• Umberto Lucangelo, Bernat Sales, Jaume Montanya, Oscar Garcia-Esquirol, Anna Estruga, Encarna Chacón, Ana Villagrá, and Rosa Jam.
• Hospital de Sabadell, Corporació Sanitària Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain. EChacon@tauli.cat
• Am. J. Crit. Care. 2012 Jul 1;21(4):e89-93.

UnlabelledBACKGROUND PATIENT: ventilator dyssynchrony is common and may influence patients' outcomes. Detection of such dyssynchronies relies on careful observation of patients and airway flow and pressure measurements. Given the shortage of specialists, critical care nurses could be trained to identify dyssynchronies.ObjectiveTo evaluate the accuracy of specifically trained critical care nurses in detecting ineffective inspiratory efforts during expiration.MethodsWe compared 2 nurses' evaluations of measurements from 1007 breaths in 8 patients with the evaluations of experienced critical care physicians. Sensitivity, specificity, positive predictive value, negative predictive value, and the Cohen κ for interobserver agreement were calculated.ResultsFor the first nurse, sensitivity was 92.5%, specificity was 98.3%, positive predictive value was 95.4%, negative predictive value was 97.1%, and κ was 0.92 (95% CI, 0.89-0.94). For the second nurse, sensitivity was 98.5%, specificity was 84.7%, positive predictive value was 70.7%, negative predictive value was 99.3%, and κ was 0.74 (95% CI, 0.70-0.78).ConclusionSpecifically trained nurses can reliably detect ineffective inspiratory efforts during expiration.

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