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