Mechanical ventilation: epidemiological insights into current practices.
OBJECTIVE
To describe the trends in the results of epidemiological studies of mechanical ventilation.


RESULTS
Changes in population demographics have increased the incidence of mechanical ventilation. Higher age and comorbidity rates portend poorer outcomes of mechanical ventilation. The most common indication for initiation of mechanical ventilation is acute respiratory failure, including postoperative respiratory failure, pneumonia, sepsis, and acute respiratory distress syndrome. Patients with sepsis and acute respiratory distress syndrome have a much higher mortality risk than the rest of this population. Changes over time in the selection of modes of ventilation, tidal volumes, positive end-expiratory pressure levels, weaning strategies, and tracheostomy timing appear to accord with data from randomized controlled trials in the literature. However, despite these changes, observational studies have not detected a statistically significant change in adjusted mortality over time.


CONCLUSIONS
The burden of critical illness will likely continue to increase in the future. Evidence from randomized trials appears to have affected the management of mechanical ventilation, but adherence to evidence-based practices may not be ideal.
Goligher
Ewan
E
Interdepartmental Division of Critical Care Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Ferguson
Niall D
ND
D006801:Humans; D007362:Intensive Care Units; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000209:etiology