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.
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.
摘要：
背景：自适应压力控制-连续强制通气（APC-CMV）是ICU设置中经常使用的呼吸机模式。该分析比较了APC-CMV和传统的容量控制连续强制通气（VC-CMV）模式，描述与启动相关的因素，维护,以及每种模式的设置更改。
方法：我们分析了来自回顾性电子健康记录数据集的呼吸机数据，该数据集作为单个学术ICU质量改进项目的一部分而收集。多数呼吸机模式被定义为包含最高比例的机械通气时间的模式。多变量逻辑回归用于确定与初始和大多数APC-CMV或VC-CMV模式相关的变量。Wilcoxon秩和检验用于比较呼吸机设置变化/d和镇静作用与APC-CMV和VC-CMV多数模式的关系。
结果：在2013年1月至2017年3月开始进行机械通气的1,213名受试者中，分别有68％和24％开始进行APC-CMV和VC-CMV。分别,占大多数呼吸机模式的62%和21%。年龄,性别,种族,和种族与初始或多数APC-CMV或VC-CMV模式无关。在APC-CMV上开始的受试者在APC-CMV模式上花费了88%的机械通气时间。与VC-CMV相比，APC-CMV多数模式的受试者经历了更多的呼吸机设置变化/d（1.1vs0.8，P<.001）。当比较接受APC-CMV与接受VC-CMV多数模式的受试者时，镇静药物没有显着差异。
结论：APC-CMV在医疗ICU中得到了较高的应用。APC-CMV上的受试者比VC-CMV上的受试者具有更多的呼吸机设置变化/d。与VC-CMV相比，APC-CMV没有减少设置调整或减少镇静的优势。
方法：我们分析了来自回顾性电子健康记录数据集的呼吸机数据，该数据集作为单个学术ICU质量改进项目的一部分而收集。多数呼吸机模式被定义为包含最高比例的机械通气时间的模式。多变量逻辑回归用于确定与初始和大多数APC-CMV或VC-CMV模式相关的变量。Wilcoxon秩和检验用于比较呼吸机设置变化/d和镇静作用与APC-CMV和VC-CMV多数模式的关系。
结果：在2013年1月至2017年3月开始进行机械通气的1,213名受试者中，分别有68％和24％开始进行APC-CMV和VC-CMV。分别,占大多数呼吸机模式的62%和21%。年龄,性别,种族,和种族与初始或多数APC-CMV或VC-CMV模式无关。在APC-CMV上开始的受试者在APC-CMV模式上花费了88%的机械通气时间。与VC-CMV相比，APC-CMV多数模式的受试者经历了更多的呼吸机设置变化/d（1.1vs0.8，P<.001）。当比较接受APC-CMV与接受VC-CMV多数模式的受试者时，镇静药物没有显着差异。
结论：APC-CMV在医疗ICU中得到了较高的应用。APC-CMV上的受试者比VC-CMV上的受试者具有更多的呼吸机设置变化/d。与VC-CMV相比，APC-CMV没有减少设置调整或减少镇静的优势。
