Pressure support ventilation in intensive care patients receiving prolonged invasive ventilation.

Journal: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
Published Date: Oct 18, 2023

Abstract

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. To collect and analyse data on the use and management of PSV in critically ill patients receiving prolonged ventilation. We performed a multicentre retrospective observational study in Australia, with a focus on PSV in patients ventilated for ≥ 7 days. We obtained detailed data on ventilator management twice daily (8am and 8pm moments) for the first 7 days of ventilation. 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 cmHO (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 < 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. 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 over-assistance. These observations provide evidence that can be used to inform interventional studies of PSV management.

Authors

  • Wisam Al-Bassam
    Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
  • Tapan Parikh
    Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
  • Ary Serpa Neto
    Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
  • Yamamah Idrees
    Department of Intensive Care, Ballarat Base Hospital, Ballarat, VIC, Australia.
  • Mark A Kubicki
    Department of Intensive Care, Ballarat Base Hospital, Ballarat, VIC, Australia.
  • Carol L Hodgson
    Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.
  • Ashwin Subramaniam
    Department of Intensive Care, Frankston Hospital, Melbourne, VIC, Australia.
  • Mallikarjuna Ponnapa Reddy
    Department of Intensive Care, Frankston Hospital, Melbourne, VIC, Australia.
  • Navya Gullapalli
    School of Medicine, Monash University, Melbourne, VIC, Australia.
  • Claire Michel
    Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Madeline Coxwell Matthewman
    Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Jack Naughton
    Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Jason Pereira
    Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.
  • Yahya Shehabi
    Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
  • Rinaldo Bellomo
    Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

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