Change in management and outcome of mechanical ventilation in Korea: a prospective observational study

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 six year since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data.

Results: 226 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 vs. 7.4 ml/kg, p = 0.372) and positive end-expiratory pressure (6 vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 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.