How Is Mechanical Ventilation Employed in the Intensive Care Unit?

TLDR

The study aimed to describe the characteristics of conventional mechanical ventilation in ICUs across North America, South America, Spain, and Portugal. A point‑prevalence survey of 412 medical‑surgical ICUs and 1,638 ventilated patients collected data on indications, airway devices, ventilator modes and settings, and weaning methods. Median age was 61 years and ventilation lasted 7 days; acute respiratory failure was the leading indication (66 %), endotracheal tubes were used in 75 % of patients, assist/control ventilation in 47 %, and while indications and settings were similar across countries, modes and weaning methods varied considerably.

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 47% 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.