title: Evolution of mechanical ventilation in response to clinical research.
abstract: BACKGROUND
  Recent literature in mechanical ventilation includes strong evidence from randomized trials. Little information is available regarding the influence of these trials on usual clinical practice.
  
  
  OBJECTIVE
  To describe current mechanical ventilation practices and to assess the influence of interval randomized trials when compared with findings from a 1998 cohort.
  
  
  METHODS
  A prospective international observational cohort study, with a nested comparative study performed in 349 intensive care units in 23 countries. We enrolled 4,968 consecutive patients receiving mechanical ventilation over a 1-month period. We recorded demographics and daily data related to mechanical ventilation for the duration of ventilation. We systematically reviewed the literature and developed 11 practice-change hypotheses for the comparative cohort study before seeing these results. In assessing practice changes, we only compared data from the 107 intensive care units (1,675 patients) that also participated in the 1998 cohort (1,383 patients).
  
  
  RESULTS
  In 2004 compared with 1998, the use of noninvasive ventilation increased (11.1 vs. 4.4%, P < 0.001). Among patients with acute respiratory distress syndrome, tidal volumes decreased (7.4 vs. 9.1 ml/kg, P < 0.001) and positive end-expiratory pressure levels increased slightly (8.7 vs. 7.7 cm H(2)O, P = 0.02). More patients were successfully extubated after their first attempt of spontaneous breathing (77 vs. 62%, P < 0.001). Use of synchronized intermittent mandatory ventilation fell dramatically (1.6 vs. 11%, P < 0.001). Observations confirmed 10 of our 11 practice-change hypotheses.
  
  
  CONCLUSIONS
  The strong concordance of predicted and observed practice changes suggests that randomized trial results have advanced mechanical ventilation practices internationally.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, 28905 Getafe, Madrid, Spain. aesteban@ucigetafe.com
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: Carlos
authors.initials: C
authors.lastname: Apezteguia
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nin
authors.forename: Javier
authors.initials: J
authors.lastname: Hurtado
authors.forename: Vinko
authors.initials: V
authors.lastname: Tomicic
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.forename: José
authors.initials: J
authors.lastname: Elizalde
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.forename: Rui
authors.initials: R
authors.lastname: Moreno
authors.forename: Manuel
authors.initials: M
authors.lastname: Jibaja
authors.forename: Gabriel
authors.initials: G
authors.lastname: D'Empaire
authors.forename: Fredi
authors.initials: F
authors.lastname: Sandi
authors.forename: Dimitros
authors.initials: D
authors.lastname: Matamis
authors.forename: Ana María
authors.initials: AM
authors.lastname: Montañez
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: D035843:Biomedical Research; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods* / Q000639:trends; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012196:Review Literature as Topic; D014600:Utilization Review; D015300:Ventilator Weaning