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Chelbi R, Thabet F, Ennouri E, Meddeb K, Toumi R, Zghidi M, Ben Saida I, Boussarsar M. The Ability of Critical Care Physicians to Identify Patient-Ventilator Asynchrony Using Waveform Analysis: A National Survey. Respir Care 2024; 69:176-183. [PMID: 38267232 PMCID: PMC10898468 DOI: 10.4187/respcare.11360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Improved patient-ventilator asynchrony (PVA) identification using waveform analysis by critical care physicians (CCPs) may improve patient outcomes. This study aimed to assess the ability of CCPs to identify different types of PVAs using waveform analysis as well as factors related to this ability. METHODS We surveyed 12 university-affiliated medical ICUs (MICUs) in Tunisia. CCPs practicing in these MICUs were asked to visually identify 4 clinical cases, each corresponding to a different PVA. We collected the following characteristics regarding CCPs: scientific grade, years of experience, prior training in mechanical ventilation, prior exposure to waveform analysis, and the characteristics of the MICUs in which they practice. Respondents were categorized into 2 groups based on their ability to correctly identify PVAs (defined as the correct identification of at least 3 of the 4 PVA cases). Univariate analysis was performed to identify factors related to the correct identification of PVA. RESULTS Among 136 included CCPs, 72 (52.9%) responded to the present survey. The respondents comprised 59 (81.9%) residents, and 13 (18.1%) senior physicians. Further, 50 (69.4%) respondents had attended prior training in mechanical ventilation. Moreover, 21 (29.2%) of the respondents could correctly identify PVAs. Double-triggering was the most frequently identified PVA type, 43 (59.7%), followed by auto-triggering, 36 (50%); premature cycling, 28 (38.9%); and ineffective efforts, 25 (34.7%). Univariate analysis indicated that senior physicians had a better ability to correctly identify PVAs than residents (7 [53.8%] vs 14 [23.7%], P = .044). CONCLUSIONS The present study revealed a significant deficiency in the accurate visual identification of PVAs among CCPs in the MICUs. When compared to residents, senior physicians exhibited a notably superior aptitude for correctly recognizing PVAs.
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Affiliation(s)
- Rym Chelbi
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Farah Thabet
- University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia; and Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; University of Medicine of Monastir, Monastir, Tunisia
| | - Emna Ennouri
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Khaoula Meddeb
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Radhouane Toumi
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Marwa Zghidi
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Imen Ben Saida
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia
| | - Mohamed Boussarsar
- University of Sousse, Faculty of Medicine of Sousse, 4002, Sousse, Tunisia; and Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure," LR12SP09, 4000, Sousse, Tunisia.
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Boussarsar M, Ennouri E, Habbachi N, Bouguezzi N, Meddeb K, Gallas S, Hafdhi M, Zghidi M, Toumi R, Ben Saida I, Abid S, Boutiba-Ben Boubaker I, Maazaoui L, El Ghord H, Gzara A, Yazidi R, Ben Salah A. Epidemiology and burden of Severe Acute Respiratory Infections (SARI) in the aftermath of COVID-19 pandemic: A prospective sentinel surveillance study in a Tunisian Medical ICU, 2022/2023. PLoS One 2023; 18:e0294960. [PMID: 38100529 PMCID: PMC10723666 DOI: 10.1371/journal.pone.0294960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Infections (SARI) caused by influenza and other respiratory viruses pose significant global health challenges, and the COVID-19 pandemic has further strained healthcare systems. As the focus shifts from the pandemic to other respiratory infections, assessing the epidemiology and burden of SARI is crucial for healthcare planning and resource allocation. Aim: to understand the impact of the post-pandemic period on the epidemiology of SARI cases, clinical outcomes, and healthcare resource utilization in Tunisia. METHODS This is a prospective study conducted in a Tunisian MICU part of a national sentinel surveillance system, focusing on enhanced SARI surveillance. SARI cases from week 39/2022, 26 September to week 19/2023, 13 May were included, according to a standardized case definition. Samples were collected for virological RT-PCR testing, and an electronic system ensured standardized and accurate data collection. Descriptive statistics were performed to assess epidemiology, trends, and outcomes of SARI cases, and univariate/multivariate analyses to assess factors associated with mortality. RESULTS Among 312 MICU patients, 164 SARI cases were identified during the study period. 64(39%) RT-PCR were returned positive for at least one pathogen, with influenza A and B strains accounting for 20.7% of cases at the early stages of the influenza season. The MICU experienced a significant peak in admissions during weeks 1-11/2023, leading to resource mobilization and the creation of a surge unit. SARI cases utilized 1664/3120 of the MICU-stay days and required 1157 mechanical ventilation days. The overall mortality rate among SARI cases was 22.6%. Age, non-COPD, and ARDS were identified as independent predictors of mortality. CONCLUSIONS The present study identified a relatively high rate of SARI cases, with 39% positivity for at least one respiratory virus, with influenza A and B strains occurring predominantly during the early stages of the influenza season. The findings shed light on the considerable resource utilization and mortality associated with these infections, underscoring the urgency for proactive management and efficient resource allocation strategies.
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Affiliation(s)
- Mohamed Boussarsar
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Emna Ennouri
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Naima Habbachi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Nabil Bouguezzi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khaoula Meddeb
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Salma Gallas
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Malek Hafdhi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Marwa Zghidi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Radhouane Toumi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen Ben Saida
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Salma Abid
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | | | | | - Ahlem Gzara
- Primary Health Care Directorate, Tunis, Tunisia
| | - Rihab Yazidi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Service of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections LR16IPT02, Institut Pasteur de Tunis, University of Tunis, El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Service of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahrain
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