"Likely overassistance" during invasive pressure support ventilation in patients in the intensive care unit

a multicentre prospective observational study

Wisam Al-Bassam, Fabian Dade, Michael Bailey, Glenn Eastwood, Eduardo Osawa, Chris Eyeington, James Anesty, 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 & 2 others Yahya Shehabi, Rinaldo Bellomo

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2 Citations (Scopus)

Abstract

OBJECTIVE: To 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. DESIGN: Multicentre prospective observational study of invasive PSV practice in six general Victorian intensive care units with blinding of staff members to data collection. PATIENTS: At 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 RESULTS: We 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. CONCLUSION: In 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.

Original languageEnglish
Pages (from-to)18-24
Number of pages7
JournalCritical Care and Resuscitation
Volume21
Issue number1
Publication statusPublished - 1 Mar 2019

Cite this

Al-Bassam, Wisam ; Dade, Fabian ; Bailey, Michael ; Eastwood, Glenn ; Osawa, Eduardo ; Eyeington, Chris ; Anesty, James ; Yi, George ; Ralph, Jolene ; Kakho, Nima ; Kurup, Vishnu ; Licari, Elisa ; King, Emma C ; Knott, Cameron ; Chimunda, Timothy ; Smith, Julie ; Subramaniam, Ashwin ; Reddy, Mallikarjuna ; Green, Cameron ; Parkin, Geoffrey ; Shehabi, Yahya ; Bellomo, Rinaldo. / "Likely overassistance" during invasive pressure support ventilation in patients in the intensive care unit : a multicentre prospective observational study. In: Critical Care and Resuscitation. 2019 ; Vol. 21, No. 1. pp. 18-24.
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title = "{"}Likely overassistance{"} during invasive pressure support ventilation in patients in the intensive care unit: a multicentre prospective observational study",
abstract = "OBJECTIVE: To 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. DESIGN: Multicentre prospective observational study of invasive PSV practice in six general Victorian intensive care units with blinding of staff members to data collection. PATIENTS: At 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 RESULTS: We 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. CONCLUSION: In 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.",
author = "Wisam Al-Bassam and Fabian Dade and Michael Bailey and Glenn Eastwood and Eduardo Osawa and Chris Eyeington and James Anesty and George Yi and Jolene Ralph and Nima Kakho and Vishnu Kurup and Elisa Licari and King, {Emma C} and Cameron Knott and Timothy Chimunda and Julie Smith and Ashwin Subramaniam and Mallikarjuna Reddy and Cameron Green and Geoffrey Parkin and Yahya Shehabi and Rinaldo Bellomo",
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language = "English",
volume = "21",
pages = "18--24",
journal = "Critical Care and Resuscitation",
issn = "1441-2772",
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"Likely overassistance" during invasive pressure support ventilation in patients in the intensive care unit : a multicentre prospective observational study. / Al-Bassam, Wisam; Dade, Fabian; Bailey, Michael; Eastwood, Glenn; Osawa, Eduardo; Eyeington, Chris; Anesty, James; Yi, George; Ralph, Jolene; Kakho, Nima; Kurup, Vishnu; Licari, Elisa; King, Emma C; Knott, Cameron; Chimunda, Timothy; Smith, Julie; Subramaniam, Ashwin; Reddy, Mallikarjuna; Green, Cameron; Parkin, Geoffrey; Shehabi, Yahya; Bellomo, Rinaldo.

In: Critical Care and Resuscitation, Vol. 21, No. 1, 01.03.2019, p. 18-24.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - "Likely overassistance" during invasive pressure support ventilation in patients in the intensive care unit

T2 - a multicentre prospective observational study

AU - Al-Bassam, Wisam

AU - Dade, Fabian

AU - Bailey, Michael

AU - Eastwood, Glenn

AU - Osawa, Eduardo

AU - Eyeington, Chris

AU - Anesty, James

AU - Yi, George

AU - Ralph, Jolene

AU - Kakho, Nima

AU - Kurup, Vishnu

AU - Licari, Elisa

AU - King, Emma C

AU - Knott, Cameron

AU - Chimunda, Timothy

AU - Smith, Julie

AU - Subramaniam, Ashwin

AU - Reddy, Mallikarjuna

AU - Green, Cameron

AU - Parkin, Geoffrey

AU - Shehabi, Yahya

AU - Bellomo, Rinaldo

PY - 2019/3/1

Y1 - 2019/3/1

N2 - OBJECTIVE: To 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. DESIGN: Multicentre prospective observational study of invasive PSV practice in six general Victorian intensive care units with blinding of staff members to data collection. PATIENTS: At 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 RESULTS: We 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. CONCLUSION: In 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.

AB - OBJECTIVE: To 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. DESIGN: Multicentre prospective observational study of invasive PSV practice in six general Victorian intensive care units with blinding of staff members to data collection. PATIENTS: At 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 RESULTS: We 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. CONCLUSION: In 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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M3 - Article

VL - 21

SP - 18

EP - 24

JO - Critical Care and Resuscitation

JF - Critical Care and Resuscitation

SN - 1441-2772

IS - 1

ER -