%) were linear, 55 (27%) were a downward concavity, and 20 (10%) were an upward concavity as determined by the reference method. The overall accuracy of visual inspection and weighted kappa statistic (95% CI) was 93% (88-96%) and 0.88 (0.82-0.94), respectively. The sensitivity and specificity to distinguish a downward concavity from a linear shape were 91% and 98%, respectively. The respective sensitivity and specificity to distinguish an upward concavity from a linear shape were 95% and 95%. CONCLUSIONS: Visual inspection of the pressure-time curve on the ventilator screen is a simple and reliable approach to assess SI at the bedside. This simplification may facilitate the implementation of SI in clinical practice to personalize mechanical ventilation. pubtype: Academic Journal doctype: clinical trial pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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