There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
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.