Sampling Frequency of Ventilation Parameters for Studying Outcomes and Quality of Mechanical Ventilation.
CCCF ePoster library. Schmidt M. Oct 31, 2016; 150885; 7 Disclosure(s): No relationships to disclose in relation to this poster.
Dr. Marcello Schmidt
Dr. Marcello Schmidt
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Abstract
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Topic: Retrospective or Prospective Cohort Study

Sampling Frequency of Ventilation Parameters for Studying Outcomes and Quality of Mechanical Ventilation.


Marcello Schmidt1, Eddy Fan2,3, Gordon Rubenfeld2,4

1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
2. Interdepartamental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
3. Toronto General Hospital, University Health Network, Toronto, Canada
4. Sunnybrook Health Sciences Centre, Toronto, Canada



Abstract:

Introduction
Clinicians do not apply lung protective ventilation consistently in patients with Acute Respiratory Distress Syndrome. Use and reporting of quality measures may increase compliance with processes that improve patient care. It 's hard, however, to measure a dynamic intervention such as mechanical ventilation, which is continued for days and changes in time.
Objectives
The objective of this study was to determine the accuracy and usefulness of once and twice daily sampling of mechanical ventilation parameters when compared with frequent sampling that includes all recorded values. This knowledge can be used for the development of quality metrics for mechanical ventialtion in ARDS or deciding on sampling frequency in clincal studies.
Methods
Using a clinical database, we compared one or the average of two daily measurements (limited dataset) of several ventilatory parameters to the time-weighted average of all available measurements (full dataset) in adult critical care patients with ARDS who were mechanically ventilated for 48 hours or more. We compared set and spontaneous tidal volumes, plateau pressures, peak pressure, mean airway pressures and PEEP using Bland-Altman analysis. Then, we assessed the agreement between the limited and full datasets in measuring adherence to clinically relevant thresholds for tidal volume, plateau pressure and PEEP, and ranked the different units included in the database according to their adherence to these thresholds.
Results
All variables showed clinically irrelevant mean differences and tight 95% confidence intervals using either one of or the two daily measurements obtained, with exception of spontaneous tidal volumes, which had a larger 95% confidence interval. Agreement in adherence measurement was >= 82% (k>=0.62) for spontaneous tidal volume, >=86% (k>=0.68) for PEEP/FiO2 appropriateness, >=93% (k>=0.72) for plateau pressure, and >=97% (k>=0.95) for set tidal volume. Finally, ranking the unit according to their adherence yielded the sames results using the full and the limited data sets.
Conclusion
Use of once or twice daily sampling of mechanical ventilation parameters is a reasonable alternative to measure the delivery of mechanical ventilation to patients with ARDS and the adherence to evidence-based thresholds of tidal volume, plateau pressure and PEEP. Ventilatory parameters set by clinicians varied little and, therefore, less frequent sampling was very accurate in these. For parameters that change frequently during the day, like the size of spantaneous tidal volumes, the mean difference remained low, but the CI widened.


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