Mechanical ventilation and clinical practice heterogeneity in intensive care units: a multicenter case-vignette study.

Détails

Ressource 1Télécharger: BIB_61E80066A10B.P001.pdf (879.81 [Ko])
Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_61E80066A10B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Mechanical ventilation and clinical practice heterogeneity in intensive care units: a multicenter case-vignette study.
Périodique
Annals of Intensive Care
Auteur(s)
Nguyen Y.L., Perrodeau E., Guidet B., Trinquart L., Richard J.C., Mercat A., Jolliet P., Ravaud P., Brochard L., REVA network
Contributeur(s)
REVA network
ISSN
2110-5820 (Electronic)
ISSN-L
2110-5820
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
4
Numéro
1
Pages
2
Langue
anglais
Notes
Publication types: Journal Article Publication Status: epublish
Résumé
BACKGROUND: Observational studies on mechanical ventilation (MV) show practice variations across ICUs. We sought to determine, with a case-vignette study, the heterogeneity of processes of care in ICUs focusing on mechanical ventilation procedures, and whether organizational patterns or physician characteristics influence practice variations.
METHODS: We conducted a cross-sectional multicenter study using the case-vignette methodology. Descriptive analyses were calculated for each organizational pattern and respondent characteristics. An Index of Qualitative Variation (IQV, from 0, no heterogeneity, to a maximum of 1) was calculated.
RESULTS: Forty ICUs from France (N = 33) and Switzerland (N = 7) participated; 396 physicians answered our case-vignettes. There was major heterogeneity of management processes related to MV within and across centers (mean IQV per center 0.51, SD 0.09). We observed the lowest variability (mean IQV per question < 0.4) for questions related to intubation procedure, ventilation of acute respiratory distress syndrome and the use of the semirecumbent position. We observed a high variability (mean IQV per question > 0.6) for questions related to management of endotracheal tube or suctioning, management of sedation and analgesia, and respect of autonomy. Heterogeneity was independent of respondent characteristics and of the presence of written procedures. There was a correlation between the processes associated with the highest variability (mean IQV per question > 0.6) and the annual volume of ICU admission (r = 0.32 (0.01 to 0.58)) and MV (r = 0.38 (0.07 to 0.63)). Within ICUs there was a large heterogeneity regarding knowledge of a local written procedure.
CONCLUSIONS: Large clinical practice variations were found among ICUs. High volume centers were more likely to have heterogeneous practices. The presence of a local written procedure or respondent characteristics did not influence practice variation.
Pubmed
Web of science
Open Access
Oui
Création de la notice
10/12/2014 15:02
Dernière modification de la notice
20/08/2019 15:18
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