| Title: |
Evolution of mortality over time in patients receiving mechanical ventilation |
| Authors: |
Esteban, A; Frutos Vivar, F; Muriel, A; Ferguson, ND; Peñuelas, O; Abraira, V; Raymondos, K; Rios, F; Nin, N; Apezteguía, C; Violi, DA; Thille, AW; Brochard, L; González, M; Villagomez, AJ; Hurtado, J; Davies, AR; Du, B; MAGGIORE, Salvatore Maurizio; Pelosi, P; Soto, L; Tomicic, V; D'Empaire, G; Matamis, D; Abroug, F; Moreno, RP; Soares, MA; Arabi, Y; Sandi, F; Jibaja, M; Amin, P; Koh, Y; Kuiper, MA; Bülow, HH; Zeggwagh, AA; Anzueto, A. |
| Contributors: |
Esteban, A; Frutos Vivar, F; Muriel, A; Ferguson, Nd; Peñuelas, O; Abraira, V; Raymondos, K; Rios, F; Nin, N; Apezteguía, C; Violi, Da; Thille, Aw; Brochard, L; González, M; Villagomez, Aj; Hurtado, J; Davies, Ar; Du, B; Maggiore, Salvatore Maurizio; Pelosi, P; Soto, L; Tomicic, V; D'Empaire, G; Matamis, D; Abroug, F; Moreno, Rp; Soares, Ma; Arabi, Y; Sandi, F; Jibaja, M; Amin, P; Koh, Y; Kuiper, Ma; Bülow, Hh; Zeggwagh, Aa; Anzueto, A. |
| Publication Year: |
2013 |
| Collection: |
ARUd'A - Archivio Istituzionale della ricerca dell'università Chieti-Pescara (IRIS) |
| Subject Terms: |
mechanical ventilation; mortality; epidemiology; cohort study |
| Description: |
Rationale: Baseline characteristics and management have changed over time in patients requiring mechanical ventilation; however, the impact of these changes on patient outcomes is unclear. Objectives: To estimate whether mortality in mechanically ventilated patients has changed over time. Methods: Prospective cohort studies conducted in 1998, 2004, and 2010, including patients receiving mechanical ventilation for more than 12 hours in a 1-month period, from 927 units in 40 countries. To examine effects over time on mortality in intensive care units, we performed generalized estimating equation models. Measurements and Main Results: We included 18,302 patients. The reasons for initiating mechanical ventilation varied significantly among cohorts. Ventilatory management changed over time (P < 0.001), with increased use of noninvasive positive-pressure ventilation (5% in 1998 to 14% in 2010), a decrease in tidal volume (mean 8.8 ml/kg actual body weight [SD = 2.1] in 1998 to 6.9 ml/kg [SD = 1.9] in 2010), and an increase in applied positive end-expiratory pressure (mean 4.2 cm H2O [SD = 3.8] in 1998 to 7.0 cm of H2O [SD = 3.0] in 2010). Crude mortality in the intensive care unit decreased in 2010 compared with 1998 (28 versus 31%; odds ratio, 0.87; 95% confidence interval, 0.80-0.94), despite a similar complication rate. Hospital mortality decreased similarly. After adjusting for baseline and management variables, this difference remained significant (odds ratio, 0.78; 95% confidence interval, 0.67-0.92). Conclusions: Patient characteristics and ventilation practices have changed over time, and outcomes of mechanically ventilated patients have improved. Clinical trials registered with www.clinicaltrials.gov (NCT01093482). |
| Document Type: |
article in journal/newspaper |
| File Description: |
STAMPA |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/23631814; info:eu-repo/semantics/altIdentifier/wos/WOS:000321817400017; volume:188; issue:2; firstpage:220; lastpage:230; numberofpages:11; journal:AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE; https://hdl.handle.net/11564/640233 |
| DOI: |
10.1164/rccm.201212-2169OC |
| Availability: |
https://hdl.handle.net/11564/640233; https://doi.org/10.1164/rccm.201212-2169OC |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.C93DF795 |
| Database: |
BASE |