Mechanical ventilation practices in Asian intensive care units: A multicenter cross-sectional study

Nam K.H. Phua J. Du B. Ohshimo S. Kim H.J. Lim C.-M. Myatra S.N. Adib N.A.B.N. Arabi Y.M. Chan M.-C. Faruq M.O. Redjeki I.S. Son D.N. Nafees K.M.K. Priyankara D. Patjanasoontorn B. Palo J.E. Konkayev A. Shrestha G.S. Koh Y.
February 2024 W.B. Saunders

Journal of Critical Care
2024 #79

Purpose: This study investigated current practices of mechanical ventilation in Asian intensive care units, focusing on tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP). Materials and methods: In this multicenter cross-sectional study, data on mechanical ventilation and clinical outcomes were collected. Predictors of mortality were analyzed by univariate and multivariable logistic regression. A scoring system was generated to predict 28-day mortality. Results: A total of 1408 patients were enrolled. In 138 patients with acute respiratory distress syndrome (ARDS), 65.9% were on a tidal volume ≤ 8 ml/kg predicted body weight (PBW), and 71.3% were on sufficient PEEP. In 1270 patients without ARDS, 88.8% were on a tidal volume ≤ 10 ml/kg PBW. A plateau pressure < 30 cmH₂O was measured in 92.2% of patients. Mortality rates increased from 13% to 74% as the generated predictive score increased from 5 to ≥8.5. Income classification, age, SOFA score, PaO₂/FiO₂ ratio, plateau pressure, number of vasopressors, and steroid use were associated with mortality. Conclusions: In Asia, low tidal volume ventilation and sufficient PEEP were underused in patients with ARDS. The majority of patients without ARDS were on intermediate tidal volumes. Country income, age, and severity of illness were associated with mortality.

Asia , Low tidal volumes , Lung-protective ventilation , Mechanical ventilation

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Department of Critical Care Medicine, Seongnam Citizens Medical Center, Seongnam, South Korea
FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
State Key Laboratory of Complex, Severe, and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing, China
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Department of Clinical Epidemiology and Biostatistics, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Critical Care Medicine and Emergency Medicine, United Medical College and United Hospital, Dhaka, 1212, Bangladesh
Faculty of Medicine, Department of Anesthesiology and Intensive Care, Padjadjaran University, Dr. Hasan Sadikin National Referral Hospital Bandung, Bandung, Indonesia
Center for Critical Care Medicine, Bach Mai Hospital, University of Medicine and Pharmacy, Hanoi National University, Viet Nam
RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
Critical Care Medicine, National Hospital of Sri Lanka, Sri Lanka
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
Anaesthesia and ICU Department, Astana Medical University, Institution of Traumatology and Orthopedics, Nur-Sultan, Kazakhstan
Department of Critical Care Medicine Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
National Chung Hsing University, Taichung, Taiwan

Department of Critical Care Medicine
FAST and Chronic Programmes
State Key Laboratory of Complex
Department of Emergency and Critical Care Medicine
Department of Clinical Epidemiology and Biostatistics
Department of Pulmonary and Critical Care Medicine
Department of Anaesthesiology
Hospital Sultanah Nur Zahirah
King Saud Bin Abdulaziz University for Health Sciences
Division of Critical Care and Respiratory Therapy
Critical Care Medicine and Emergency Medicine
Faculty of Medicine
Center for Critical Care Medicine
RIPAS Hospital
Critical Care Medicine
Division of Respiratory and Critical Care Medicine
Acute and Critical Care Institute
Anaesthesia and ICU Department
Department of Critical Care Medicine Institute of Medicine
Division of Respiratory and Critical Care Medicine
National Chung Hsing University

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