title: Nurses' detection of ineffective inspiratory efforts during mechanical ventilation.
abstract: BACKGROUND PATIENT: ventilator dyssynchrony is common and may influence patients' outcomes. Detection of such dyssynchronies relies on careful observation of patients and airway flow and pressure measurements. Given the shortage of specialists, critical care nurses could be trained to identify dyssynchronies.
  
  
  OBJECTIVE
  To evaluate the accuracy of specifically trained critical care nurses in detecting ineffective inspiratory efforts during expiration.
  
  
  METHODS
  We compared 2 nurses' evaluations of measurements from 1007 breaths in 8 patients with the evaluations of experienced critical care physicians. Sensitivity, specificity, positive predictive value, negative predictive value, and the Cohen κ for interobserver agreement were calculated.
  
  
  RESULTS
  For the first nurse, sensitivity was 92.5%, specificity was 98.3%, positive predictive value was 95.4%, negative predictive value was 97.1%, and κ was 0.92 (95% CI, 0.89-0.94). For the second nurse, sensitivity was 98.5%, specificity was 84.7%, positive predictive value was 70.7%, negative predictive value was 99.3%, and κ was 0.74 (95% CI, 0.70-0.78).
  
  
  CONCLUSIONS
  Specifically trained nurses can reliably detect ineffective inspiratory efforts during expiration.
authors: Hospital de Sabadell, Corporació Sanitària Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain. EChacon@tauli.cat
authors: Encarna
authors: E
authors: Chacón
authors: Anna
authors: A
authors: Estruga
authors: Gastón
authors: G
authors: Murias
authors: Bernat
authors: B
authors: Sales
authors: Jaume
authors: J
authors: Montanya
authors: Umberto
authors: U
authors: Lucangelo
authors: Oscar
authors: O
authors: Garcia-Esquirol
authors: Ana
authors: A
authors: Villagrá
authors: Jesus
authors: J
authors: Villar
authors: Robert M
authors: RM
authors: Kacmarek
authors: María Jose
authors: MJ
authors: Burgueño
authors: Lluis
authors: L
authors: Blanch
authors: Rosa
authors: R
authors: Jam
mesh_terms: D003194:Computer-Assisted Instruction / Q000379:methods; D006801:Humans; D001239:Inhalation / Q000502:physiology; D007362:Intensive Care Units; D008505:Medical Staff, Hospital / Q000600:supply & distribution; D009733:Nursing Diagnosis / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000193:education; D019370:Observation; D015397:Program Evaluation; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000451:nursing*; D012135:Respiratory Sounds / Q000175:diagnosis; D012680:Sensitivity and Specificity; D000078329:Workforce