Pressure support ventilation in intensive care patients receiving prolonged invasive ventilation

Wisam Al-Bassam; Tapan Parikh; Ary Serpa Neto; Yamamah Idrees; Mark A Kubicki; Carol L Hodgson; Ashwin Subramaniam; Mallikarjuna Ponnapa Reddy; Navya Gullapalli; Claire Michel; Madeline Coxwell Matthewman; Jack Naughton; Jason Pereira; Yahya Shehabi; Rinaldo Bellomo

doi:10.51893/2021.4.OA4

Pressure support ventilation in intensive care patients receiving prolonged invasive ventilation

Crit Care Resusc. 2023 Oct 18;23(4):394-402. doi: 10.51893/2021.4.OA4. eCollection 2021 Dec 6.

Authors

Wisam Al-Bassam¹, Tapan Parikh¹, Ary Serpa Neto^{2

3

4}, Yamamah Idrees⁵, Mark A Kubicki⁵, Carol L Hodgson⁶, Ashwin Subramaniam⁷, Mallikarjuna Ponnapa Reddy⁷, Navya Gullapalli⁸, Claire Michel⁹, Madeline Coxwell Matthewman⁹, Jack Naughton⁹, Jason Pereira⁶, Yahya Shehabi^{1

10}, Rinaldo Bellomo^{2

4

9

11}

Affiliations

¹ Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
² Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
³ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
⁴ Data Analytics Research and Evaluation Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Intensive Care, Ballarat Base Hospital, Ballarat, VIC, Australia.
⁶ Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.
⁷ Department of Intensive Care, Frankston Hospital, Melbourne, VIC, Australia.
⁸ School of Medicine, Monash University, Melbourne, VIC, Australia.
⁹ Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
¹⁰ Department of Surgery, Monash University, Melbourne, VIC, Australia.
¹¹ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.

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.