Ventilator setting in ICUs: comparing a Dutch with a European cohort

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Clinical Epidemiology

Background:

• Comparison of mechanical ventilation practices between Dutch and European cohorts from the third International Study on Mechanical Ventilation (ISMV).
• Hypothesis that Dutch patients receive smaller tidal volumes and higher positive end-expiratory pressure (PEEP).
• Investigation into differences in non-invasive ventilation (NIV) use and patient outcomes.

Purpose of the Study:

• To compare mechanical ventilation strategies, including tidal volume and PEEP, between Dutch and European intensive care units (ICUs).
• To assess the utilization of non-invasive ventilation (NIV) as an initial mode of mechanical ventilation.
• To evaluate differences in ICU-acquired infections (pneumonia, sepsis), delirium, and mortality rates.

Main Methods:

• Post-hoc analysis of a prospective observational study involving patients on mechanical ventilation.
• Comparison of data from a Dutch cohort against a broader European cohort within the ISMV dataset.

Main Results:

• Dutch cohort: smaller tidal volumes (7.6 vs. 8.1 ml/kg PBW), higher PEEP (8 vs. 6 cm H2O).
• Lower incidence of NIV as first-line ventilation (7.1% vs. 16.7%), ICU-acquired pneumonia (4.5% vs. 12.3%), and sepsis (5.7% vs. 10.9%) in the Netherlands.
• Higher incidence of delirium (15.8% vs. 4.6%) in the Dutch cohort.
• Lower ICU and in-hospital mortality in the Dutch cohort (19% and 25% vs. 26% and 33%).

Conclusions:

• Dutch mechanical ventilation practices (smaller tidal volumes, higher PEEP) differ from European norms.
• While potentially reducing pneumonia and sepsis, these practices may increase delirium rates.
• NIV is less frequently used as an initial ventilation mode in the Netherlands.
• Both Dutch and international practices may exceed recommended tidal volumes for ARDS prevention/treatment.