title: Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study.
abstract: BACKGROUND
  Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine.
  
  
  METHODS
  We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations.
  
  
  RESULTS
  Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and FIO2 perfectly correlated (r = 1, all P < .001) as did the presence of a CO2 monitor and need for increased ventilatory support (kappa = 1). The Pearson correlation coefficient for VT, minute ventilation, mean airway pressure, and oxygen saturation ranged from 0.84 to 0.97 (all P < .001). kappa = 0.41 (95% CI 0.02-0.80) for patient-triggered breaths, and kappa = 0.57 (95% CI 0.19-0.94) for breathing frequency higher than set frequency. kappa = -0.25 (95% CI -0.46 to -0.04) for need for suctioning.
  
  
  CONCLUSIONS
  Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patient-generated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope.
authors.affiliation: Division of Inpatient and Critical Care Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Bell
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics.
authors.forename: Phoebe H
authors.initials: PH
authors.lastname: Yager
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Clark
authors.affiliation: Division of Neonatology and Newborn Medicine, Department of Pediatrics.
authors.forename: Serguei
authors.initials: S
authors.lastname: Roumiantsev
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Venancio
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Chipman
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics nnoviski@partners.org.
authors.forename: Natan N
authors.initials: NN
authors.lastname: Noviski
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D008297:Male; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D015203:Reproducibility of Results; D012119:Respiration; D012121:Respiration, Artificial; D012138:Respiratory Therapy; D018709:Statistics, Nonparametric; D017216:Telemedicine / Q000379:methods*; D012122:Ventilators, Mechanical
keywords: intensive care; pediatrics; physical examination; reliability of results; telemedicine