Third International Study on Mechanical Ventilation

Mechanical ventilation is commonly used in patients admitted to intensive care units.
Clinical studies have investigated some of the aspects associated with its utilization, and
have contributed to improve the knowledge and management of patients with acute respiratory
failure. In 1998 the invesgtigators conducted the first international study on mechanical
ventilation, including 5183 patients who were mechanically ventilated longer than 12 hours
(Esteban A. JAMA 2002). Six years later, the investigators carried out the second
international study on mechanical ventilation including 4968 patients. These studies allowed
us to analyze the evolution of mechanical ventilation and to judge the concordance of
practice with results of randomized trials (Esteban A. Am J Respir Crit Care 2008). The main
finding of this study was the high degree of concordance between observed changes in
mechanical ventilation practice and changes predicted from reports of randomized controlled
trials. However, despite apparently beneficial changes in ventilatory practice, the
investigators were not able to detect significant differences in clinical outcomes over this
time period. Our results serve as an updated benchmark on the usual care and outcomes of
mechanically ventilated patients in a 'real-world' setting.

The investigators now propose to conduct a third international study of mechanical
ventilation, 6 years after the 2nd study and 12 years after the original. This will again be
a prospective, multicenter single-cohort study, which will enroll consecutive patients who
have received mechanical ventilation for at least 12 hours during a 1-month period, and will
follow each patient for the duration of mechanical ventilation, up to 28 days. With this 3rd
study the investigators aim: 1) to determine if the observed changes that the investigators
reported previously are maintained over time; 2) to evaluate if the changes implemented have
impacted outcomes; 3) to analyze some aspects related to withdrawal of mechanical
ventilation; and implementation non-invasive positive pressure ventilation; and 4) to
evaluate what differences may occur between geographical areas.

Inclusion Criteria:

- Patients who are admitted to the intensive care unit and require invasive mechanical
ventilation (endotracheal tube or tracheostomy) for more than 12 hours.

- Patients who are admitted to the intensive care unit and require non-invasive
mechanical ventilation (BIPAP or CPAP with nasal or facial mask) for more than 1 hour.

Exclusion Criteria:

- Patients less than 18 years old