Determining the Basis for a Taxonomy of Mechanical Ventilation

Abstract

Over the last 30 years, there has been a rapid evolution of the technologic capabilities of mechanical ventilators. These capabilities have motivated the creation of dozens of names to describe modes of ventilation. This proliferation of names has become counterproductive, making education of end users very difficult and potentially compromising the quality of patient care. Therefore, this study was designed as a survey of stakeholders in a taxonomy of mechanical ventilation. The specific hypotheses were that 1) There is sufficient (>50 %) concordance on 10 basic constructs related to mechanical ventilation modes to form the basis for a standardized taxonomy; 2) Concordance with the basic constructs will vary among stakeholders according to their professional training and professional activity; 3) The degree of concordance will vary among the set of constructs. Methods: The study was designed as an Internet based survey. The survey population was composed of physicians, respiratory therapists, nurses, engineers and others involved with mechanical ventilation. Invitations to participate were emailed to 2,994 people internationally. Hypotheses were tested with Chi Square, with P < 0.05 considered significant. Results: Of the emails sent, 185 were returned as undeliverable. Survey responses were received from 432 people (15.4 % response rate). Respondents were 55.3 % respiratory therapists, 35.4 % physicians, 2.5% nurses, 1.4% engineers, and 5.3 % other professionals. Overall, there was an 82.4 % concordance with the 10 constructs, significantly greater than the postulated 50 % (P < 0.001). When the data were grouped by profession, respiratory therapists showed the highest degree of concordance (84.3%) and other profession showed the lowest (79.1%), P = 0.006. When the data were grouped by professional activity, there was no significant difference (P = 0.072) in concordance. Concordance differed significantly among the survey questions (P < 0.001) indicating either confusion about question wording or disagreement