Modes of mechanical ventilation vary between hospitals and intensive care units within a university healthcare system: A retrospective observational study

• Type of Material: Article
• Authors: Craig S. Jabaley, Emory University; Robert F. Groff, Emory University; Milad Sharifpour, Emory University; Jayashree K. Raikhelkar, Emory University; James M. Blum, Emory University
• Language: English
• Date: 2018-07-03
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13104-018-3534-z
• Title of Journal or Parent Work: BMC Research Notes
• ISSN: 1756-0500
• Volume: 11
• Issue: 1
• Start Page: 425
• End Page: 425
• Grant/Funding Information: Internal departmental funds were used to support the authors’ time to conduct the present study.
• Keywords: Mechanical ventilators; Intensive care; Respiratory failure; Ventilator weaning; Noninvasive ventilation; Positive pressure ventilation
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

Objective: As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming approaches could be readily identified. We conducted an exploratory retrospective observational database study of routinely recorded mechanical ventilation parameters between January 1, 2010 and December 31, 2016 from 12 intensive care units. Mode epoch count proportions were examined using Chi squared and Fisher exact tests as appropriate on an inter-unit basis with outlier detection for two test cases via post hoc pairwise analyses of a binomial regression model. Results: Final analysis included 559,734 mode epoch values. Significant heterogeneity was demonstrated between individual units (P < 0.05 for all comparisons). One unit demonstrated heightened utilization of high-frequency oscillatory ventilation, and three units demonstrated frequent synchronized intermittent mandatory ventilation utilization. Assist control ventilation was the most commonly recorded mode (51%), followed by adaptive support ventilation (23.1%). Volume-controlled modes were about twice as common as pressure-controlled modes (64.4% versus 35.6%). Our methodology provides a means by which to characterize the epidemiology of mechanical ventilation approaches and identify nonconforming practices. The observed variability warrants further clinical study about contributors and the impact on relevant outcomes.