Change in management and outcome of mechanical ventilation in Korea: a prospective observational study
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Background/Aims: There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. Methods: International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. Results: Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% vs. 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. Conclusions: There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.
Abstract
Background/Aims: There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. Methods: International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. Results: Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% vs. 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. Conclusions: There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.
참고문헌 (29)
- Esteban A, "Evolution of mortality over time in patients receiving mechanical ventilation", Am J Respir Crit Care Med, 188, pp.220~230 (2013)
- Fan E, "An official American Thoracic Society", European Society of Intensive Care Medicine, Am J Respir Crit Care Med, pp.2017, 195[DOI]
- Esteban A, "Evolution of mechanical ventilation in response to clinical research", Am J Respir Crit Care Med, 177, pp.170~177 (2008)
- Esteban A, "Characteristics and outcomes in adult patients receiving mechanical ventilation : a 28-day international study", JAMA, 287, pp.345~355 (2002)
- 정병호, "Clinical Demographics and Outcomes in Mechanically Ventilated Patients in Korean Intensive Care Units", Journal of Korean Medical Science, 29(6), pp.864~870 (2014), 대한의학회
- Bernard GR, "The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination", Am J Respir Crit Care Med, 149(3 Pt 1), pp.818~824 (1994)
- ARDS Definition Task Force, "Acute respiratory distress syndrome : the Berlin Definition", JAMA, 307, pp.2526~2533 (2012)
- Garner JS, "CDC definitions for nosocomial infections, 1988", Am J Infect Control, 16, pp.128~140 (1988)
- Fan E, "An official American Thoracic Society Clinical Practice guideline : the diagnosis of intensive care unit-acquired weakness in adults", Am J Respir Crit Care Med, 190, pp.1437~1446 (2014)
- Vincent JL, "The SOFA(Sepsis-related Organ Failure Assessment)score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Bone RC, "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP", SCCM Consensus Conference Committee. American College of Chest Physicians, Chest, pp.1992, 101[DOI]
- Demoule A, "Changing use of noninvasive ventilation in critically ill patients : trends over 15 years in francophone countries", Intensive Care Med, 42, pp.82~92 (2016)
- Maheshwari V, "Utilization of noninvasive ventilation in acute care hospitals : a regional survey", Chest, 129, pp.1226~1233 (2006)
- Rittayamai N, "Pressure-controlled vs volume-controlled ventilation in acute respiratory failure : a physiology-based narrative and systematic review", Chest, 148, pp.340~355 (2015)
- Chacko B, "Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury(ALI)or acute respiratory distress syndrome(ARDS)", Cochrane Database Syst Rev, 1, pp.CD008807~ (2015)
- 장항제, "국내 중환자실에서 72시간 이상 인공호흡기 치료를 받는 환자들의 진정제, 진통제 및 근이완제 사용 실태에 대한 전향적 다 기관 공동 조사연구", Acute and Critical Care, 24(3), pp.145~151 (2009), 대한중환자의학회
- Barr J, "Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit", Crit Care Med, 41, pp.263~306 (2013)
- Kim HH, "Analysis of trends in usage of analgesics and sedatives in intensive care units of South Korea: a retrospective nationwide population-based study", Medicine(Baltimore), 97, pp.e12126~ (2018)
- "Crit Care", 2004, R1~R11
- Girard TD, "Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care(Awakening and Breathing Controlled trial) : a randomised controlled trial", Lancet, 371, pp.126~134 (2008)
- Maggiore SM, "Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome", Am J Respir Crit Care Med, 190, pp.282~288 (2014)
- Rittayamai N, "High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation : a randomized crossover physiologic study", Respir Care, 59, pp.485~490 (2014)
- Frat JP, "High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure", N Engl J Med, 372, pp.2185~2196 (2015)
- 임채만, "Critical Care In Korea: Present and Future", Journal of Korean Medical Science, 30(11), pp.1540~1544 (2015), 대한의학회
- The Korean Society of Critical Care Medicine White Paper: report on the status of intensive care units in Korea No.2 2015, "The Korean Society of Critical Care Medicine, Committee on White Paper Publication", The Korean Society of Critical Care Medicine, ~ (2015)
- Jeongwon Heo, "Changes in the Characteristics and Long-term Mortality Rates of Intensive Care Unit Patients from 2003 to 2010: A Nationwide Population-Based Cohort Study Performed in the Republic of Korea", Acute and Critical Care, 33(3), pp.135~145 (2018), 대한중환자의학회[DOI]
- Guerin C, "Prone positioning in severe acute respiratory distress syndrome", N Engl J Med, 368, pp.2159~2168 (2013)
- Farhan H, "Acquired muscle weakness in the surgical intensive care unit : nosology, epidemiology, diagnosis, and prevention", Anesthesiology, 124, pp.207~234 (2016)
- Owen GD, "International analgesia, sedation, and delirium practices : a prospective cohort study", J Intensive Care, 7, pp.25~ (2019)