The first quantified listing of the information at the bedside of a ventilator patient in the adult ICU.
Using the modified Delphi technique,1 three RT students in their last semester were asked to participate in the development of a list of all information potentially available to the RT at the bedside of an adult ventilator patient. Their lists were to be based on personal observation and experience in at least two different adult ICUs, using common volume ventilators.
After the first lists were compiled, the group and a faculty facilitator pared down the items. This procedure was repeated twice. The final list was put into the current format. It consists of 98 separate items of directly observable information distributed among the following five categories: ventilator function, patient/ventilator interface, patient, external monitoring, and immediate patient environment. A sixth category, communicated information (medical record and other caregivers), potentially contained at least 10 separate information items.
The results indicate that RTs must assimilate a substantial amount of information every time they approach a patient receiving ventilatory support. How many of the 98 items the individual RT actually looks at has yet to be studied, and probably varies from patient to patient and from situation to situation. In addition, this study only looked at adult ICU patients. The list would probably be shorter for patients in postacute care, and longer for neonatal/pediatric patients and patients receiving nonconventional forms of ventilatory support (jet ventilation).
William A. French, MA, RRT, is clinical director of the respiratory therapy program at Lakeland Community College, Kirtland, Ohio. The author acknowledges the assistance of Christina Egan, CRT; John Gallagher, RRT; and Dawnell Zukoski, CRT.
Ventilator Function
1. Type of ventilation/ventilator
2. Mode of ventilation
3. Date
4. Time
5. Ventilator set rate
6. Set tidal volume
7. Flow
8. Flow pattern
9. FIO2
10. Positive end-expiratory pressure (PEEP)
11. Pressure support
12. Flow by
13. Set pressure
14. Sensitivity
15. Alarm settings
16. Status alarms
17. Sigh frequency
18. Sigh volume
19. Type of humidification
20. Appearance of ventilator circuit
21. Type of suction device
22. Source gas
23. Previous settings/changes
Patient/Ventilator Interface
1. Spontaneous rate
2. Spontaneous tidal volume
3. Spontaneous minute volume
4. Static compliance
5. Airway resistance
6. AutoPEEP
7. Peak airway pressure
8. Plateau pressure
9. Mean airway pressure
10. Graphics
11. I:E ratio/inspiratory time
12. Frequency to tidal volume ratio
13. Cuff pressure
14. Arterial blood gas results
Patient
1. Age
2. Gender
3. Level of consciousness
4. Level of anxiety
5. Ability to communicate
6. Physical appearance
7. Skin temperature
8. Skin turgor/presence of peripheral edema
9. Type of airway
10. Condition of airway/stoma site
11. Presence of oral secretions
12. Skin color
13. Chest expansion
14. Breath sounds
15. Body position
16. Pulse
17. Presence of intravenous lines
18. Presence of chest tubes
19. Presence of arterial line
20. Presence of feeding/nasogastric tube
21. Amount and nature of urine
22. Patient hygiene
23. Presence of any physical abnormalities
24. Presence of restraints
Monitor
1. Heart rate
2. Heart rhythm
3. Arterial blood pressure
4. SpO2
5. Arterial wave pattern
6. Central venous pressure
7. Pulmonary artery pressure
8. Wedge pressure
9. Cardiac output
10. PetcO2
Immediate Patient Environment
1. Type of bed
2. Type of unit (medical ICU or surgical ICU)
3. Type of suction apparatus
4. Contents of suction canister
5. Presence of IV pumps
6. Types of medications hanging
7. Presence of feeding pump
8. Bed position
9. Type and content of chest tube bottles
10. Presence of resuscitation bag and mask
11. Presence of spare endotracheal tubes and/or tracheostomy tubes
12. Isolation gear
13. Contents of waste containers
14. Television on or off
15. Room temperature
16. Any posted precautions about the patient
17. Isolation sign
18. Presence of any extra equipment
19. Evidence of food and/or water
20. Type of room lighting in use
21. Chest radiograph posted nearby
22. Presence of other caregivers
23. Presence and demeanor of visitors
24. Patient personal items
25. Type and arrangement of peripheral furniture
26. Types of other therapeutic equipment
27. Ambulation equipmentAdditional Information (not directly observable)
1. Physician orders
2. Current laboratory results
3. Admission date
4. Diagnosis
5. Medication list
6. DNR status
7. Care plan
8. Recent vital signs and trends
9. Prognosis
10. Patient history |
References
1. Tobin MJ. Respiratory monitoring in the intensive care unit. Am Rev Respir Dis. 1988;138:1625-1642.
2. Kelly WJ, OÕBrien J, Baartz S, Zelcer J. Clinical information systems and quality of care in the intensive care unit. Medinfo. 1995;8(Pt 2):1042-1046.
3. Hess D, Kacmarek R, Stoller J. Perspectives on monitoring in respiratory care. In: Kacmarek R, Hess D, and Stoller J, eds. Monitoring in Respiratory Care. St Louis: Mosby/Year Book; 1993.
4. Wicklein RC. Identifying critical issues and problems in technology education using a modified Delphi technique. Journal of Technology Education. 1993;5(1).
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