The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

DETERMINING THE BASIS FOR A TAXONOMY OF MECHANICAL VENTILATION

Robert L. Chatburn; Respiratory Institute, Cleveland Clinic, Cleveland, OH

The respiratory care community has not adopted a standardized classification system for modes of ventilation. As a result, the risk for confusion affects many aspects of the profession, including patient care, education, and marketing. To date, no official consensus has been attempted among either manufacturers or professional organizations related to a lexicon of mechanical ventilation, despite book chapters and published papers on the subject. The purpose of this pilot study was to determine if there may be a basis for such a consensus. The specific hypothesis tested was that among thought leaders in respiratory care, there is sufficient agreement on a few basic concepts related to modes of ventilation to form the basis for a standardized taxonomy. METHODS: I created an online survey based on 10 constructs: (1) definition of a breath (2) definition of “assisted” breath (3) definition of pressure control, PC, and volume control, VC (4) definitions of trigger and cycle (5) machine vs patient triggering/cycling (6) definition of “spontaneous” vs “mandatory” breaths (7) breath sequences: continuous mandatory ventilation, CMV, intermittent mandatory ventilation, IMV, continuous spontaneous ventilation, CSV (8) “ventilatory patterns” as control variable- breath sequence combinations like VC-CMV or PC-IMV (9) adding detail to ventilatory patterns using targeting schemes (10) using the above constructs to define “mode”. Respondents used a 5 point ordinal scale ranging from strongly agree to strongly disagree. A pilot sample of volunteer respondents was obtained from respiratory therapist members of the AARC Educational Specialty Section. The study was approved by the institutional review board of Youngstown State University. A significant agreement value was arbitrarily set at > 50%. RESULTS: The survey was returned by 8 respondents. Percent agreement with the 10 constructs is shown in the Table. Overall agreement was 84%. The lowest agreement centered on the concept of “assist”. CONCLUSIONS: These pilot data suggest that enough potential consensus exists among educators to justify a larger survey including stakeholders working in patient care and manufacturing. Lack of consensus about the word “assist” is not surprising given the wide range of interpretations for this term in the literature and common usage. The results of a larger study (in progress) will inform future efforts to establish an international standard. Sponsored Research - None

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