Am. J. Respir. Crit. Care Med., Volume 161, Number 5, May 2000, 1450-1458

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, and MARTIN J. TOBIN,  for the Mechanical Ventilation International Study Group

Hospital Universitario de Getafe, Madrid, Spain; University of Texas Health Science Center, San Antonio, Texas; Hospital Profesor Posadas, Buenos Aires, Argentina; Clínica Bazterrica, Buenos Aires, Argentina; Hospital Universitario Clementino Fraga Filho, Río de Janeiro, Brazil; Instituto Nacional de Enfermedades Respiratorias y Cirugía Torácica, Santiago, Chile; Pontificia Universidad Católica de Chile, Santiago, Chile; Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay; Hospital da Universidade, Coimbra, Portugal; F.L.E.N.I., Buenos Aires, Argentina; and Loyola University, Chicago; and Hines Veterans Affairs Hospital, Hines, Illinois

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.

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