The intensive care units is of the main components of modern healthcare systems.
Formally, its aim is to offer the critically ill health care fit to their needs; ensuring
that this health care is appropriate, sustainable, ethical and respectful of their
autonomy. Intensive medicine is a cross-sectional specialty that encompasses a broad
spectrum of pathologies in their most severe condition, and specifically has as its
foundation the practice of comprehensive care of the patient with organ dysfunction and
susceptible to recovery. Although critically ill patients are a heterogeneous population,
they have in common the need for a high level of care, often requiring the use of high
technology, specific procedures for the support of organ dysfunction and the
collaboration of other medical and surgical specialties for their management and
treatment.
Since their origins in the late 1950s, intensive care units have been adapting to the
changes arising from the best scientific evidence. In the late 1990s and early 2000s,
there were some successful clinical trials published that had tested alternative
management strategies in the ICU.
Mechanical ventilation is an intervention that defines the critical care specialty.
Between 1970 and the 1990s, the management focused on normalizing arterial blood gas with
aggressive mechanical ventilation. Over the ensuing decades, it became apparent that
performing positive pressure ventilation worsened lung injury. The pivotal moment in the
mechanical ventilation story would be the low versus high tidal volume trial. This trial
shifted the focus away from normalizing gas exchange to reducing harm with mechanical
ventilation. Further, it paved way for further trials testing ventilation interventions
(PEEP strategy, prone position ventilation) and nonventilation interventions
(neuromuscular blockade, corticosteroids, inhaled nitric oxide, extracorporeal gas
exchange) in critically ill patients.
That evidence-based intensive care medicine has undoubtedly had an influence on the
outcome of critically ill patients, in general, and, particularly, of patients requiring
mechanical ventilation. Temporal changes in mortality over the time have been scarcely
reported for patients admitted to intensive care unit.
Objective of this study is to estimate the changes over the time in several outcomes in
the patients admitted to an 18-beds medical-surgical intensive care unit from 1991 (year
of start of activity) to 2026