Purpose: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. Design: Post-hoc analysis of four cohort studies. Ambit: 138 Spanish ICUs. Patients: 2141 patients scheduled extubated. Interventions: None. Variables of interest: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. Results: There was a significant increase (p < 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) andfor difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attemptat disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435). Conclusions: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed. (C) 2021 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.

Purpose: To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. Design: A post hoc analysis of four cohort studies was carried out. Setting: A total of 138 Spanish ICUs. Patients: A sample of 4293 patients requiring invasive mechanical ventilation for more than 12 h or noninvasive ventilation for more than 1 h. Interventions: None. Variables of interest: Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. Results: There was an increase in severity (SAPS II: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p < 0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9 ml/kg actual b.w. in 1998 and 6.6 ml/kg in 2016; p < 0.001) as well as an increase in PEEP (3 cmH(2)O in 1998 and 6 cmH(2)O in 2016; p < 0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p < 0.001), without geographical variability (median OR 1.43; p = 0.258). Conclusions: A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury. (C) 2020 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.Y

Evaluar cambios en la epidemiología de la ventilación mecánica en España desde 1998 hasta 2016. Análisis post-hoc de 4 estudios de cohortes. Un total de 138 UCI españolas. Un total de 4.293 enfermos con ventilación mecánica invasiva más de 12 h o no invasiva más de 1 h. Ninguna. Demográficas, motivo de ventilación mecánica, relacionadas con el soporte ventilatorio (modo de ventilación, volumen tidal, PEEP, presiones en vía aérea), complicaciones, duración de la ventilación mecánica, estancia y mortalidad en la UCI. Se observa aumento en la gravedad (SAPS II: 43 puntos en 1998 frente a 47 puntos en 2016), cambios en el motivo de la ventilación mecánica (disminución de la enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria secundaria a traumatismo y aumento de la patología neurológica y tras parada cardiaca). Aumento en la ventilación no invasiva como primer modo de soporte ventilatorio (p < 0,001). El modo más utilizado es la ventilación controlada por volumen con un aumento de la presión de soporte y de la ventilación controlada por volumen regulada por presión. Disminuyó el volumen tidal (9 ml/kg de peso estimado en 1998 y 6,6 ml/kg en 2016, p < 0,001) y aumentó la PEEP (3 cmH2O en 1998 y 6 cmH2O en 2016, p < 0,001). La mortalidad disminuye (34% en 1998 y 27% en 2016; p < 0,001) sin variabilidad geográfica (MOR 1,43; p = 0,258). Se observa una disminución en la mortalidad de los enfermos ventilados en UCI españolas. Esta disminución podría estar relacionada con cambios para minimizar el daño inducido por el ventilador. To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. A post hoc analysis of four cohort studies was carried out. A total of 138 Spanish ICUs. A sample of 4293 patients requiring invasive mechanical ventilation for more than 12 h or noninvasive ventilation for more than 1 h. None. Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. There was an increase in severity (SAPS II: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p < 0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9 ml/kg actual b.w. in 1998 and 6.6 ml/kg in 2016; p < 0.001) as well as an increase in PEEP (3 cmH2O in 1998 and 6 cmH2O in 2016; p < 0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p < 0.001), without geographical variability (median OR 1.43; p = 0.258). A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.