Critical Care Nursing
پرستاری مراقبت ویژه
jccnursing
Medical Sciences
http://jccnursing.com
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admin
2008-336X
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gregorian
2022
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اعتبارسنجی شاخص ترکیبی جدید در جداسازی بیماران مزمن انسدادی ریوی از دستگاه تهویه مکانیکی: یک مطالعه مشاهدهای آیندهنگر
Validation of New Integrative Weaning Index during Weaning from Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Observational Study
تخصصي
Special
پژوهشي
Research
<span style="font-size:12pt"><span style="line-height:87%"><span style="tab-stops:-15.8pt 29.2pt 45.2pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">زمینه و هدف:</span></span></span></b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> مبتلایان به بیماری مزمن انسدادی ریوی، چالش</span></span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">برانگیزترین فرآیند جداسازی از دستگاه تهویه مکانیکی را دارا هستند و میزان مرگ</span></span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">و</span></span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">میر آنان به علت شکست در فرآیند جداسازی تا هفت برابر بیش</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">تر از سایر بیماران است. این پژوهش در جمعیت بیماران مزمن انسدادی ریوی با دو هدف تعیین نقاط برش شاخص ترکیبی جدید و شاخص</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های مرسوم و مقایسه مؤلفههای پیش</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">بینی کننده جداسازی در شاخص</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های ترکیبی جدید و مرسوم انجام شد.</span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:87%"><span style="tab-stops:-15.8pt 29.2pt 45.2pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">روشها:</span></span></span></b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> این مطالعه از نوع مشاهده</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">ای آینده</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">نگر سه</span></span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">سوکور بود که از سال 1392 تا 1393 در جامعه 180 نفری بیماران مزمن انسدادی ریوی بستری در بخش</span></span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">مراقبت</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های ویژه بیمارستان</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های منتخب شهر تهران در دو گروه تعیین نقطه برش شاخصها و گروه تعیین مؤلفههای شاخص</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های پیش</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">بینی کننده جداسازی انجام شد. فرآیند جداسازی از دستگاه تهویه مکانیکی در هر دو گروه یکسان و بر اساس یک پروتکل بود. برای گروه تعیین نقاط برش از تحلیل راک و در گروه دوم از مؤلفههای پیشبینی کننده جداسازی استفاده شد.</span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:87%"><span style="tab-stops:-15.8pt 29.2pt 45.2pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">یافتهها: </span></span></span></b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">شاخص تنفس سطحی</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">Rapid Shallow Breathing Index (RSBI) (927/0) </span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">و</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">NIWI (878/0) </span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">بیشترین مقدار ناحیه زیر منحنی را کسب کردند. بالاترین میزان حساسیت مربوط به </span></span></span><span dir="LTR" style="font-size:11.0pt"><span style="line-height:87%">NIWI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> با مقدار 100 درصد و بالاترین ویژگی مربوط به شاخص </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">RSBI %90</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">، ارزش اِخباری مثبت مربوط به معیار </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">RSBI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> با 5/87 درصد، ارزش اِخباری منفی مربوط به </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">NIWI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> با مقدار 100 درصد و بالاترین دقت تشخیصی نیز با مقدار 67/98 درصد متعلق به </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">RSBI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> به دست آمد. نقطه برش و مؤلفههای مختلف پیشبینی کننده جداسازی در مقایسه بین شاخص</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های مورد مطالعه به ترتیب شاخص</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">های </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">RSBI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">، </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">NIWI</span></span> <span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">، </span></span></span><span dir="LTR" style="font-size:11.0pt"><span style="line-height:87%">P0.1</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> و </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">NIF</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> مطلوب</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">ترین مؤلفهها را داشتند.</span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:87%"><span style="tab-stops:-15.8pt 29.2pt 45.2pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">نتیجهگیری: </span></span></span></b><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">شاخص </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:87%">NIWI</span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:"> با توجه به دارا بودن مؤلفههای پیشبینی کننده مناسب می تواند به عنوان یک شاخص پیشبینی کننده</span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span cambria="" style="font-family:"></span></span></span><span lang="FA" style="font-size:11.0pt"><span style="line-height:87%"><span b="" mitra="" style="font-family:">ی مکمل جهت جداسازی از دستگاه تهویه مکانیکی استفاده شود.</span></span></span></span></span></span></span></span></span>
<span style="font-size:12pt"><span style="line-height:115%"><span style="text-autospace:none"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:115%">Background and aim</span></span></b><span style="font-size:10.0pt"><span style="line-height:115%">: Chronic Obstructive Pulmonary Disease patients are certainly the most challenging ones for weaning from mechanical ventilation. Mortality in these patients compared to others due to failure in the weaning process is more than seven times. The present study was performed on the population of ventilated chronic obstructive pulmonary disease purposes of determining cut-off points of New Integrative Weaning Index (NIWI) and conventional indexes and comparing differences between their predictive components.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:115%"><span style="text-autospace:none"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:115%">Methods</span></span></b><span style="font-size:10.0pt"><span style="line-height:115%">: The observational prospective, triple blinded study was conducted in 2012-2013 on 180 hospitalized COPD patients in critical care units of selected hospitals in Tehran in two groups including cut-off points determining group and determining different predicting weaning factors group. The process of weaning was based on the same and defined protocol. The ROC analysis was used to determine the cut-off points group and the predicting factors were used in the other group.</span></span><span dir="RTL" lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:115%"><span style="text-autospace:none"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:115%">Results</span></span></b><span style="font-size:10.0pt"><span style="line-height:115%">: </span></span><span style="font-size:10.0pt"><span style="line-height:115%">The highest area under the curves was devoted to Rapid Shallow Breathing Index (0.927) and NIWI (0.878). The highest sensitivity was related to NIWI with 100% and the highest specificity was related to RSBI index 90%, the positive predictive value to RSBI Index was 87.5%, the negative predictive value to NIWI with 100% and highest diagnostic accuracy related to RSBI was 98.67%. The cut-off point and the most desirable components predicting weaning were RSBI, NIWI, P0.1, and NIF indexes, respectively.</span></span><span dir="RTL" lang="FA" style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:"B Mitra""></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:115%"><span style="text-autospace:none"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:115%">Conclusion</span></span></b><span style="font-size:10.0pt"><span style="line-height:115%">: </span></span><span style="font-size:10.0pt"><span style="line-height:115%">The NIWI index can be used as a complementary predictive indicator for weaning from mechanical ventilation in chronic obstructive pulmonary disease patients due to its good predictive components.</span></span></span></span></span></span></span>
اعتبارسنجی, جداسازی, تهویه مکانیکی, بیماری مزمن انسدادی ریوی
COPD, Mechanical Ventilation, Validity, Weaning
4
13
http://jccnursing.com/browse.php?a_code=A-10-89-1&slc_lang=fa&sid=1
Reza
Goharani
رضا
گوهرانی
r.goharani@sbmu.ac.ir
10031947532846006256
10031947532846006256
No
Department of Anesthesiology and Critical Care, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
گروه بیهوشی و مراقبتهای ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
Keyvan
Gohari Moghadam
کیوان
گوهری مقدم
kgohari@tums.ac.ir
10031947532846006257
10031947532846006257
No
Department of Internal Medicine, School of medicine, Tehran University of Medical Scienecs, Tehran, Iran
گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران
Masuom
Khoshfetrat
معصوم
خوش فطرت
drkhoshfetrat@yahoo.com
10031947532846006258
10031947532846006258
No
Department of Anesthesiology and Critical Care, School of medicine, Zahedan University of Medical Scienecs, Zahedan, Iran
گروه بیهوشی و مراقبتهای ویژه، دانشکده پزشکی، داشگاه علوم پزشکی زاهدان، زاهدان، ایران
Sadegh
Shabab
صادق
شباب
sadegh_shabab@yahoo.com
10031947532846006259
10031947532846006259
No
Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
مرکز تحقیقات تروما، دانشکده پرستاری، دانشگاه علوم پزشکی بقیهالله (ع)، تهران، ایران
Malihe sadat
Moayed
ملیحه السادات
مؤید
msmoayed@gmail.com
10031947532846006260
10031947532846006260
Yes
Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
مرکز تحقیقات تروما، دانشکده پرستاری، دانشگاه علوم پزشکی بقیهالله (ع)، تهران، ایران