• M C Marín, J Elizalde, A Villagómez, U Cerón, M Poblano, I Palma-Lara, J R Sánchez, E Monares, A Arellano, A Muriel, Ó Peñuelas, F Frutos-Vivar, A Esteban, Investigadores en el primer estudio (1998), Investigadores en el segundo estudio (2004), Investigadores en el tercer estudio (2010), and Investigadores en el cuarto estudio (2016).
• Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México; Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
• Med Intensiva. 2020 Aug 1; 44 (6): 333-343.

ObjectiveThe main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV).DesignA retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out.SettingIntensive Care Units (ICUs) in Mexico.ParticipantsAdult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion.InterventionsNone.Principal Variables Of InterestAge, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital.ResultsA total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368).ConclusionsThe clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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