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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 April;67(4):215-22

language: English

Evolution in the utilization of the mechanical ventilation in the critical care unit

Frutos F., Alìa I., Esteban A., Anzueto A.

From the In­ten­sive ­Care ­Unit Hos­pi­tal Uni­ver­sit­a­rio de ­Getafe (­Madrid, ­Spain) and Depart­ment of Med­i­cine Divi­sion of Pul­mo­nary Dis­eas­es/Crit­i­cal ­Care Med­i­cine
The Uni­ver­sity of Tex­as ­Health Sci­ence Cen­ter at San Anto­nio The ­South Tex­as Vet­e­rans ­Health ­Care ­System Audie L. Mur­phy Memo­ri­al Vet­e­rans Hos­pi­tal Divi­sion
(San Anto­nio, Tex­as, USA)


Use of mechan­i­cal ven­ti­la­tion has ­increased in ­recent ­years and con­sti­tutes a ­major ther­a­peu­tic modal­ity in the inten­sive ­care ­unit (ICU). In the ­recent ­years, chang­es in the ven­til­a­to­ry ­modes, in the ven­til­a­to­ry strat­e­gies and in the wean­ing ­from mechan­i­cal ven­ti­la­tion ­have ­occurred. We ­have com­pared the ­data ­obtained ­from the Span­ish ­ICUs in stud­ies ­that ­were car­ried out in ­three peri­ods of the nine­ties, ­with the aim to ­test wheth­er the afore­men­tioned inno­va­tions ­have mod­i­fied the clin­i­cal prac­tice. We ana­lyzed dem­o­graph­ic ­data, pri­mary rea­son for mechan­i­cal ven­ti­la­tion, ven­til­a­to­ry param­e­ters, ­mode of wean­ing and per­for­mance of trach­e­os­to­my. It was ­observed a ­decrease in the per­cent­age of ­patients receiv­ing mechan­i­cal ven­ti­la­tion. ­There was a sig­nif­i­cant ­trend to ven­ti­late old­er ­patients ­over the ­course of the ­decade. In the ­mode of ven­ti­la­tion, we ­observed a sig­nif­i­cant ­decrease in the use of the syn­chron­ized inter­mit­tent man­da­to­ry ven­ti­la­tion ­with a incre­ment in the use of ­assist-con­trol ven­ti­la­tion. We did not ­find dif­fer­enc­es in the ven­til­a­to­ry set­tings. Con­cern­ing to wean­ing, ­over the ­course of the ­decade ­occurred an ­increase in use of pres­sure sup­port ven­ti­la­tion and spon­ta­ne­ous breath­ing ­trial, ­being ­this meth­od the ­most fre­quent­ly ­used at the end of the ­decade. The per­for­mance of the trach­e­os­to­my has ­been less­er and ear­li­er ­over the ­time. The ­results ­obtained sug­gest ­that find­ings ­from ­research on mechan­i­cal ven­ti­la­tion are incor­po­rat­ed ­into clin­i­cal prac­tice at a ­very ­slow ­pace where­as the evi­dence ­obtained ­from the clin­i­cal ­trials ­about wean­ing has had a bet­ter recep­tion.

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