Philipp G. H. Metnitz MD, PhD, Prof., DEAA, EDIC Barbara Metnitz PhD Rui P. Moreno MD, PhD, Prof. Peter Bauer PhD, Prof., Chairman Lorenzo Del Sorbo MD Christoph Hoermann MD, Prof. Susana Afonso de Carvalho MD V. Marco Ranieri MD, Prof., Chairman on behalf of the SAPS 3 Investigators Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database Received: 1 October 2008 Accepted: 30 December 2008 Published online: 14 March 2009 Ó Springer-Verlag 2009 Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, Project # 12690 ONB. This article is discussed in the editorial available at: doi:10.1007/s00134-009-1450-3. Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1449-9) contains supplementary material, which is available to authorized users. Philipp G. H. Metnitz, MD, PhD, Prof., DEAA, EDIC ICU 13I1, Dept. of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria Barbara Metnitz, PhD Á Peter Bauer, PhD, Prof., Chairman Dept. of Medical Statistics, Medical University of Vienna, Vienna, Austria Rui P. Moreno, MD, PhD, Prof. ( ) ) Susana Afonso de Carvalho, MD Unidade de Cuidados Intensivos Polivalente, Hospital de St. Anto ´nio dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E. Lisboa, Portugal e-mail: r.moreno@mail.telepac.pt Lorenzo Del Sorbo, MD Á V. Marco Ranieri, MD, Prof., Chairman Dipartimento di Anestesiologia e Rianimazione, Universita ` di Torino, Ospedale S. Giovanni Battista-Molinette, Torino, Italy Christoph Hoermann, MD, Prof. Transplant ICU, Dept. of Anesthesiology and General Intensive Care, Medical University of Innsbruck, Innsbruck, Austria ABSTRACT Objective: To eval- uate current practice of mechanical ventilation in the ICU and the char- acteristics and outcomes of patients receiving it. Design: Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3). Patients: 13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries. Interventions: None. Main measurements and results: Patients were divided into three groups: no mechanical ventilation (MV), noninvasive MV (NIV), and invasive MV. More than half of the patients (53% [CI: 52.2-53.9%]) were mechanically ventilated at ICU admission. FIO 2 ,VT and PEEP used during invasive MV were on average 50% (40-80%), 8 mL/kg actual body weight (6.9-9.4 mL/kg) and 5 cmH 2 O (3-6 cmH 2 O), respectively. Several invMV patients (17.3% (CI:16.4- 18.3%)) were ventilated with zero PEEP (ZEEP). These patients exhib- ited a significantly increased risk- adjusted hospital mortality, compared with patients ventilated with higher PEEP (O/E ratio 1.12 [1.05-1.18]). NIV was used in 4.2% (CI: 3.8-4.5%) of all patients and was associated with an improved risk-adjusted outcome (OR 0.79, [0.69-0.90]). Conclusion: Ventilation mode and parameter settings for MV varied significantly across ICUs. Our results provide evidence that some ventila- tory modes and settings could still be used against current evidence and recommendations. This includes ventilation with tidal volumes [ 8mL/ kg body weight in patients with a low PaO2/FiO2 ratio and ZEEP in invMV patients. Invasive mechanical venti- lation with ZEEP was associated with a worse outcome, even after control- ling for severity of disease. Since our study did not document indications for MV, the association between MV settings and outcome must be viewed with caution. Key Words intensive care unit Á mechanical ventilation Á PEEP Á mortality Á risk adjustment Á outcome Intensive Care Med (2009) 35:816–825 DOI 10.1007/s00134-009-1449-9 ORIGINAL