Development of a post-extubation respiratory failure risk assessment web application among critically ill medical patients
Keywords:
การประเมินความเสี่ยง, ภาวะหายใจล้มเหลว , เว็บแอปพลิเคชันAbstract
The objective of this research and development study was to develop a post-extubation respiratory failure (PERF) risk assessment web application (PERF Risk Assessment Web Application: PRAWA) and evaluate PRAWA effectiveness in predicting PERF. The study conducted in two phases. Phase 1 encompassed extensive literature review of research evidence to development of PRAWA. Phase 2 was carried out to evaluate PRAWA accuracy in predicting PERF using information from electronic medical records of 150 patients who had endotracheal extubation during January to October 2022. Research instruments included 1) PRAWA’s user manual, 2) patient data record form, 3) PRAWA record form, and 4) PERF diagnostic form. Descriptive statistics were used to summarize data and receiver operating characteristic (ROC) curve was used to illustrate diagnostic ability of the PRAWA.
Twenty-one studies were included and synthesized to develop the PRAWA. PRAWA consisted of 18 items with a total score of 30 points. PRAWA assessed PERF risk in two categories; 1) patient factors including age, sex, diagnosis, underlying conditions, indication for intubation, APACHE II score, hemoglobin, albumin, PaO 2 /FiO 2 or SpO 2 /FiO 2 ratio, level of consciousness, cough effectiveness, respiratory secretion and (2) healthcare-related factors including hemodialysis, sepsis status, vasopressor received, sedative received, duration of intubation, and ventilator-associated pneumonia. PRAWA had a content validity index of 1 and inter-rater reliability of 0.97. Efficiency test of PRAWA revealed that, at the cut-off of 10 points, PRAWA had a sensitivity of 88.6%, specificity of 87.2%, and the area under ROC curve (AUC) of 0.95 (95%CI=0.91-0.98; p<.001).
The results of this study demonstrated that the PRAWA was highly effective in classifying the risk for PERF and can be used in risk screening to prevent PERF according to risk levels.
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