J Clin Monit Comput - Elucidating the fuzziness in physician decision making in ARDS.

Tópicos

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Resumo

The current standard of care for patients suffering from acute respiratory distress syndrome (ARDS) is ventilation with a tidal volume of 6 ml/kg predicted body weight (PBW), but variability remains in the tidal volumes that are actually used. This study aims to identify patient scenarios for which there is discordance between physicians in choice of tidal volume and positive end-expiratory pressure (PEEP) in ARDS patients. We developed an algorithm based on fuzzy logic for encapsulating the expertise of individual physicians regarding their use of tidal volume and PEEP in ARDS patients. The algorithm uses three input measurements: (1) peak airway pressure (PAP), (2) PEEP, and (3) arterial oxygen saturation (SaO2). It then generates two output parameters: (1) the deviation of tidal volume from 6 ml/kg PBW, and (2) the change in PEEP from its current value. We captured 6 realizations of intensivist expertise in this algorithm and assessed their degree of concordance using a Monte Carlo simulation. Variability in the tidal volume recommended by the algorithm increased for PAP > 30 cmH2O and PEEP > 5 cmH2O. Tidal volume variability decreased for SaO2 > 90 %. Variability in the recommended change in PEEP increased for PEEP > 5 cmH2O and for SaO2 near 90 %. Intensivists vary in their management of ARDS patients when peak airway pressures and PEEP are high, suggesting that the current goal of 6 ml/kg PBW may need to be revisited under these conditions.

Resumo Limpo

current standard care patient suffer acut respiratori distress syndrom ard ventil tidal volum mlkg predict bodi weight pbw variabl remain tidal volum actual use studi aim identifi patient scenario discord physician choic tidal volum posit endexpiratori pressur peep ard patient develop algorithm base fuzzi logic encapsul expertis individu physician regard use tidal volum peep ard patient algorithm use three input measur peak airway pressur pap peep arteri oxygen satur sao generat two output paramet deviat tidal volum mlkg pbw chang peep current valu captur realiz intensivist expertis algorithm assess degre concord use mont carlo simul variabl tidal volum recommend algorithm increas pap cmho peep cmho tidal volum variabl decreas sao variabl recommend chang peep increas peep cmho sao near intensivist vari manag ard patient peak airway pressur peep high suggest current goal mlkg pbw may need revisit condit

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