TY - JOUR
T1 - Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico
AU - Investigadores en el primer estudio (1998)
AU - Investigadores en el segundo estudio (2004)
AU - Investigadores en el tercer estudio (2010)
AU - Investigadores en el cuarto estudio (2016)
AU - Marín, M. C.
AU - Elizalde, J.
AU - Villagómez, A.
AU - Cerón, U.
AU - Poblano, M.
AU - Palma-Lara, I.
AU - Sánchez, J. R.
AU - Monares, E.
AU - Arellano, A.
AU - Muriel, A.
AU - Peñuelas,
AU - Frutos-Vivar, F.
AU - Esteban, A.
AU - Aguilera Almazán, F.
AU - Benítez Cortázar, M.
AU - Carrillo Speare, R.
AU - Castaño, R.
AU - Corral, R.
AU - D́Ector Lira, D. N.
AU - Díaz Polanco, G.
AU - Elizalde, J. J.
AU - Envila Fisher, R.
AU - Franco, G.
AU - García Balbuena, P.
AU - Gayoso Cruz, O.
AU - Green, L.
AU - Herrera Hoyos, J. O.
AU - Hinojosa, J.
AU - Huerta, J.
AU - Juárez, V. A.
AU - Loera, M.
AU - López Alzate, C.
AU - López Mora, E.
AU - Martínez Caro, S.
AU - Méndez Reyes, R.
AU - Mendoza, M.
AU - Narváez Porras, O.
AU - Ortiz, E.
AU - Padua, A.
AU - Pureco Reyes, V.
AU - Querevalum, W.
AU - Quesada, A.
AU - Ramírez Rivera, A.
AU - Tamariz, A.
AU - Vargas, A.
AU - Vázquez, C.
AU - Cerda, P.
AU - Mercado, R.
AU - Albe Castañón, J.
AU - Villagómez Ortiz, A. J.
N1 - Publisher Copyright:
© 2019 Elsevier España, S.L.U. y SEMICYUC
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objective: The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). Design: A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Setting: Intensive Care Units (ICUs) in Mexico. Participants: Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12 hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. Interventions: None. Principal variables of interest: Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. Results: A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5 ml/kg b.w. in 1998 to 6 ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9 ml/kg b.w. in 1998 to 6 ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6 ml/kg or < 8 ml/kg and a plateau pressure < 30 cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). Conclusions: The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.
AB - Objective: The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). Design: A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. Setting: Intensive Care Units (ICUs) in Mexico. Participants: Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12 hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. Interventions: None. Principal variables of interest: Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. Results: A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5 ml/kg b.w. in 1998 to 6 ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9 ml/kg b.w. in 1998 to 6 ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6 ml/kg or < 8 ml/kg and a plateau pressure < 30 cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). Conclusions: The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.
KW - Invasive mechanical ventilation
KW - Mortality
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85065977954&partnerID=8YFLogxK
U2 - 10.1016/j.medin.2019.03.010
DO - 10.1016/j.medin.2019.03.010
M3 - Artículo
C2 - 31130359
AN - SCOPUS:85065977954
SN - 0210-5691
VL - 44
SP - 333
EP - 343
JO - Medicina Intensiva
JF - Medicina Intensiva
IS - 6
ER -