Outcome of acute respiratory distress syndrome in university and non-university hospitals in GermanyReportar como inadecuado




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Critical Care

, 21:122

First Online: 30 May 2017Received: 09 April 2016Accepted: 02 May 2017DOI: 10.1186-s13054-017-1687-0

Cite this article as: Raymondos, K., Dirks, T., Quintel, M. et al. Crit Care 2017 21: 122. doi:10.1186-s13054-017-1687-0

Abstract

BackgroundThis study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome ARDS between university and non-university hospitals in Germany.

MethodsThis subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings e.g., driving pressure, complications, and care settings—for example, case volume of ventilated patients, size-type of intensive care unit ICU, and type of hospital university-non-university hospital. To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis.

ResultsOf the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals 39.3% vs 57.5%; p = 0.012. Treatment in non-university hospitals was independently associated with increased mortality OR 95% CI: 2.89 1.31–6.38; p = 0.008. This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures OR 1.10; 1 cmH2O increments were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure PEEP mean ± SD: 11.7 ± 4.7 vs 9.7 ± 3.7 cmH2O; p = 0.005 and lower driving pressures 15.1 ± 4.4 vs 17.0 ± 5.0 cmH2O; p = 0.02 were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long median IQR: 16 9–29 vs 8 3–16 days; p < 0.001.

ConclusionsMortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals.

KeywordsAcute respiratory distress syndrome Care setting Mechanical ventilation Driving pressure Biphasic positive airway pressure AbbreviationsALIAcute lung injury

ALIENAcute Lung Injury: Epidemiology and Natural History

ARDSAcute respiratory distress syndrome

ARFAcute respiratory failure

AUCArea under the curve

BIPAPBiphasic positive airway pressure

BMIBody mass index

CIConfidence interval

FiO2Fraction of inspired oxygen

ICUIntensive care unit

IQRInterquartile range

KCLIP studyKing County Lung Injury Project

NIVNon-invasive ventilation

OROdds ratio

PaCO2Partial pressure of arterial carbon dioxide tension

PaO2Partial pressure of arterial oxygen tension

PaO2-FiO2Arterial-to-inspired-oxygen

PEEPPositive end-expiratory pressure

ROCReceiver-operator characteristic

SAPS IISimplified Acute Physiology Score II

SDStandard deviation

VENTILA studyInternational Study of Mechanical Ventilation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-017-1687-0 contains supplementary material, which is available to authorized users.





Autor: Konstantinos Raymondos - Tamme Dirks - Michael Quintel - Ulrich Molitoris - Jörg Ahrens - Thorben Dieck - Kai Johanning -

Fuente: https://link.springer.com/







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