title: Ventilator setting in ICUs: comparing a Dutch with a European cohort.
abstract: BACKGROUND
  From data collected during the third International Study on Mechanical Ventilation (ISMV), we compared data from a Dutch cohort with a European cohort. We hypothesised that tidal volumes were smaller and applied positive end-expiratory pressure (PEEP) was higher in the Netherlands, compared with the European cohort. We also compared use of non-invasive ventilation (NIV) and outcomes in both cohorts.
  
  
  METHODS
  A post-hoc analysis of a prospective observational study of patients receiving mechanical ventilation.
  
  
  RESULTS
  Tidal volumes were smaller (7.6 vs. 8.1 ml÷kg predicted bodyweight) in the Dutch cohort and applied PEEP was higher (8 vs. 6 cm H2O). Fewer patients admitted in the Netherlands received NIV as first mode of mechanical ventilation (7.1 vs. 16.7%). Fewer patients in the Dutch cohort developed an ICU-acquired pneumonia (4.5 vs. 12.3%, p < 0.01) and sepsis (5.7 vs. 10.9%, p = 0.03), but more patients were diagnosed as having delirium (15.8 vs. 4.6%, p < 0.01). ICU and in-hospital mortality rates were 19% and 25%, respectively, in Dutch ICUs vs. 26% and 33% in Europe (p = 0.06 and 0.03).
  
  
  CONCLUSIONS
  Tidal volumes were smaller and applied PEEP was higher in the Dutch cohort compared with international data, but both Dutch and international patients received larger tidal volumes than recommended for prevention or treatment of acute respiratory distress syndrome. NIV as first mode of mechanical ventilation is less commonly used in the Netherlands. The incidence of ICU-acquired pneumonia is lower and of delirium higher in the Netherlands compared with international data.
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: M C O
authors.initials: MC
authors.lastname: van IJzendoorn
authors.forename: M
authors.initials: M
authors.lastname: Koopmans
authors.forename: U
authors.initials: U
authors.lastname: Strauch
authors.forename: S
authors.initials: S
authors.lastname: Heines
authors.forename: S
authors.initials: S
authors.lastname: den Boer
authors.forename: B M
authors.initials: BM
authors.lastname: Kors
authors.forename: P H J
authors.initials: PH
authors.lastname: van der Voort
authors.forename: P J W
authors.initials: PJ
authors.lastname: Dennesen
authors.forename: I
authors.initials: I
authors.lastname: van den Hul
authors.forename: E
authors.initials: E
authors.lastname: Alberts
authors.forename: P
authors.initials: P
authors.lastname: Egbers
authors.forename: A
authors.initials: A
authors.lastname: Esteban
authors.forename: F
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: M A
authors.initials: MA
authors.lastname: Kuiper
mesh_terms: D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011175:Positive-Pressure Respiration / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013990:Tidal Volume