• Wisam Al-Bassam, Fabien Dade, Michael Bailey, Glenn Eastwood, Eduardo Osawa, Chris Eyeington, James Anstey, George Yi, Jolene Ralph, Nima Kakho, Vishnu Kurup, Elisa Licari, Emma C King, Cameron Knott, Timothy Chimunda, Julie Smith, Ashwin Subramaniam, Mallikarjuna Reddy, Cameron Green, Geoffrey Parkin, Yahya Shehabi, and Rinaldo Bellomo.
• Monash Medical Centre, Melbourne, VIC, Australia. Wisam.AlBassam@monashhealth.org.au.
• Crit Care Resusc. 2019 Mar 1; 21 (1): 18-24.

ObjectiveTo evaluate the prevalence of "likely overassistance" (categorised by respiratory rate [RR] ≤ 17 breaths/min or rapid shallow breathing index [RSBI] ≤ 37 breaths/min/L) during invasive pressure support ventilation (PSV), and the additional prevalence of fixed ventilator settings.DesignMulticentre prospective observational study of invasive PSV practice in six general Victorian intensive care units with blinding of staff members to data collection.PatientsAt each hospital, investigators collected data between 11 am and 2 pm on all invasive PSV-treated patients on 60 sequential days, excluding weekends and public holidays, between 22 February and 30 August 2017. Each patient was included for maximum of 3 days.Main ResultsWe studied 231 patients, with a total of 379 observations episodes over the study period. There were 131 patients (56.7%) with at least one episode of RR ≤ 17 breaths/min; 146 patients (63.2%) with at least one episode of RSBI ≤ 37 breaths/min/L, and 85 patients (36.8%) with at least one episode of combined RR ≤ 17 breaths/min and RSBI ≤ 37 breaths/min/L. Moreover, the total number of observations with "likely overassistance" (RR ≤ 17 or RSBI ≤ 37 breaths/min/L) was 178 (47%) and 204 (53.8%), respectively; while for both combined criteria, it was 154 (40.6%). We also found that 10 cmH2O pressure support was delivered on 210 of the observations (55.4%) and adjusted in less than 25% of observations. Finally, less than half (179 observations) of all PSV-delivered tidal volumes (VT) were at the recommended value of 6-8 mL/kg predicted body weight (PBW) and more than 20% (79 observations) were at ≥ 10 mL/kg PBW.ConclusionIn a cohort of Victorian hospitals in Australia, during invasive PSV, "likely overassistance" was common, and the pressure support level was delivered in a standardised and unadjusted manner at 10 cmH2O, resulting in the frequent delivery of potentially injurious VT.

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