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Author Notes:

Craig S. Jabaley, Phone: +1-404-778-7777, Email: csjabaley@emory.edu

All authors meet criteria for authorship under ICMJE criteria.

JMB conceived the study with critical input from CSJ and RFG.

JMB developed and conducted the structured data queries with assistance from CSJ and RFG.

CSJ and JMB designed and implemented the analysis plan with input from RFG.

RFG, MS, and JKR critically reviewed the analysis plan and results.

CSJ wrote the manuscript with critical revisions and conceptual advice from RFG, MS, JKR, and JMB.

All authors read and approved the final manuscript.

Preliminary findings were previously presented at the International Anesthesia Research Society and Society of Critical Care Anesthesiologists 2017 annual meetings in Washington, DC, USA.

The authors declare that they have no competing interests. JMB has an equity stake in Intensix (Netanya, Israel).

Subjects:

Research Funding:

Internal departmental funds were used to support the authors’ time to conduct the present study.

Keywords:

  • Intensive care
  • Mechanical ventilators
  • Noninvasive ventilation
  • Positive pressure ventilation
  • Respiratory failure
  • Ventilator weaning

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

Tools:

Journal Title:

BMC Research Notes

Volume:

Volume 11, Number 1

Publisher:

, Pages 425-425

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2018 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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