Mechanical ventilation in Spain, 1998-2016: Epidemiology and outcomes

Abstract

Purpose: To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016.

Design: A post hoc analysis of four cohort studies was carried out.

Setting: A total of 138 Spanish ICUs.

Patients: A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h.

Interventions: None.

Variables of interest: Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality.

Results: There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p<0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9ml/kg actual b.w. in 1998 and 6.6ml/kg in 2016; p<0.001) as well as an increase in PEEP (3cmH₂O in 1998 and 6cmH₂O in 2016; p<0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p<0.001), without geographical variability (median OR 1.43; p=0.258).

Conclusions: A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.

Keywords: Epidemiology; Epidemiología; Mechanical ventilation; Mortalidad; Mortality; Variabilidad clínica; Variability; Ventilación mecánica.