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KMID : 0338420220370030618
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The Korean Journal of Internal Medicine
2022 Volume.37 No. 3 p.618 ~ p.630
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Change in management and outcome of mechanical ventilation in Korea: a prospective observational study
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Sim Jae-Kyeom
Lee Sang-Min
Kang Hyung-Koo
Kim Kyung-Chan
Kim Young-Sam
Kim Yun-Seong
Lee Won-Yeon
Park Sung-Hoon
Park So-Young
Park Ju-Hee
Sim Yun-Su
Lee Kwang-Ha
Lee Yeon-Joo
Lee Jin-Hwa
Lee Heung-Bum
Lim Chae-Man
Choi Won-Il
Hong Ji-Young
Song Won-Jun
Suh Gee-Young
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Abstract
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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.
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KEYWORD
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Respiration, artificial, Pain, Agitation, Ventilator weaning
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