Survey of Respiratory Support for Intensive Care Patients in 10 Tertiary Hospital of Thailand
Kaweesak Chittawatanarat MD, PhD*1, Kanwan Jaikriengkrai MD*2, Chairat Permpikul MD*3, Thai Society of Critical Care Medicine Study group*4
Affiliation : *1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *2 Fellow of Critical Care Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *3 Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand *4 The Thai Society of Critical Care Medicine, Royal Jubilee Building, Bangkok, Thailand
Objective : There are varieties of clinical practices for intensive care respiratory support. However, there has been no
published report characterizing its current practice in Thailand. The present study was undertaken to characterize the
practice of respiratory support for intensive care patients in Thai tertiary hospitals.
Material and Method: A cross-sectional survey and retrospective historical cohort of intensive care units (ICUs) was
performed on May 30, 2011 from ten tertiary hospitals in Thailand. The participating ICUs were asked to complete the
following data of all patients who were mechanically ventilated in the ICUs: demographic data, characteristics of respiratory
support, ICU type, causes of respiratory failure, and weaning technique.
Results : A total of 258 patients from ten tertiary hospitals were included and analyzed. The medical ICU patients remained in
the ICU significantly longer than patients in other ICUs. Patients in surgical ICUs were significantly younger than patients in
other ICUs. The prevalence of mechanically ventilated patients in this survey was 64.7% with a significantly higher proportion
in the medical ICUs. The median of ventilator days was also significantly higher in the medical ICUs. An invasive ventilator
was more commonly used in all ICUs rather than non-invasive ventilators. The three common causes of respiratory support
were severe sepsis or septic shock, respiratory failure and post-operation, respectively. Volume-controlled continuous
mandatory ventilation (VC-CMV) ventilation was more commonly used as the initial mode of ventilation in both surgical and
medical ICUs. The maximum plateau pressure was significantly higher in the medical ICU patients but there were no
differences in maximum tidal volume and PEEP level. One-third of the patients were in the weaning process, mostly in the
medical ICUs. Pressure support was the predominant weaning mode in the medical ICUs, while synchronized intermittent
mandatory ventilation (SIMV) was more predominant in the surgical ICUs. Protocol-based weaning was used in approximately
two-thirds of patients who were in the weaning process. With repeated estimation equation logistic model and left censors’
cohort to 28 days, the medical ICUs had significantly lower ventilator free overtime individual patients when compared with
surgical ICUs, while there was no difference within mixed ICUs.
Conclusion : The VC-CMV was more commonly used as the initial mode of ventilation in both surgical and medical ICUs.
Pressure support was the predominant weaning mode in the medical ICUs, while SIMV was more predominant in the surgical
ICUs. Individual patients in medical ICU had a greater number of ventilator days and less probability of being ventilator-
free.
Keywords : Ventilatory support, Thai ICUs, Weaning of ventilator, Mode of ventilation
