How is mechanical ventilation employed in the intensive care unit? An international utilization review

Andrés Esteban, Antonio Anzueto, Inmaculada Alía, Federico Gordo, Carlos Apezteguía, Fernando Pálizas, David Cide, Rosanne Goldwaser, Luis Soto, Guillermo Bugedo, Carlos Rodrigo, Jorge Pimentel, Guillermo Raimondi, Martin J. Tobin

Research output: Contribution to journalArticlepeer-review

521 Scopus citations

Abstract

A 1-d point-prevalence study was performed with the aim of describing the characteristics of conventional mechanical ventilation in intensive care units ICUs from North America, South America, Spain, and Portugal. The study involved 412 medical-surgical ICUs and 1,638 patients receiving mechanical ventilation at the moment of the study. The main outcome measures were characterization of the indications for initiation of mechanical ventilation, the artificial airways used to deliver mechanical ventilation, the ventilator modes and settings, and the methods of weaning. The median age of the study patients was 61 yr, and the median duration of mechanical ventilation at the time of the study was 7 d. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic obstructive pulmonary disease (13%), coma (10%), and neuromuscular disorders (10%). Mechanical ventilation was delivered via an endotracheal tube in 75% of patients, a tracheostomy in 24%, and a facial mask in 1%. Ventilator modes consisted of assist/control ventilation in 4.7% of patients and 46% were ventilated with synchronized intermittent mandatory ventilation, pressure support, or the combination of both. The median tidal volume setting was 9 ml/kg in patients receiving assist/control and the median setting of pressure support was 18 cm H2O. Positive end-expiratory pressure was not employed in 31% of patients. Method of weaning varied considerably from country to country, and even within a country several methods were in use. We conclude that the primary indications for mechanical ventilation and the ventilator settings were remarkably similar across countries, but the selection of modes of mechanical ventilation and methods of weaning varied considerably from country to country.

Original languageEnglish (US)
Pages (from-to)1450-1458
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume161
Issue number5
DOIs
StatePublished - Jan 1 2000

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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