Titration and characteristics of pressure-support ventilation use in Argentina: an online cross-sectional survey study

ABSTRACT Objective: To identify common practices related to the use and titration of pressure-support ventilation (PC-CSV - pressure control-continuous spontaneous ventilation) in patients under mechanical ventilation and to analyze diagnostic criteria for over-assistance and under-assistance. The secondary objective was to compare the responses provided by physician, physiotherapists and nurses related to diagnostic criteria for over-assistance and under-assistance. Methods: An online survey was conducted using the Survey Monkey tool. Physicians, nurses and physiotherapists from Argentina with access to PC-CSV in their usual clinical practice were included. Results: A total of 509 surveys were collected from October to December 2018. Of these, 74.1% were completed by physiotherapists. A total of 77.6% reported using PC-CSV to initiate the partial ventilatory support phase, and 43.8% of respondents select inspiratory pressure support level based on tidal volume. The main objective for selecting positive end-expiratory pressure (PEEP) level was to decrease the work of breathing. High tidal volume was the primary variable for detecting over-assistance, while the use of accessory respiratory muscles was the most commonly chosen for under-assistance. Discrepancies were observed between physicians and physiotherapists in relation to the diagnostic criteria for over-assistance. Conclusion: The most commonly used mode to initiate the partial ventilatory support phase was PC-CSV. The most frequently selected variable to guide the titration of inspiratory pressure support level was tidal volume, and the main objective of PEEP was to decrease the work of breathing. Over-assistance was detected primarily by high tidal volume, while under-assistance by accessory respiratory muscles activation. Discrepancies were observed among professions in relation to the diagnostic criteria for over-assistance, but not for under-assistance.

摘要
目的：识别机械通气患者中压力支持通气（pressure-support ventilation）及压力控制-持续自主通气（pressure control-continuous spontaneous ventilation，PC-CSV）的使用与滴定常见临床实践，并分析通气过度与通气不足的诊断标准。次要研究目的为比较医师、物理治疗师与护士针对通气过度、通气不足诊断标准的应答差异。
方法：本研究采用Survey Monkey工具开展线上问卷调查，纳入阿根廷地区日常临床工作中可使用PC-CSV的医师、护士及物理治疗师作为研究对象。
结果：2018年10月至12月共回收有效问卷509份，其中74.1%的问卷由物理治疗师完成。77.6%的受访者表示使用PC-CSV启动部分通气支持阶段，43.8%的受访者根据潮气量选择吸气压力支持水平。临床医师选择呼气末正压（positive end-expiratory pressure，PEEP）水平的主要目的为降低呼吸做功。检测通气过度的首要变量为高潮气量，而评估通气不足最常选用的指标为辅助呼吸肌激活。医师与物理治疗师在通气过度的诊断标准上存在分歧。
结论：临床中启动部分通气支持阶段最常用的通气模式为PC-CSV。指导吸气压力支持水平滴定的最常用变量为潮气量，设置PEEP的主要目的为降低呼吸做功。通气过度主要通过高潮气量识别，通气不足则通过辅助呼吸肌激活进行判断。不同职业群体在通气过度的诊断标准上存在差异，但通气不足的诊断标准未出现显著分歧。