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Abstract
BACKGROUND: Adaptive pressure control–continuous mandatory ventilation (APC-CMV) is a frequently utilized ventilator mode in ICU settings. This analysis compared APC-CMV and traditional volume control–continuous mandatory ventilation (VC-CMV) mode, describing factors associated with initiation, maintenance, and changes in settings of each mode.
METHODS: We analyzed ventilator data from a retrospective electronic health record data set collected as part of a quality improvement project in a single academic ICU. The majority ventilator mode was defined as the mode comprising the highest proportion of mechanical ventilation time. Multivariable logistic regression was used to identify variables associated with initial and majority APC-CMV or VC-CMV modes. Wilcoxon rank-sum tests were used to compare ventilator setting changes/d and sedation as a function of APC-CMV and VC-CMV majority modes.
RESULTS: Among 1,213 subjects initiated on mechanical ventilation from January 2013–March 2017, 68% and 24% were initiated on APC-CMV and VC-CMV, respectively, which composed 62% and 21% of the majority ventilator modes. Age, sex, race, and ethnicity were not associated with the initial or majority APC-CMV or VC-CMV modes. Subjects initiated on APC-CMV spent 88% of the mechanical ventilation time on APC-CMV mode. Compared to VC-CMV, subjects with APC-CMV majority mode experienced more ventilator setting changes/d (1.1 vs 0.8, P < .001). There were no significant differences in sedative medications when comparing subjects receiving APC-CMV versus VC-CMV majority modes.
CONCLUSIONS: APC-CMV was highly utilized in the medical ICU. Subjects on APC-CMV had more ventilator setting changes/d than those on VC-CMV. APC-CMV offered no advantage of reduced setting adjustments or less sedation compared to VC-CMV.
- ventilators
- mechanical: respiration
- artificial: ICUs
- respiratory insufficiency
- critical illness
- observational study
Footnotes
- Correspondence: Linh N Tran MD, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, 9300 Campus Point Drive #7381, La Jolla, CA 92093. E-mail: Lit004{at}ucsd.edu
Dr Malhotra discloses relationships with LivaNova, Jazz Zoll, and Eli Lilly. Dr Buhr discloses relationships with Viatris/Theravance Biopharma and DynaMed/American College of Physicians. Dr Martin discloses relationship with the American Academy of Sleep Medicine. The remaining authors have disclosed no conflicts of interest.
Dr Tran is supported by a Diversity, Equity, Inclusion, and Accessibility in Mentoring Supplement (National Institutes of Health [NIH]/National Institute of Allergy and Infectious Diseases [NIAID] K76 AG059936-05S1). Dr Kamdar is supported by the NIH/NIAID (K76 AG059936). Dr Buhr is supported by NIH/National Center for Advancing Translational Sciences (KL2 TR001882) and the NIH/National Heart, Lung, and Blood Institute (NHLBI) (L30 HL134025). Dr Malhotra is supported by the NIH. Dr Martin is supported by the NIH/NHLBI (K24 HL143055) and the Veterans Health Administration (HSR&D Service Research Career Scientist Award RCS 20–191).
This study was performed at University of California, Los Angeles, Los Angeles, California; and University of California, San Diego, San Diego, California.
Supplementary material related to this paper is available at http://www.rcjournal.com.
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