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Title: Pressure support ventilation in intensive care patients receiving prolonged invasive ventilation.
Author: Al-Bassam, W.
Parikh, T.
Neto, A.
Idrees, Yamamah
Kubicki, M.
Hodgson, C.
Subramaniam, A.
Reddy, M.
Gullapalli, N.
Michel, C.
Matthewman, M.
Naughton, J.
Pereira, J.
Shehabi, Y.
Bellomo, R.
Issue Date: 2021
Publication Title: Critical Care and Resuscitation
Volume: 23
Issue: 4
Start Page: 394
End Page: 402
Abstract: Background: To our knowledge, the use and management of pressure support ventilation (PSV) in patients receiving prolonged (>= 7 days) invasive mechanical ventilation has not previously been described. <br /><br /> Objective: To collect and analyse data on the use and management of PSV in critically ill patients receiving prolonged ventilation. <br /><br /> Design, setting and participants: We performed a multicentre retrospective observational study in Australia, with a focus on PSV in patients ventilated for >= 7 days. Main outcome measures: We obtained detailed data on ventilator management twice daily (8am and 8pm moments) for the first 7 days of ventilation. <br /><br /> Results: Among 143 consecutive patients, 90/142 (63.4%) had received PSV by Day 7, and PSV accounted for 40.5% (784/1935) of ventilation moments. The most common pressure support level was 10 cmH2O (352/780) observations [45.1%]) with little variation over time, and 37 of 114 patients (32.4%) had no change in pressure support. Mean tidal volume during PSV was 8.3 (7.0-9.5) mL/kg predicted bodyweight (PBW) compared with 7.5 (7.0-8.3) mL/kg PBW during mandatory ventilation (P < 0.001). For 74.6% (247/331) of moments, despite a tidal volume of more than 8 mL/kg PBW, the pressure support level was not changed. Among 122 patients exposed to PSV, 97 (79.5%) received likely over-assistance according to rapid shallow breathing index criteria. Of 784 PSV moments, 411 (52.4%) were also likely over-assisted according to rapid shallow breathing index criteria, and 269/346 (77.7%) having no subsequent adjustment of pressure support. <br /><br /> Conclusions: In patients receiving prolonged ventilation, almost two-thirds received PSV, which accounted for 40.5% of mechanical ventilation time. Half of the PSV-treated patients were exposed to high tidal volume and two-thirds to likely overassistance. These observations provide evidence that can be used to inform interventional studies of PSV management.
Internal ID Number: 02383
Type: Journal Article
Appears in Collections:Research Output

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