Establishing And Clinical Empirical Study On The Effectiveness Assessment Of Adult Invasive Mechanical Ventilation System

Objective:1. To establish effectiveness assessment system of adult invasive mechanical ventila- tion system and develop the clinical protocol.2. By clinical empirical study , this thesis is to describe the current situation of clinical mechanical ventilation care effectiveness and explore its influential factors so as to provide practice reference for clinical medical staff.Methods:This research included two parts.The first part is about establishing the effectiveness assessment system of adult invasive mechanical ventilation system. Based on ADC effectiveness assessment theory proposed by U.S. Weapon System Efficiency Industry Advisory Committee, the basic framework and evaluation indicators of adult invasive mechanical ventilation system was developed initially from three dimensions including availability (A), Dependability (D), Capacity (C), Content validity was estimated by use of an expert panel. Then, the Effectiveness Assessment Protocol for Adult Invasive Mechanical Ventilation System was developed. The form of adult invasive mechanical ventilation system effectiveness assessment was tested its reliability and revised by pre-survey of 30 patients. A convenience sample of 200 patients on mechanical ventilation was assessed according to the protocol. Construct validity was determined by exploratory factor analysis and correlation analysis. Internal consistency, test-retest reliability and inter-rater reliability were calculated through Cronbach's alpha, Kappa and intra-class correlation coefficient respectively.The second part is about clinical empirical study. 200 patients were facilitated selected from 10 intensive care unit of 8 hospitals in Fujian Province and received on-site assessment. The descriptive statistics, t test, rank sum test and Spearman correlation analysis were adopted to describe status and analyze the difference and correlation in gender, age, disease type, reasons for mechanical ventilation, the basis of lung disease, disease severity APACHEⅡscore, ventilator type, type of artificial airway, mechanical ventilation time and outcome.Results1. The effectiveness assessment system of adult invasive mechanical ventilation system included 3 dimensions, 12 indicators and 54 indexes, which have their weight distribution.2. Evaluation for assessment form:①Content validity: the assessment form was developed based on the ADC theoretical framework, literature review, Delphi expert consultation and pre-test, its content validity index(CVI) was 0.87.②Construct validity: the result of factor analysis showed that three dimensions extracted four factors respectively , which cumulatively explained 77.691%, 75.418% and 79.155% of the variance. The internal relations between item and its attributive part ware 0.480 ~ 0.960, 0.229 ~ 0.849 and 0.689 ~ 0.994, all showed statistically significant correlation (P<0.01).③Reliability: the Cronbach'sαCoefficient of internal consistency reliability for overall assessment form was 0.948, the three dimensions were 0.755,0.925 and 0.909. The Kappa value for test-retest reliability was ranged from 0.857 to 0.976, Intra-class correlation coefficient was ranged from0.802 to 0.935.3. The effectiveness of 200 patients with mechanical ventilation system scored 9.84~15.40, an average of 13.02, median 13.28 (11.73-14.33). Compared with 0 ~ 16 theoretical score range, it is above the middle level.4. The results of factor analysis: the effectiveness score in different gender and type of ventilator were no statistically difference (P>0.05). Patients aged≥75 years were scored lower than 45-54, 55-64 and 65-74 years old. Ascending order of the score in different types of diseases was respiratory system, other diseases (chronic renal failure, shock, MODS, etc.) ,nervous system, cardiovascular system and digestive system. The patients with lung disease were scored lower than those with non-lung disease. The mechanical ventilation patients due to postoperative respiratory support had higher scores than those due to acute respiratory failure and acute exacerbation of chronic respiratory failure. Higher effectiveness scores were got by the orotracheal intubation patients than nasotracheal intubation and tracheostomy patients. The patients with successful ventilator -weaning were scored higher than those died during mechanical ventilation. All above showed statistically significant differences (P <0.01).5. Deviation of some care performance indicators influence effectiveness.①Cuff pressure:There were 600 cases were monitored, of which 162 cases(27.0%) were in the normal range, 99 cases(16.5%) were below 25cmH2O, 339 cases(56.5%) were above 30cmH2O, total 438 cases did not meet the standards, accounting for 73.0%.②Gas temperature close to patients: the gas temperature of heated humidifier(median 35?C) and artificial noses (median 32?C)were lower than the standard temperature (37?C), the way of artificial noses is lower than that of heated humidifier.③The compliance of 30-45? bed head elevation care: 552 cases were surveyed, the compliance is 83.2%, 16.8% did not attain the acquirement.Conclusions:1. The adult invasive mechanical ventilation system effectiveness assessment form had comprehensive content, reasonable structure, internal consistency and correlation with the theme, and could fully reflects the full nursing quality control of mechanical ventilation. It is a scientific, practical, feasible clinical evaluation model.2. The empirical research results not only help nurses effectively identify key indicators, regulate nursing behavior and improve efficiency, but also provide judgements of quality evaluation and control for nursing managers.