Variation in Definition of Prolonged Mechanical Ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Health Services Research

Background:

• Consistent terminology for mechanical ventilation cohorts is crucial for research and resource allocation.
• Prolonged mechanical ventilation (PMV) lacks standardized definitions, hindering comparative analysis.
• Understanding PMV cohort characteristics is vital for clinical decision-making and research.

Purpose of the Study:

• To quantify the application and definition of terms used for prolonged mechanical ventilation.
• To identify variations in terminology and criteria for defining PMV cohorts.
• To assess the need for standardization in PMV research.

Main Methods:

• Conducted a scoping review of studies (all designs except single-case) reporting adult and pediatric populations using PMV or synonyms.
• Screened over 5,331 references, reviewed 539 full-text articles, and included 419 studies from 38 countries.
• Analyzed 741 terms used, definitions based on duration, and rationale provided for criteria.

Main Results:

• A total of 419 studies were included, with 71% reporting heterogeneous cohorts and 16% focusing on surgical subjects (primarily cardiac).
• 741 different terms were identified, with "prolonged mechanical ventilation" being most common (60%).
• Significant variation in ventilation duration criteria (37 different durations) and lack of rationale (57%) or consensus definitions (7%) were observed.

Conclusions:

• Substantial variation exists in terminology and definitional criteria for prolonged mechanical ventilation cohorts.
• Standardization of terminology and definitional criteria is essential for maximizing the informativeness of study data.
• This lack of standardization impedes understanding of prevalence, risk stratification, and intervention effectiveness.