Conclusion

In conclusion, when one examines the available data and considers a typical medical-surgical ICU, it appears that approximately one third of the patients admitted to the ICU will receive mechanical ventilatory support for more than 12 hours. The reason for initiating mechanical ventilation will be acute respiratory failure in 2 out of every 3 cases. The average age ofthe ventilated patients will likely be close to 62 years of age and in 65% of cases they will be male. Most typically they will be ventilated using an assist-control (A/C) volume based ventilator mode throughout their course on the ventilator. The average Vt and PEEP levels employed are likely to be around 8.5 ml/kg and < 5 cmH2O, respectively. Finally, the average duration of mechanical ventilation will be approximately 5 days with a probability of survival to hospital discharge of about 61%. These estimates are based largely on the multicenter international observational study performed in 1998. Clearly the data presented here may not be applicable to every ICU, and it is possible that practice patterns may have changed in the last fewyears. Nevertheless, these data represent the most up to date and comprehensive information available at the current time. Further studies will be needed in the future to determine how (if at all) these figures are changing over time.

References

1. Snider GL (1989) Historical perspective on mechanical ventilation; from simple life support system to ethical dilemma. Am Rev Respir Dis 140:52-57

2. SlutskyAS (1993) ACCP Consensus Conference Mechanical Ventilation. Chest 104:1833-1859

3. Linton RC, Walker FW, Spoerel WE (1965) Respiratory care in a general hospital: a five-year survey. Can Anaesth Soc J 12:451-457

4. Bigelow DB, Petty TL, Ashbaugh DG, Levine BE, Nett LM, Tyler SW (1967) Acute respiratory failure. Experiences of a respiratory care unit. Med Clin North Am 51:323-40

5. Noehren TH, Friedman I (1968) A ventilation unit for special intensive care of patients with respiratoryfailure. JAMA 203:641-3.

6. Rogers RM, Weiler C, Ruppenthal B (1972) Impact of the respiratory intensive care unit on survival of patients with acute respiratory failure. Chest 62:94-97

7. Nunn JF, Milledge JS, Singaraya J (1979) Survival ofpatients ventilated in an intensive therapy unit. Br Med J 1:1525-1527

8. Knaus WA (1989) Prognosis with mechanical ventilation: the influence of disease, severity of disease, age, and chronic health status on survival from an acute illness. Am Rev Respir Dis 140: S8-S13

9. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ and the Spanish Lung Failure Collaborative Group (1994) Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. Chest 106:1188-1193

10. Esteban A, Anzueto A, Alia I, et al, for the Mechanical Ventilation International Study Group (2000) How is mechanical ventilation employed in the Intensive Care Unit? An international utilization review. Am J Respir Crit Care Med 161:1450-1458.

11. Esteban A, Anzueto A, Frutos F, et al., for the Mechanical Ventilation International Study Group (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA 287:345-355

12. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301-1308

13. Bernard GR, Vincent JL, Laterre PF, et al. (2001) Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. N Engl J Med 344:699-709

14. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators (1997) A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 337:1118-23

15. Aldrich TK, Prezant DJ (1994) Indications for mechanical ventilation. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation. McGraw-Hill, New York, pp 155-189

16. Bishop MJ (1994) Airway management. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation, McGraw-Hill, New York, pp 695-709

17. Holzapfel L, ChastangC, Demingeon G, Bohe J, PirallaB,CoupryA (1999) A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med 159:695-701

18. MacIntyre NL, Cook DJ, Ely EW, et al. (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest 120:375S-395S

19. Kollef MH, Ahrens TS, Shannon W (1999) Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med 27:1714-1720

20. Esteban A, Frutos F, Anzuelo A, et al. (2001) Impact oftracheostomyon outcome of mechanical ventilation. Am J Respir Crit Care Med 163:A129

21. Venus B, Smith RA, Mathru M (1997) National survey of methods and criteria used for weaning from mechanical ventilation. Crit Care Med 15:530-533

22. Leung P, Jubran A, Tobin MJ (1997) Comparison of assisted modes on triggering, patient effort and dyspnea. Am J Respir Crit Care Med 155:1940-1948

23. Pingleton SK (1994) Complications associated with mechanical ventilation. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation. McGraw-Hill, New York, pp 775-792

24. Carlucci A, Richard J, Wysocki M, Lepage E, Brochard L, and the SRLF collaborative group on mechanical ventilation (2001) Noninvasive versus conventional mechanical ventilation. An epidemiological survey. Am J Respir Crit Care Med 163:874-880

25. Peter JV, Moran JL, Phillips-Hughes J, Warn D (2002) Noninvasive ventilation in acute respiratory failure - A meta-analysis update. Crit Care Med 30:555 562

26. Lutch JS, Murray JF (1972) Continuous positive pressure ventilation: effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med 76:193-202

27. Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury. Lessons from experimental studies. Am J Respir Crit Care Med 157:294323

28. Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372-377

29. Hickling KG, Walsh J, Henderson S, Jackson R (1994) Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercap-nia: a prospective study. Crit Care Med 22:1568-1578

30. Amato MB, Barbas CS, Medeiros DM, et al. (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347-354

31. Stewart TE, Meade MO, Cook DJ, et al. (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med 338:355-361

32. Brochard L, Roudot-Thoraval F, Roupie E, et al. (1998) Tidal volume reduction for prevention ofventilator-inducedlung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med 158:1831-1838

33. Brower RG, Shanholtz CB, Fessler HE, et al. (1999) Prospective, randomized, controlled trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 27:1492-1498

34. Thompson BT, Hayden D, Matthay MA, Brower R, Parsons PE (2001) Clinicians' approaches to mechanical ventilation in acute lung injury and ARDS. Chest 120:1622-1627

35. Petty TL, Ashbaugh DG (1971) The adult respiratory distress syndrome: clinical features, factors influencing prognosis and principles of management. Chest 60:273-279

36. Rossi A, Ranieri MV (1994) Positive end-expiratorypressure. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation, McGraw-Hill, New York, pp 259-303

37. Dreyfuss D, Saumon G (1993) Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 148:1194-1203

38. BshoutyZ, Ali J, Younes M (1988) Effect of tidal volume and PEEP on rate of edema formation in in situ perfused canine lobes. J Appl Physiol 64:1900-1907

39. Sandhar BK, Niblett DJ, Argiras EP, Dunnill MS, Sykes MK (1988) Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome. Intensive Care Med 14:538-546

40. Argiras EP, Blakeley CR, Dunnill MS, Otremski S, Sykes MK (1987) High PEEP decreases hyaline membrane formation in surfactant deficient lungs. Br J Anaesth 59:1278-1285

41. Brochard L, RaussA, Benito S, et al. (1994) Comparison ofthreemethods ofgradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896-903

42. Esteban A, Frutos F, Tobin MJ, et al. for the Spanish Lung Failure Collaborative Group (1995) A comparison of four methods ofweaning patients from mechanical ventilation. N Engl J Med 332:345-350

43. Jounieaux V, Duran A, Levi-Valensi P (1994) Synchronized intermittent mandatory ventilation with and without pressure support ventilation in weaning patients with COPD from mechanical ventilation. Chest 105:1204-1210

44. Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, Tagliabue M (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 271:1772-1779

45. Gammon RB, Shin MS, Buchalter SE (1992) Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 102:568-572

46. Schnapp LM, Chin DP, Szaflarski N, Matthay MA (1995) Frequency and importance of barotrauma in 100 patients with acute lung injury. Crit Care Med 23:272-278

47. Cullen DJ, Caldera DL (1979) The incidence of ventilator-induced pulmonary barotrauma in critically ill patients. Anesthesiology 50:187-190

48. Gammon RB, Shin MS, Groves RH, Hardin JM, Hsu C, Buchalter SE (1995) Clinical risk factors for pulmonary barotrauma: A multivariate analysis. Am J Respir Crit Care Med 152:1235-1240

49. Weg JG, Anzueto A, Balk RA, Wiedemann HP, Pattishall EN, Schork MA, Wagner LA (1998) The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med 338:341-346

50. de Latorre FJ, Tomasa A, Klamburg J, Leon C, Soler M, Rius J (1977) Incidence of pneumothorax and pneumomediastinum in patients with aspiratoryaspiration pneumonia requiring ventilatory support. Chest 72:141-144

51. Sepkowitz KA, Telzak EE, Jonathan W, et al (1991) Pneumothorax in AIDS. Ann Intern Med 114:458-459

52. Petersen GW, Baier H (1983) Incidence of pulmonary barotrauma in a medical ICU. Crit Care Med 11:67-69

53. Kumar A, Pontoppidam H, Falke KJ, Wilson RS, Laver MD (1973) Pulmonary barotrauma during mechanical ventilation. Crit Care Med 4:181-186

54. Zwillich CW, Pierson DJ, Creagh CE, et al. (1974) Complications of assisted ventilation: a prospective study of 354 consecutive patients. Am J Med 57:161-170

55. Anzueto A, Frutos F, Esteban A, et al. (2003) Incidence, risk factors andoutcome ofbarotrauma in mechanically ventilated patients. (In press)

56. Schnapp LM, Chin DP, Szaflarski N, Matthay MA (1995) Frequency and importance of barotrauma in 100 patients with acute lung injury. Crit Care Med 23:272-278

57. Mathru M, Rao TLK, Venus B (1983) Ventilator-induced barotrauma in controlled mechanical ventilation versus intermittent mandatory ventilation. Crit Care Med 11:359-361

58. Williams TJ, Tuxen DJ, Scheindestel CD (1992) Risk factors for morbidity in mechanically ventilated patients with severe asthma. Am Rev Respir Dis 146:607-615

59. Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:1618-1623

60. Langer M, Mosconi P, Cigada M, Mandelli M (1989) Long-term respiratory support and risk of pneumonia in critically ill patients. Am Rev Respir Dis 140:302-305

61. Fagon JY, Chastre J, Domart Y, et al. (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877-884

62. Cook DJ, Walter SD, Cook RJ, et al. (1998) Incidence of and risks factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433-440

63. Stauffer JL, Fayter NA, Graves B, et al. (1993) Survival following mechanical ventilation for acute respiratory failure in adult men. Chest 104:1222-1229

64. Troché G, Moine P (1997) Is the duration of mechanical ventilation predictable? Chest 112:745-751

65. Papadakis MA, Lee KK, Brower WS, et al. (1993) Prognosis of mechanically ventilated patients. West J Med 159:659-664

66. Douglas SL, Daly BJ, Brennan PF, Harris S, Nochowitz M, Dyer MA (1997) Outcomes of long-term ventilator patients: a descriptive study. Am J Crit Care 6:99-105

67. US Preventive Services Task Force (1989) An assessment of the effectiveness of 169 interventions. Williams and Wilkins, Baltimore

68. Hamel MB, Phillips RS, Davis RB, et al. (2000) Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome. Am J Med 109:614-620

69. Ely EW, Baker AM, Evans GW, Haponik EF (2000) The distribution of costs of care in mechanically ventilated patients with chronic obstructive pulmonary disease. Crit Care Med 28:408-413

70. Añón JM, García de Lorenzo A, Zarazaga A, Gómez-Tello V, Garrido G (1999) Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis. Intensive Care Med 25:452-457

71. Hamel MB, Phillips R, Teno J, et al. (2002) Cost effectiveness of aggressive care for patients with nontraumatic coma. Crit Care Med 30:1191-1196

72. Mayer SA, Copeland D, Bernardini GL, et al. (2000) Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke 31:2346-2353

73. Wachter RM, Luce JM, Safrin S, Berrios DC, Charlebois E, Scitovsky AA (1995) Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratoryfailure. JAMA 273:230-235

74. Schmidt CD, Elliott CG, Carmelli D, et al. (1983) Prolonged mechanical ventilation for respiratoryfailure: a cost-benefit analysis. Crit Care Med 11:407-411

75. Rodríguez Roldán JM, Alonso Cuesta P, López Martínez J, Del Nogal Sáez F, Jiménez Martín MJ, Suárez Saiz J (2002) Análisis de coste-efectividad de la ventilación mecánica y del tratamiento intensivo de pacientes en situación crítica. Med Intensiva 26:391-398

76. Advisory Group in Health Technology Assessment (1993) Assessing the effects of health technologies, principles, practice, and proposals. Department of Health, London

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment