Influencing Factors Of Icu Physicians Regulating Levels Of Sedation For Mechanically Ventilated Patients

Objective: To explore whether the indicators related to the intensity of stimulation(support conditions of ventilator and vital organ functions)affect our ICU physicians adjusting the sedation depth of patient with ventilator Methods:Invite 15 members of Medical Doctors Branch of the Chinese Medical Doctor Association and the Chinese Medical Association Medicine Branch to develop a questionnaire based on the Delphi law.Among three grade hospitals across the country with different titles of ICU physicians(maximum no more than 2 physicians each title)conduct a sample survey.Results:(1)After 3 rounds of Delphi(Delphi)law selection,the final selection of the 10 indicators of the acceptance rate of more than 85% as an evaluation index affecting the ICU physicians in China to adjust the sedation depth of mechanical ventilation patients,in which 4 ventilator parameters: Ventilator mode,PEEP(positive end expiratory pressure),Pplat(platform pressure),oxygen concentration;6 Organ function indicators: Respiratory frequency,oxygenation index,minute ventilation,GCS(Glasgow coma scale),vascular activity Drug dose,blood lactate levels.(2)576 ICU physicians from 102 ICUs of 90 tertiary teaching hospitals in the country received a questionnaire survey,and finally recovered 558 valid questionnaires with an effective rate of 96.88%.When adjusting the depth of sedation,respondents generally considered the level of ventilator support conditions(93.2%)and critical organ dysfunction(99.1%),and only 3 physicians(0.5%)did not consider ventilator support conditions and the vital organs of the patient.The expert panel selected indicators affecting the depth of sedation in patients with mechanical ventilation that were widely accepted by respondents.The most recognized index was respiratory frequency(92.8%),and the lowest level of acceptance was blood lactate level(66.13%),and the respondents' consideration consistency with the expert group's consideration of the indicators is relatively close.Respondents will not implement shallow sedation programs when the indicators are at what level,and the range of fluctuations is large.More than half of the respondents with ventilator models,oxygenation index,and oxygen inhalation concentration at a high level will not have a shallow sedation program.More than half of the respondents with GCS at a low level will not perform a shallow sedation protocol.More than half of the interviewees at the moderate level of the rest 6 indicators will not implement the shallow sedation plan.(3)In terms of shallow sedation tendencies,the majority of respondents were unclear about the tendency toward shallow sedation,and 107(19.3%)of the interviewees with the highest absolute inclination to shallow sedation(selected answers were A?7).For people,respondents with absolutely low propensity(C?7 in the selected answer)only had 15 people.Female ICU physicians have high propensity for shallow calmness;ICU physicians with bed-to-nures ratios ?1:2.5,hospital beds <2000,and ICU physicians with <1000 total mechanical ventilation patients last year have low propensities for shallow calmness.Conclusion:The level of ventilator support conditions and severity of vital organ dysfunction are important factors affecting our ICU physicians adjusting the sedation depth of patient with ventilator.However,the level of indicators is not suitable for the shallow sedation of patients with mechanical ventilation.Their opinions are not uniform.Insufficient knowledge of the ICU's stimulating intensity of noxious stimuli suffered by mechanically ventilated patients may be a major cause of the current clinicians' low compliance to shallow sedation.In addition,the high proportion of ICU beds is also one of the reasons that ICU physicians have low compliance to shallow calm.