Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34391
Title: Pressure support ventilation in intensive care patients receiving prolonged invasive ventilation.
Austin Authors: Al-Bassam, Wisam ;Parikh, Tapan;Neto, Ary Serpa;Idrees, Yamamah;Kubicki, Mark A ;Hodgson, Carol L;Subramaniam, Ashwin;Reddy, Mallikarjuna Ponnapa;Gullapalli, Navya;Michel, Claire;Matthewman, Madeline Coxwell;Naughton, Jack;Pereira, Jason;Shehabi, Yahya;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.;Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.;Data Analytics Research and Evaluation Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.
Department of Intensive Care, Ballarat Base Hospital, Ballarat, VIC, Australia.
Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.
Department of Intensive Care, Frankston Hospital, Melbourne, VIC, Australia.
School of Medicine, Monash University, Melbourne, VIC, Australia.
Intensive Care
Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.
Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.;Department of Surgery, Monash University, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.;Data Analytics Research and Evaluation Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.;Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.;Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Issue Date: 6-Dec-2021
Date: 2023
Publication information: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2021-12-06; 23(4)
Abstract: Background: To our knowledge, the use and management of pressure support ventilation (PSV) in patients receiving prolonged (≥ 7 days) invasive mechanical ventilation has not previously been described. Objective: To collect and analyse data on the use and management of PSV in critically ill patients receiving prolonged ventilation. Design, setting and participants: We performed a multicentre retrospective observational study in Australia, with a focus on PSV in patients ventilated for ≥ 7 days. Main outcome measures: We obtained detailed data on ventilator management twice daily (8am and 8pm moments) for the first 7 days of ventilation. Results: Among 143 consecutive patients, 90/142 (63.4%) had received PSV by Day 7, and PSV accounted for 40.5% (784/1935) of ventilation moments. The most common pressure support level was 10 cmH2O (352/780) observations [45.1%]) with little variation over time, and 37 of 114 patients (32.4%) had no change in pressure support. Mean tidal volume during PSV was 8.3 (7.0-9.5) mL/kg predicted bodyweight (PBW) compared with 7.5 (7.0-8.3) mL/kg PBW during mandatory ventilation (P < 0.001). For 74.6% (247/331) of moments, despite a tidal volume of more than 8 mL/kg PBW, the pressure support level was not changed. Among 122 patients exposed to PSV, 97 (79.5%) received likely over-assistance according to rapid shallow breathing index criteria. Of 784 PSV moments, 411 (52.4%) were also likely over-assisted according to rapid shallow breathing index criteria, and 269/346 (77.7%) having no subsequent adjustment of pressure support. Conclusions: In patients receiving prolonged ventilation, almost two-thirds received PSV, which accounted for 40.5% of mechanical ventilation time. Half of the PSV-treated patients were exposed to high tidal volume and two-thirds to likely over-assistance. These observations provide evidence that can be used to inform interventional studies of PSV management.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34391
DOI: 10.51893/2021.4.OA4
ORCID: 
Journal: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
Start page: 394
End page: 402
PubMed URL: 38046681
Type: Journal Article
Appears in Collections:Journal articles

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