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Reliability of clinical assessments of respiratory system compliance (Crs) made by junior doctors
B J Stenson1, R A Wilkie, I A Laing
1Neonatal Unit, Simpson Memorial Maternity Pavilion, Edinburgh, UK.
Objective:
To assess the reliability of estimates of static respiratory system compliance (Crs) made by junior hospital doctors caring for ventilated newborn infants.
Design:
A prospective comparison of junior doctors' estimates of Crs to the Crs measured immediately afterwards.
Setting:
A regional neonatal intensive care nursery in Edinburgh, Scotland.
Patients:
46 ventilated newborn infants.
Measurements And Results:
Crs was estimated by three grades of junior doctor (Senior House Officer, Registrar and Research Fellow) using two different methods, (i) based on visual assessment of tidal volume in relation to inflation pressure (optical Crs) and (ii) directly using a visual analogue scale (analogue Crs). The Crs was then measured immediately afterwards using the single breath passive expiratory flow technique. The differences between the estimates and the measurements were calculated for each grade of observer and plotted against the corresponding measurements. The relationship between estimates and measurements was also expressed in terms of the coefficients of determination r2 calculated by least squares regression. With both methods of estimation observers tended to overestimate the Crs of infants with lower measured Crs and underestimate that of infants with higher measured Crs with many estimates differing from the measurements by more than 50%. Values of r2 ranged from 0.086 to 0.481 indicating a weak relationship between the estimates and the measurements.
Conclusions:
Junior doctors' estimates of Crs were unreliable and did not represent a useful method of assessing respiratory function. The clinical use of compliance measurements merits wider evaluation.