Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico

Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico

The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). A retrospective subanalysis of a prospective observational study conducted...

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Veröffentlicht in:Medicina intensiva 2020-08, Vol.44 (6), p.333-343
Hauptverfasser: Marín, M C, Elizalde, J, Villagómez, A, Cerón, U, Poblano, M, Palma-Lara, I, Sánchez, J R, Monares, E, Arellano, A, Muriel, A, Peñuelas, Ó, Frutos-Vivar, F, Esteban, A
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container_issue 6
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container_title Medicina intensiva
container_volume 44
creator Marín, M C
Elizalde, J
Villagómez, A
Cerón, U
Poblano, M
Palma-Lara, I
Sánchez, J R
Monares, E
Arellano, A
Muriel, A
Peñuelas, Ó
Frutos-Vivar, F
Esteban, A
description The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Intensive Care Units (ICUs) in Mexico. Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. None. Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P
doi_str_mv 10.1016/j.medin.2019.03.010
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A multicenter observational study in Mexico</title><source>Elsevier ScienceDirect Journals</source><creator>Marín, M C ; Elizalde, J ; Villagómez, A ; Cerón, U ; Poblano, M ; Palma-Lara, I ; Sánchez, J R ; Monares, E ; Arellano, A ; Muriel, A ; Peñuelas, Ó ; Frutos-Vivar, F ; Esteban, A</creator><creatorcontrib>Marín, M C ; Elizalde, J ; Villagómez, A ; Cerón, U ; Poblano, M ; Palma-Lara, I ; Sánchez, J R ; Monares, E ; Arellano, A ; Muriel, A ; Peñuelas, Ó ; Frutos-Vivar, F ; Esteban, A ; Investigadores en el primer estudio ; Investigadores en el cuarto estudio ; Investigadores en el tercer estudio ; Investigadores en el segundo estudio</creatorcontrib><description><![CDATA[The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Intensive Care Units (ICUs) in Mexico. Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. None. Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.]]></description><identifier>EISSN: 1578-6749</identifier><identifier>DOI: 10.1016/j.medin.2019.03.010</identifier><identifier>PMID: 31130359</identifier><language>eng ; spa</language><publisher>Spain</publisher><ispartof>Medicina intensiva, 2020-08, Vol.44 (6), p.333-343</ispartof><rights>Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. 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A multicenter observational study in Mexico</title><title>Medicina intensiva</title><addtitle>Med Intensiva</addtitle><description><![CDATA[The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Intensive Care Units (ICUs) in Mexico. Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. None. Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. 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title Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico
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