Nurses' detection of ineffective inspiratory efforts during mechanical ventilation

Background Patient-ventilator dyssynchrony is common and may influence patients\u2019 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\u2019 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 \u3ba 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 \u3ba was 0.92 (95% CI, 0.89\u20130.94). 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 \u3ba was 0.74 (95% CI, 0.70\u20130.78). Conclusion Specifically trained nurses can reliably detect ineffective inspiratory efforts during expiration