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Abstract
BACKGROUND: Improved patient-ventilator asynchrony (PVA) identification using waveform analysis by critical care physicians (CCPs) may improve patient outcomes. This study aimed to assess the ability of CCPs to identify different types of PVAs using waveform analysis as well as factors related to this ability.
METHODS: We surveyed 12 university-affiliated medical ICUs (MICUs) in Tunisia. CCPs practicing in these MICUs were asked to visually identify 4 clinical cases, each corresponding to a different PVA. We collected the following characteristics regarding CCPs: scientific grade, years of experience, prior training in mechanical ventilation, prior exposure to waveform analysis, and the characteristics of the MICUs in which they practice. Respondents were categorized into 2 groups based on their ability to correctly identify PVAs (defined as the correct identification of at least 3 of the 4 PVA cases). Univariate analysis was performed to identify factors related to the correct identification of PVA.
RESULTS: Among 136 included CCPs, 72 (52.9%) responded to the present survey. The respondents comprised 59 (81.9%) residents, and 13 (18.1%) senior physicians. Further, 50 (69.4%) respondents had attended prior training in mechanical ventilation. Moreover, 21 (29.2%) of the respondents could correctly identify PVAs. Double-triggering was the most frequently identified PVA type, 43 (59.7%), followed by auto-triggering, 36 (50%); premature cycling, 28 (38.9%); and ineffective efforts, 25 (34.7%). Univariate analysis indicated that senior physicians had a better ability to correctly identify PVAs than residents (7 [53.8%] vs 14 [23.7%], P = .044).
CONCLUSIONS: The present study revealed a significant deficiency in the accurate visual identification of PVAs among CCPs in the MICUs. When compared to residents, senior physicians exhibited a notably superior aptitude for correctly recognizing PVAs.
- patient-ventilator asynchrony
- waveform analysis
- respiratory support
- mechanical ventilation
- identification accuracy
- education and training
- critical care physicians
Footnotes
- Correspondence: Mohamed Boussarsar MD, University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia; Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure,” LR12SP09, 4000, Sousse, Tunisia. E-mail: hamadi.boussarsar{at}gmail.com
The authors have disclosed no conflicts of interest.
Dr Chelbi presented a version of this paper at Réanimation 2023, Annual Congress of the Société de Réanimation de Langue Française, held June 14–16, 2023, in Paris, France.
Supplementary material related to this paper is available at http://www.rcjournal.com.
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