Mechanical ventilation practices in Asian intensive care units: A multicenter cross-sectional study

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Clinical Research

Background:

• Mechanical ventilation is a cornerstone of critical care for respiratory failure.
• Optimizing ventilation settings is crucial for patient outcomes, particularly in acute respiratory distress syndrome (ARDS).
• Understanding current practices in diverse geographical regions like Asia is essential for improving care standards.

Purpose of the Study:

• To investigate current mechanical ventilation strategies in Asian intensive care units.
• To assess the utilization of tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP).
• To identify factors associated with mortality in mechanically ventilated patients.

Main Methods:

• A multicenter, cross-sectional study involving 1408 patients across Asian intensive care units.
• Data collection on mechanical ventilation parameters and clinical outcomes.
• Univariate and multivariable logistic regression analysis to determine predictors of 28-day mortality.
• Development of a scoring system to predict mortality.

Main Results:

• In 138 ARDS patients, 65.9% received tidal volume ≤ 8 ml/kg predicted body weight (PBW) and 71.3% received sufficient PEEP.
• In 1270 non-ARDS patients, 88.8% received tidal volume ≤ 10 ml/kg PBW.
• Plateau pressure < 30 cmH2O was observed in 92.2% of patients.
• Mortality increased significantly with a higher predictive score.
• Key mortality predictors included income classification, age, SOFA score, PaO2/FiO2 ratio, plateau pressure, vasopressor use, and steroid use.

Conclusions:

• Low tidal volume ventilation and adequate PEEP were underutilized in Asian ARDS patients.
• Most non-ARDS patients received intermediate tidal volumes.
• Country income, patient age, and severity of illness were significant determinants of mortality.