Document Detail


Elucidating the fuzziness in physician decision making in ARDS.
MedLine Citation:
PMID:  23463162     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The current standard of care for patients suffering from acute respiratory distress syndrome (ARDS) is ventilation with a tidal volume of 6 ml/kg predicted body weight (PBW), but variability remains in the tidal volumes that are actually used. This study aims to identify patient scenarios for which there is discordance between physicians in choice of tidal volume and positive end-expiratory pressure (PEEP) in ARDS patients. We developed an algorithm based on fuzzy logic for encapsulating the expertise of individual physicians regarding their use of tidal volume and PEEP in ARDS patients. The algorithm uses three input measurements: (1) peak airway pressure (PAP), (2) PEEP, and (3) arterial oxygen saturation (SaO₂). It then generates two output parameters: (1) the deviation of tidal volume from 6 ml/kg PBW, and (2) the change in PEEP from its current value. We captured 6 realizations of intensivist expertise in this algorithm and assessed their degree of concordance using a Monte Carlo simulation. Variability in the tidal volume recommended by the algorithm increased for PAP > 30 cmH₂O and PEEP > 5 cmH₂O. Tidal volume variability decreased for SaO₂ > 90 %. Variability in the recommended change in PEEP increased for PEEP > 5 cmH₂O and for SaO₂ near 90 %. Intensivists vary in their management of ARDS patients when peak airway pressures and PEEP are high, suggesting that the current goal of 6 ml/kg PBW may need to be revisited under these conditions.
Authors:
David B Bernstein; Binh Nguyen; Gilman B Allen; Jason H T Bates
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-03-06
Journal Detail:
Title:  Journal of clinical monitoring and computing     Volume:  27     ISSN:  1573-2614     ISO Abbreviation:  J Clin Monit Comput     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-15     Completed Date:  2014-01-06     Revised Date:  2014-08-04    
Medline Journal Info:
Nlm Unique ID:  9806357     Medline TA:  J Clin Monit Comput     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  357-63     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Decision Making*
Fuzzy Logic*
Humans
Monte Carlo Method
Physicians
Positive-Pressure Respiration
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Therapy, Computer-Assisted / statistics & numerical data*
Tidal Volume
Grant Support
ID/Acronym/Agency:
P30 GM103532/GM/NIGMS NIH HHS; P30 GM103532/GM/NIGMS NIH HHS; T32 GM008764/GM/NIGMS NIH HHS
Comments/Corrections

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