Conclusion

As the evidence base for clinical decisions in mechanical ventilation increases, investigators must devote attention to seeing that innovations in mechanical ventilation are translated into community practice. Evidence from other fields suggests that this will not be easy, particularly if the innovations involve protocols that use existing technology rather than new devices which will be promoted by a corporate developer. Unique barriers to implementing effective practice in mechanical ventilation are likely to be encountered. For example, differences in ICU organization mean that different clinicians have responsibility for ventilator management in each hospital. Implementing protocols for management, as opposed to simply convincing clinicians to prescribe a drug, may require more complex ongoing interventions.

An aggressive research program directed at understanding how current ventilator decisions are made, who makes them, and why effective strategies are or are not used should be started. Although several studies exist describing mechanical ventilation in broad populations, data have not been provided specifically oriented toward estimating the proportion of patients receiving care that deviates from published guidelines. Information about the use of NIV is particularly lacking. Future research directed at these questions can save lives while reducing costs and morbidity.

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