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Erschienen in:

01.05.2009 | Original

Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database

verfasst von: Philipp G. H. Metnitz, MD, PhD, Prof., DEAA, EDIC, Barbara Metnitz, PhD, Rui P. Moreno, MD, PhD, Prof., Peter Bauer, PhD, Prof., Chairman, Lorenzo Del Sorbo, MD, Christoph Hoermann, MD, Prof., Susana Afonso de Carvalho, MD, V. Marco Ranieri, MD, Prof., Chairman, on behalf of the SAPS 3 Investigators

Erschienen in: Intensive Care Medicine | Ausgabe 5/2009

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ABSTRACT

Objective

To evaluate current practice of mechanical ventilation in the ICU and the characteristics and outcomes of patients receiving it.

Design

Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3).

Patients

13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries.

Interventions

None.

Main measurements and results

Patients were divided into three groups: no mechanical ventilation (MV), noninvasive MV (NIV), and invasive MV. More than half of the patients (53% [CI: 52.2-53.9%]) were mechanically ventilated at ICU admission. FiO₂, Vt and PEEP used during invasive MV were on average 50% (40-80%), 8 mL/kg actual body weight (6.9-9.4 mL/kg) and 5 cmH₂O (3-6 cmH₂O), respectively. Several invMV patients (17.3% (CI:16.4-18.3%)) were ventilated with zero PEEP (ZEEP). These patients exhibited a significantly increased risk-adjusted hospital mortality, compared with patients ventilated with higher PEEP (O/E ratio 1.12 [1.05-1.18]). NIV was used in 4.2% (CI: 3.8-4.5%) of all patients and was associated with an improved risk-adjusted outcome (OR 0.79, [0.69-0.90]).

Conclusion

Ventilation mode and parameter settings for MV varied significantly across ICUs. Our results provide evidence that some ventilatory modes and settings could still be used against current evidence and recommendations. This includes ventilation with tidal volumes >8mL/kg body weight in patients with a low PaO2/FiO2 ratio and ZEEP in invMV patients. Invasive mechanical ventilation with ZEEP was associated with a worse outcome, even after controlling for severity of disease. Since our study did not document indications for MV, the association between MV settings and outcome must be viewed with caution.

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Titel: Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database
verfasst von: Philipp G. H. Metnitz, MD, PhD, Prof., DEAA, EDIC
Barbara Metnitz, PhD
Rui P. Moreno, MD, PhD, Prof.
Peter Bauer, PhD, Prof., Chairman
Lorenzo Del Sorbo, MD
Christoph Hoermann, MD, Prof.
Susana Afonso de Carvalho, MD
V. Marco Ranieri, MD, Prof., Chairman
on behalf of the SAPS 3 Investigators
Publikationsdatum: 01.05.2009
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 5/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1449-9

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Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database