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Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A

M C Marín1, J Elizalde2, A Villagómez3

  • 1Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México; Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.

Medicina Intensiva
|May 28, 2019
PubMed
Abstract

Insights

Mechanical ventilation practices in Mexican ICUs shifted towards lung-protective strategies, significantly reducing tidal volume over 18 years. However, these changes in invasive mechanical ventilation did not impact patient mortality rates.

Area of Science:

  • Critical Care Medicine
  • Respiratory Therapy
  • Public Health

Background:

  • Invasive mechanical ventilation (IMV) is a critical intervention for patients in intensive care units (ICUs).
  • Understanding trends in IMV practices and their impact on outcomes is essential for improving patient care.

Purpose of the Study:

  • To describe the evolution of mechanical ventilation practices in Mexican ICUs over an 18-year period.
  • To assess changes in mortality rates among critically ill patients receiving IMV.

Main Methods:

  • Retrospective subanalysis of a prospective observational study.
  • Data collected in 1998, 2004, 2010, and 2016 from adult patients in Mexican ICUs.
  • Analysis included demographic data, severity scores, blood gas parameters, and clinical outcomes up to 28 days.

Main Results:

  • Tidal volume (VT) significantly decreased for both ARDS and non-ARDS patients (8.5-9 ml/kg in 1998 to 6 ml/kg in 2016).
  • Adoption of lung-protective ventilation strategies (low VT and plateau pressure) increased from 19% in 1998 to 75% in 2016.
  • Adjusted ICU mortality showed no significant consistent change across the study periods.

Conclusions:

  • Mechanical ventilation practices in Mexican ICUs have significantly evolved, with a notable shift towards lung-protective strategies.
  • The implementation of lower tidal volumes has become standard practice.
  • Despite changes in ventilation strategy, there has been no statistically significant associated change in patient mortality.
Keywords:
DesenlacesInvasive mechanical ventilationMortalidadMortalityOutcomesVentilación mecánica invasiva

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