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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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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)


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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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