Correlation Analysis between Compliance of Clinical Respiratory Bundle and Duration of Mechanical Ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XingXuezhong , WangHaijun , QuShining , HuangChulin , ZhangHao , WangHao , YangQuanhui ,  GaoYong

Intensive Care Unit, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, China;

Corresponding author：

GaoYong, Email: 2354839907@qq.com

Keywords：

Respiratory insufficiency; Bundle strategy; Compliance; Duration of mechanical ventilation

DOI：

10.7507/1671-6205.2016090

Video：

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Objective To investigate the correlation between compliance of clinical respiratory bundle and duration of mechanical ventilation. Methods The data of patients who admitted to intensive care unit (ICU)of Cancer Hospital Chinese Academy of Medical Sciences between June 2013 and December 2014 were retrospectively reviewed and analyzed.The patients with respiratory insufficiency who ventilated more than 48 hours were included into the study. Results Fifty-five patients were enrolled into the final analysis.There were 43 males and 12 females with a mean age of 63.47±12.49 years.The mean sequential organ failure assessment (SOFA)score was 2.8±2.2,and the mean simplified acute physiology score 3 (SAPS3)was 51±14 on ICU admission.The mean duration of mechanical ventilation of all 55 patients was 7.3±5.5 days.The compliance of low tidal volume strategy was 23.6%(13/55).No significant difference was found on duration of mechanical ventilation between the patients who was compliant with low tidal volume strategy and the patients who was not compliant (7.31±7.02 days vs. 7.31±5.07 day,P=0.444).A negative correlation between compliance of protocolized sedation strategy and duration of mechanical ventilation was found by Bivariate spearman correlation analysis (r²=0.312,P<0.001).A negative correlation between compliance of spontaneous awakening trial strategy and duration of mechanical ventilation (r²=0.337,P<0.001)and a negative correlation between compliance of spontaneous breathing trial strategy and duration of mechanical ventilation (r²=0.280,P<0.001)were also found by Bivariate spearman correlation analysis.Multiple linear regression analysis showed that only spontaneous awakening trial strategy was correlated with duration of mechanical ventilation(B=-0.623,P<0.001). Conclusion The more compliance with clinical respiratory bundle,especially with spontaneous awakening trial strategy,the shorter of duration of mechanical ventilation.The effect of low tidal volume strategy on the duration of mechanical ventilation needs further studies.

Citation： XingXuezhong, WangHaijun, QuShining, HuangChulin, ZhangHao, WangHao, YangQuanhui, GaoYong. Correlation Analysis between Compliance of Clinical Respiratory Bundle and Duration of Mechanical Ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 384-388. doi: 10.7507/1671-6205.2016090 Copy

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15.	Vincent JL,Moreno R,Takala J,et al.The SOFA (Sepsis-related Organ Failure Assessment)score to describe organ dysfunction/failure.Intensive Care Med,1996,22:707-710.
16.	The ARDS Definition Task Force.Acute respiratory distress syndrome:the Berlin definition.JAMA,2012,307:2526-2533.
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19.	Metcalf AY,Stoller JK,Fry TD,et al.Patterns and factors associated with respiratory care protocol use.Respir Care,2015,60:636-643.
20.	骆勇, 贾文钗,王征.依从性表格法实施呼吸机相关性肺炎集束化管理的临床疗效.中国呼吸与危重监护杂志,2012,11:358-361.
21.	Xing XZ,Gao Y,Wang HJ,et al.Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency.World J Emerg Med,2015,6:147-152.
22.	岳茂奎, 刘芙蓉,赵蕾,等.集束化治疗中/重度急性呼吸窘迫综合征的多中心临床研究.中国危重病急救医学,2015,27:601-605.
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1. Esteban A,Anzueto A,Frutos F,et al.Characteristics and outcomes in adult patients receiving mechanical ventilation:a 28-day international study.JAMA,2002,287:345-355.
2. Du B,An Y,Kang Y,et al.Characteristics of critically ill patients in ICUs in mainland China.Crit Care Med,2013,41:84-92.
3. Peñuelas O,Frutos-Vivar F,Fernández C,et al.Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation.Am J Respir Crit Care Med,2011,184:430-437.
4. The Acute Respiratory Distress Syndrome Network.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med,2000,342:1301-1308.
5. Arias-Rivera S,Sánchez-Sánchez Mdel M,Santos-Díaz R,et al.Effect of a nursing-implemented sedation protocol on weaning outcome.Crit Care Med,2008,36:2054-2060.
6. Girard TD,Kress JP,Fuchs BD,et al.Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial):a randomised controlled trial.Lancet,2008,371:126-134.
7. 宋海晶, 刘京涛,高素芹,等.呼吸机集束化治疗依从性及有效性的临床研究.中国危重病急救医学,2009,21:660-663.
8. Kalb T,Raikhelkar J,Meyer S,et al.A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy,decreased ventilator duration,and decreased intensive care unit mortality.J Crit Care,2014,29:691.e7-e14.
9. Sneyers B,Laterre PF,Perreault MM,et al.Current practices and barriers impairing physicians' and nurses' adherence to analgo-sedation recommendations in the intensive care unit--a national survey.Crit Care,2014,18:655.
10. Kahn JM,Gunn SR,Lorenz HL,et al.Impact of nurse-led remote screening and prompting for evidence-based practices in the ICU.Crit Care Med,2014,42:896-904.
11. Bone RC,Balk RA,Cerra FB,et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.The ACCP/SCCM Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine.Chest,1992,101:1644-1655.
12. 邢学忠, 高勇,王海军,等.血管活性药与休克患者的预后.中国急救医学,2012,32(10增刊):5-8.
13. Kellum JA,Lameire N; KDIGO AKI Guideline Work Group.Diagnosis,evaluation,and management of acute kidney injury:a KDIGO summary (Part 1).Crit Care,2013,17:204.
14. Moreno RP,Metnitz PG,Almeida E,et al; SAPS 3 Investigators.SAPS 3--From evaluation of the patient to evaluation of the intensive care unit.Part 2:Development of a prognostic model for hospital mortality at ICU admission.Intensive Care Med,2005,31:1345-1355.
15. Vincent JL,Moreno R,Takala J,et al.The SOFA (Sepsis-related Organ Failure Assessment)score to describe organ dysfunction/failure.Intensive Care Med,1996,22:707-710.
16. The ARDS Definition Task Force.Acute respiratory distress syndrome:the Berlin definition.JAMA,2012,307:2526-2533.
17. McConville JF,Kress JP.Weaning patients from the ventilator.N Engl J Med,2012,367:2233-2239.
18. Haas CF,Loik PS.Ventilator discontinuation protocols. Respir Care,2012,57:1649-1662.
19. Metcalf AY,Stoller JK,Fry TD,et al.Patterns and factors associated with respiratory care protocol use.Respir Care,2015,60:636-643.
20. 骆勇, 贾文钗,王征.依从性表格法实施呼吸机相关性肺炎集束化管理的临床疗效.中国呼吸与危重监护杂志,2012,11:358-361.
21. Xing XZ,Gao Y,Wang HJ,et al.Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency.World J Emerg Med,2015,6:147-152.
22. 岳茂奎, 刘芙蓉,赵蕾,等.集束化治疗中/重度急性呼吸窘迫综合征的多中心临床研究.中国危重病急救医学,2015,27:601-605.
23. Xing XZ,Gao Y,Wang HJ,et al.Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency.World J Emerg Med,2013,4:43-47.

Chinese Journal of Respiratory and Critical Care Medicine

Correlation Analysis between Compliance of Clinical Respiratory Bundle and Duration of Mechanical Ventilation

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