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Title: Evolution of mortality over time in patients receiving mechanical ventilation.
Authors: Esteban, Andres
Frutos-Vivar, Fernando
Muriel, Alfonso
Ferguson, Niall D.
Penuelas, Oscar
Abraira, Victor
Raymondos, Konstantinos
Rios, Fernando
Nin, Nicolas
Apezteguia, Carlos
Violi, Damian A.
Thille, Arnaud W.
Brochard, Laurent
Gonzalez, Marco
Villagomez, Asisclo J.
Hurtado, Javier
Davies, Andrew R.
Du, Bin
Maggiore, Salvatore M.
Pelosi, Paolo
Soto, Luis
Tomicic, Vinko
D'Empaire, Gabriel
Matamis, Dimitrios
Abroug, Fekri
Moreno, Rui P.
Soares, Marco Antonio
Arabi, Yaseen
Sandi, Freddy
Jibaja, Manuel
Amin, Pravin
Koh, Younsuck
Kuiper, Michael A.
Bulow, Hans-Henrick
Ali Zeggwagh, Amine
Azueto, Antonio
Issue Date: 2013
Publisher: American Thoracic Society
Place of publication: New York, NY
Publication Title: American Journal of Respiratory and Critical Care Medicine
Volume: 188
Issue: 2
Start Page: 220
End Page: 230
Abstract: 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 (NCT01093482). Ballarat Health Services provided data for this study.
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ISSN: 1073-449X
Internal ID Number: 00844
Health Subject: COHORT STUDY
Type: Journal Article
Appears in Collections:Research Output

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