• Wisam Al-Bassam, Tapan Parikh, NetoAry SerpaASAustralian 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 Centr, 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, and Rinaldo Bellomo.
• Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia.
• Crit Care Resusc. 2021 Dec 6; 23 (4): 394402394-402.

AbstractBackground: 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.© 2021 College of Intensive Care Medicine of Australia and New Zealand.

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