Impact of a dedicated ventilatory support team on how mechanical ventilation is employed in a tertiary-care hospital

Abstract

Introduction Advances in our knowledge of the pathophysiology of respiratory failure have forced major revisions of our approach to ventilatory support. We describe how mechanical ventilation is employed in four different ICUs (surgical, clinical, cardiac and neurological) of a tertiary-care Brazilian hospital where a ventilatory support team composed of intensivists is responsible for a daily-basis follow up. Methods A prospective observational study enrolled all invasive mechanically ventilated patients admitted to four ICUs from May 2004 through June 2008. Daily recorded data included: demographics, diagnosis, modes of ventilation, tidal volume/kg (Vt), positive end-expiratory pressure (PEEP) level, peak inspiratory pressure, plateau pressure (Pplat), recruitment maneuvers, use of sedation and neuromuscular blocking agents (NBA), tracheotomy, barotrauma, ventilation days, and length of stay (LOS) in the ICU. Results are expressed as the mean ± SD and percentage. Differences were assessed by one-way ANOVA followed by the Tukey test. P < 0.05 was considered significant. Results A total of 1,715 patients was studied. Diagnosis prevailed depending on the ICU's characteristics. Ventilatory data are depicted in Table 1. Recruitment maneuvers were used in less than 2% of patients. The most frequent type of ventilatory mode was spontaneous (P < 0.05). Barotrauma was similar and occurred in less than 0.63% (P > 0.05). Intravenous sedation was administered for no more than 40% of the time on mechanical ventilation. NBA was used for no more than 0.25% of patients. LOS and ventilation days were different among ICUs (P < 0.05). Table 1 Ventilatory data Vt (ml/kg) PEEP (cmH2O) Pplat (cmH2O) Surgical 6.6 ± 2 8.9 ± 3.2 22 ± 6.3 Clinical 6.6 ± 1.7 8.6 ± 2.7 22 ± 5.9 Neuro 6.7 ± 2.1 8.3 ± 2.3 22.7 ± 4.4 Cardiac 6.8 ± 1.5 8.7 ± 2.1 21.3 ± 4 Conclusion Daily interaction of the ventilatory support team and the ICU practitioners guaranteed a homogeneous and up-to-date form of ventilatory support care to the patients in the different ICUs.