Ventilator treatment in the Nordic countries. A multicenter survey

Sigurbergur Kárason, K. Antonsen, A. Åneman, Alma Möller, Anders Åvall, Anders Samuelsson, Ásbjörn Blöndal, Felix Valsson, Heba Shemais, Henrik Christensen, Jón Bragi Bergmann, Jonas Claesson, Jouko Laurilla, Kim M. Larsen, Kristinn Sigvaldason, Kurt Knudsen, Lars Quist, Martin Skielboe, Ole Kristian Rolfseng, Patrik Rossi & 5 others Peter Stjernholm, Roman Sarbonovski, Seppo Hovilehto, Sten Walther, Tero Varpula

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

Background: A 1-day point prevalence study was performed in the Nordic countries to identify ventilator-treatment strategies in the region. Material and methods: On 30 May 30 2001 all mechanically ventilated patients in 27 intensive care units (ICUs) were registered via the internet. The results are shown as medians (25th, 75th percentile). Results: One hundred and eight patients were included (69% male) with new simplified acute physiology score (SAPS) 48 (37, 57) and 4.5 d (2, 11) of ventilator treatment. The most frequent indication for ventilator treatment was acute respiratory failure (73%). Airway management was by endotracheal tube (64%), tracheostomy (32%) and facial mask (4%). Pressure regulated ventilator modes were used in 86% of the patients and spontaneous triggering was allowed in 75%. The tidal volume was 7ml/kg (6, 9), peak inspiratory pressure 22cmH2O (18, 26) and positive end-expiratory pressure (PEEP) 6cmH2O (6, 9). FiO2 was 40% (35, 50), SaO2 97% (95-98), PaO2 11 kPa (10, 13), PaCO2 5.4 kPa (4.7, 6.3), pH7.43 (7.38, 7.47) and BE 2.0mmol/1 (-0.5, 5). The PaO2/FiO2 ratio was 220 mmHg (166, 283). The peak inspiratory pressure (r=0.37), mean airway pressure (r=0.36), PEEP (r=0.33), tidal volume (r=0.22) and SAPS score (r=0.19) were identified as independent variables in relation to the PaO2/FiO2 ratio. Conclusion: The vast majority of patients were ventilated with pressure-regulated modes. Tidal volume was well below what has been considered conventional in recent large trials. Correlations between the parameters of gas exchange, respiratory mechanics, ventilator settings and physiological status of the patients was poor. It appears that blood gas values are the main tool used to steer ventilator treatment. These results may help to design future interventional studies of ventilator treatment.

Original languageEnglish
Pages (from-to)1053-1061
Number of pages9
JournalActa Anaesthesiologica Scandinavica
Volume46
Issue number9
DOIs
Publication statusPublished - 2002

Keywords

  • Intensive care unit
  • Mechanical ventilation
  • Recruitment maneuvers
  • Respiratory failure
  • Tidal volume
  • Ventilator settings

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