c allerød 1,2 , ds karbing 1 , p thorgaard 2 , s andreassen 1 , s kjærgaard 2 , se rees 1
DESCRIPTION
Use of the INVENT system for standardized quantification of clinical preferences towards mechanical ventilation. C Allerød 1,2 , DS Karbing 1 , P Thorgaard 2 , S Andreassen 1 , S Kjærgaard 2 , SE Rees 1. 1 : Center for Model-based Medical Decision Support, Aalborg University, Denmark - PowerPoint PPT PresentationTRANSCRIPT
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Use of the INVENT system for standardized quantification of clinical preferences towards mechanical ventilation
C Allerød1,2, DS Karbing1, P Thorgaard2, S Andreassen1, S Kjærgaard2, SE Rees1
1: Center for Model-based Medical Decision Support, Aalborg University, Denmark2: Anaesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, Denmark
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Introduction
• Several RCTs indicate that low tidal volumes are beneficial in mechanically ventilated patients
• Large variability in ventilator settings are still seen in the ICU
• But how well do physicians agree when presented to identical patients?
The ARDS Network. N Engl J Med 2000; 342:1301-8.
Young et al. Crit Care Med 2004; 32:1260-5.Esteban et al. Am J respir Crit Care Med 2008; 177:170-7
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Using INVENT for quantifying preferences
• INVENT: Model-based decision support system for mechanical ventilation– Advice on FiO2, Vt and f.
J Clin Monit Comput 2006; 20:421-9.J Crit Care 2010; 25:367-74.
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Research questions
• What is the variability in physicians’ preferences in the same patient?
• What are physicians’ opinion about other physicians’ advice?
• What are the physicians’ opinion about INVENT’s advice?
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Methods• Included 10 senior ICU physicians, representing the 4
Danish University Hospitals
• 10 real patient cases, presented in random order– Reflecting range of respiratory, circulatory and metabolic status in
patients with ALI/ARDS
• Asked to set FiO2, Vt and f– Assuming correct PEEP and I:E ratio, 70 kg body weight and that
model simulations were correct
• Evaluated and ranked other physicians’, and INVENT’s advice (blinded, and in random case order)
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Results
• What is the variability in physicians’ preferences in the same patient? Example: Vt
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Variability in physicians’ preferences
6 ml/kg
8 ml/kg
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Variability in physicians’ preferences
6 ml/kg
8 ml/kg
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Results
• What is the variability in physicians’ preferences in the same patient? Example: Vt
• What are physicians’ opinion about other physicians’ advice?
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Opinion’s about other physicians’ advice
Classification Average (range)
Good 21.2 % (9.9% – 26.0%)
Acceptable 45.5 % (36.4% – 56.8 %)
Unacceptable 33.3 % (25.4% – 39.9 %)
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Opinion’s about other physicians’ advice
Classification Average (range)
Good 21.2 % (9.9% – 26.0%)
Acceptable 45.5 % (36.4% – 56.8 %)
Unacceptable 33.3 % (25.4% – 39.9 %)
Rank Best Worst
Average 5.0 7.1
Range 2-10 2-10
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Results
• What is the variability in physicians’ preferences in the same patient? Example: Vt
• What are physicians’ opinion about other physicians’ advice?
• What are the physicians’ opinion about INVENT’s advice?
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Opinion about INVENT’s advice
Classification Average (range) INVENT
Good 21.2 % (9.9% – 26.0%) 26.0 %
Acceptable 45.5 % (36.4% – 56.8 %) 41.0 %
Unacceptable 33.3 % (25.4% – 39.9 %) 34.0 %
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Opinion about INVENT’s advice
Classification Average (range) INVENT
Good 21.2 % (9.9% – 26.0%) 26.0 %
Acceptable 45.5 % (36.4% – 56.8 %) 41.0 %
Unacceptable 33.3 % (25.4% – 39.9 %) 34.0 %
Rank Best Worst INVENT
Average 5.0 7.1 5.3
Range 2-10 2-10 3-10
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Conclusions
• Physiological models may be a beneficial tool for quantifying clinical preferences– Separate variation in preference from variation in patient
pathophysiology
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Conclusions
• Physiological models may be a beneficial tool for quantifying clinical preferences– Separate variation in preference from variation in patient
pathophysiology
• Large variability found in physicians’ preferences towards appropriate levels of Vt, FiO2, f, PIP, SaO2 and pH
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Conclusions
• Physiological models may be a beneficial tool for quantifying clinical preferences– Separate variation in preference from variation in patient
pathophysiology
• Large variability found in physicians’ preferences towards appropriate levels of Vt, FiO2, f, PIP, SaO2 and pH
• When a physician’s advice was evaluated by other physicians, a third were found unacceptable
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Conclusions• Physiological models may be a beneficial tool for quantifying
clinical preferences– Separate variation in preference from variation in patient
pathophysiology
• Large variability found in physicians’ preferences towards appropriate levels of Vt, FiO2, f, PIP, SaO2 and pH
• When a physician’s advice was evaluated by other physicians, a third were found unacceptable
• INVENT ranked third best, evaluated similar to physicians– Prospective testing is necessary
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Thank you.