Potential Acceptability of a Pediatric Ventilator Management Computer Protocol*
| Autor: | John T. Berger, Murray M. Pollack, Allan Doctor, Rick Harrison, Robinder G. Khemani, Thomas P. Shanley, Joseph A. Carcillo, Katherine A. Sward, Richard Holobkov, Tammara L. Jenkins, J. Michael Dean, Heidi J. Dalton, Robert A. Berg, Kent Page, Kathleen L. Meert, David L. Wessel, Carol Nicholson, Frank W. Moler, Christopher J. L. Newth |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care Attitude of Health Personnel Psychological intervention MEDLINE Peak inspiratory pressure Computer-assisted web interviewing Acute respiratory distress Intensive Care Units Pediatric Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Clinical Protocols Physicians Surveys and Questionnaires medicine Humans Child Intensive care medicine Protocol (science) Respiratory Distress Syndrome business.industry 030208 emergency & critical care medicine Middle Aged Decision Support Systems Clinical Respiration Artificial 030228 respiratory system Scale (social sciences) Practice Guidelines as Topic Pediatrics Perinatology and Child Health Emergency medicine Female Pediatric critical care business |
| Zdroj: | Pediatric Critical Care Medicine. 18:1027-1034 |
| ISSN: | 1529-7535 |
| Popis: | Objectives To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Design Survey/questionnaire. Setting The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Participants One hundred twenty-two physicians (attendings and fellows). Interventions None. Measurements and main results We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for FIO2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Conclusions Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes. |
| Databáze: | OpenAIRE |
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