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(Chest. 1994;106:1188-1193.)
© 1994 American College of Chest Physicians

Modes of Mechanical Ventilation and Weaning

A National Survey of Spanish Hospitals

Andrés Esteban MD, PhD1; Inmaculada Alía MD1; Jordi Ibañez MD2; Salvador Benito MD, PhD, FCCP3; Martin J. Tobin MD, FCCP4; and ;the Spanish Lung Failure Collaborative Group

1 From the Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain
2 From the Intensive Care Unit, Hospital Son Dureta, Palma de Mallorca, Spain
3 From the Intensive Care Unit, Hospital de la Santa Cruz y San Pablo, Barcelona. Spain
4 From the Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine

Little information exists regarding the proportion of patients treated with mechanical ventilation in intensive care unis (ICUs), their underlying disease states, the modes of ventilation used, duration of ventilator support, methods and time required for weaning, and mortality in these patients. We carried out a cross-sectional multicenter study in 47 medical-surgical ICUs in Spain to investigate these issues in 290 patients who required mechanical ventilation for at least 24 hs. Relative frequency of different modes was as follows: assist-control ventilatin (AC), 55%; synchronized intermittent mandatory ventilation (SIMV), 26%; pressure support ventilation (PSV), 8%; SIMV plus PSV, 8%; pressure-controlled venilation (PCV), 1%; and continuous positive airway pressure (CPAP), 2%. Overall duration of mechanical ventilation was 27.1 ± 1.1 (SE). A variety of techniques were used for weaning: T-tube trials, 24%; SIMV, 18%; PSV, 15%; SIMV plus PSV, 9%; and some combination of two or more methods in succession in 33% of the patients. Time required for weaning using a combination of SIMV and PSV was longer (17.8 days) than with other techniques (about 5 days, p<0.01). Time between initiation of weaning and removal of mechanical cal ventilation accounted for 41% of total ventilator time and was particularly high (59%) in patients with chronic obstructive pulmonary disease. Overall mortality rate was 34%, and it was higher in patients who were ventilated for 1 to 10 days than in those ventilated for a longer time. Despite the availability of several new modes of ventilator support, older modes such as AC and SIMV were more commonly used. Weaning constitutes a large portion of total ventilator time, and thus, measures that expedite the weaning process should markedly decrease the duration of mechanical ventilation.

Key Words: critical illness • intensive care units • mortality

Submitted on October 4, 1993
Accepted on April 28, 1994




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