J Clin Monit Comput - Oxygenation advisor recommends appropriate positive end expiratory pressure and FIO2 settings: retrospective validation study.


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A decision support, rule-based oxygenation advisor that provides guidance for setting positive end expiratory pressure (PEEP) and fractional inhaled oxygen concentration (FIO2) for patients with respiratory failure is described. The target oxygenation goal is to achieve and maintain pulse oximeter oxygen saturation (SpO2) = 88 and = 95%, as posited by the Acute Respiratory Distress Syndrome Network, by recommending appropriate combinations of PEEP and FIO2. For patient safety, the oxygenation advisor monitors mean arterial blood pressure (MAP) to ensure it is = 65 mmHg for hemodynamic stability and inspiratory plateau pressure (Pplt) so it is = 30 cm H2O for lung protection. The purpose of this validation study was to compare attending physicians' recommendations to those recommendations of the oxygenation advisor for setting PEEP and FIO2. Adults with respiratory failure (n = 117) receiving ventilatory support were studied. PEEP, FIO2, SpO2, MAP, and Pplt are input variables into the advisor. Recommendations to increase, maintain, or decrease PEEP and FIO2 are the oxygenation advisor's output variables. Physicians' recommendations for setting PEEP and FIO2 were recorded; the oxygenation advisor's recommendations were also recorded for comparison. At all times, ventilator settings were based on recommendations from attending physicians. PEEP ranged from 2 to 22 cm H2O and FIO2 ranged from 0.30 to 0.65. A total of 326 recommendations by the oxygenation advisor and attending physicians were made to increase, maintain, or decrease PEEP and FIO2. There was a very significant relationship (p < 0.0001) between recommendations of the oxygenation advisor and attending physicians for setting PEEP and FIO2. The agreement rate for recommendations by the oxygenation advisor and attending physicians was 92%. The K statistic, a test of the strength of agreement of recommendations between the oxygenation advisor and attending physicians, was 0.82 (p < 0.0001), indicating "almost perfect agreement". Relationships for recommendations made by the oxygenation advisor and attending physicians for setting PEEP and FIO2 were excellent, PEEP: r = 0.98 (p < 0.01), r(2) = 0.96; FIO2: r = 0.91 (p < 0.01), r(2) = 0.83, bias and precision values were negligible. A novel oxygenation advisor provided continuous and automatic recommendations for setting PEEP and FIO2 that were shown to be as good as the clinical judgment of experienced attending physicians. For all patients, the target oxygenation goal was achieved. Concerning patient safety, the oxygenation advisor detected those occasions when MAP and Pplt were in potentially unsafe ranges.

Resumo Limpo

decis support rulebas oxygen advisor provid guidanc set posit end expiratori pressur peep fraction inhal oxygen concentr fio patient respiratori failur describ target oxygen goal achiev maintain puls oximet oxygen satur spo posit acut respiratori distress syndrom network recommend appropri combin peep fio patient safeti oxygen advisor monitor mean arteri blood pressur map ensur mmhg hemodynam stabil inspiratori plateau pressur pplt cm ho lung protect purpos valid studi compar attend physician recommend recommend oxygen advisor set peep fio adult respiratori failur n receiv ventilatori support studi peep fio spo map pplt input variabl advisor recommend increas maintain decreas peep fio oxygen advisor output variabl physician recommend set peep fio record oxygen advisor recommend also record comparison time ventil set base recommend attend physician peep rang cm ho fio rang total recommend oxygen advisor attend physician made increas maintain decreas peep fio signific relationship p recommend oxygen advisor attend physician set peep fio agreement rate recommend oxygen advisor attend physician k statist test strength agreement recommend oxygen advisor attend physician p indic almost perfect agreement relationship recommend made oxygen advisor attend physician set peep fio excel peep r p r fio r p r bias precis valu neglig novel oxygen advisor provid continu automat recommend set peep fio shown good clinic judgment experienc attend physician patient target oxygen goal achiev concern patient safeti oxygen advisor detect occas map pplt potenti unsaf rang

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