Evolution of mortality over time in patients receiving mechanical ventilation

Andres Esteban, Fernando Frutos-Vivar, Alfonso Muriel, Niall Ferguson, Oscar Penuelas, Victor Abraira, Konstantinos Raymondos, Fernando Rios, Nicolas Nin, Carlos Apezteguia, Damian A Violi, Arnaud W Thille, Laurent Brochard, Marco Gonzalez, Asisclo Villagomez, Javier Hurtado, Andrew Ross Davies, Bin Du, Salvatore Maggiore, Paolo PelosiLuis Soto, Vinko Tomicic, Gabriel D'Empaire, Dimitrios Matamis, Fekri Abroug, Rui Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael Kuiper, Hans-Henrik Bulow, Amine Ali Zeggwagh, Antonio Anzueto

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Abstract

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 ofmechanically ventilated patients have improved.
Original languageEnglish
Pages (from-to)220 - 230
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume188
Issue number2
DOIs
Publication statusPublished - 2013

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