Spectrum of Use of Mechanical Ventilation in the Intensive Care Unit

Abstract

Background:

Mechanical ventilation is a lifesaving intervention provided by most hospitals. Despite its wide usage, its application can vary significantly among institutions, and particularly between countries. There are many options when it comes to selecting a ventilator, its modes, and settings that may affect the quality of care and comfort of the patient. The purpose of this study was to determine the spectrum of use of mechanical ventilation in intensive care units in different parts of the world.

Methods:

This cross-sectional survey was created using Google Forms and included 57 items examining demographic information and the implementation of mechanical ventilation. It was distributed internationally via social media to clinicians with mechanical ventilation responsibilities in adult ICUs between February and April 2022. The Google Forms responses were routed to Google Sheets to perform analyses. Descriptive statistics were used to report the results. IRB approval was obtained.

Results:

A total of 453 responses were received. Most respondents were RTs (97.13%) and from North America (80%), followed by Asia (10%). The most widely utilized ventilators were Puritan Bennett (25%), Servo (22.3%), Drager (19.2%), Hamilton (15%), Avea (7.5%), and General Electric (7%). VC/AC (39.3%) was most used to initiate mechanical ventilation, followed by PRVC/AC (33.6%) and PC/AC (20.5%). Most participants (85.9%) reported using IBW to determine initial V_T and common initial settings were PEEP 5-8 cwp, Ti 0.8-1.2 sec, V_T 6-8 mL/g IBW, and ARDS V_T 6 mL/kg IBW. Wide variations were seen in initial settings for FIO₂, (mean 0.57; range 0.21-1.0) PS (52% titrate to V_T exhaled and 39% initiate at 10 cwp), and RR (mean 16; range: 10-18). Flow was the most common method used for triggering (89.8%) and more than half (54%) reported routinely selecting tube compensation. The most common weaning criteria selected were RSBI (19.5%) and NIF (12.9%) and the most common weaning methods were CPAP/PS (67%) and T-piece (12%). When considering extubation, 19.4% of respondents used the cuff leak test.

Conclusions:

The results of this international survey revealed that while initial selection of modes of ventilation varies, many of the primary ventilator parameters are set consistently across geographic areas.