, Volume 40, Issue 3, pp 453-455
Date: 07 Feb 2014

Should mechanical ventilation care be centralized and should we thus transfer all ventilated patients to high volume units? Take a breath first

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For years, many critical care physicians considered mechanical ventilation as an easy and harmless intervention in intensive care unit (ICU) patients. Nowadays, preclinical and clinical researchers and critical care physicians increasingly appreciate the potential harmful effects of ventilation, in both patients with the acute respiratory distress syndrome (ARDS) [1] and those with uninjured lungs [2]. Ventilation turns out to be everything but safe, as it can cause so-called ‘ventilator-induced lung injury’ (VILI) [3] and ‘ventilator-induced diaphragm dysfunction’ (VIDD) [4]. Mitigating this harm is far from simple. It requires skill, which like all skills improves with experience.

One steady observation in ICU medicine is the finding that ICUs that care for high volumes of patients experience improved outcomes. This finding, also known as the ‘volume-outcome relationship,’ has been demonstrated in several cohorts of patients [5], including those who are ventilated [6]. However, the la