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01-03-2020 | Original

Inter-country variability over time in the mortality of mechanically ventilated patients

Authors: Oscar Peñuelas, Alfonso Muriel, Victor Abraira, Fernando Frutos-Vivar, Jordi Mancebo, Konstantinos Raymondos, Bin Du, Arnaud W. Thille, Fernando Ríos, Marco González, Lorenzo del-Sorbo, Niall D. Ferguson, Maria del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M. Maggiore, Andrew Bersten, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Antonio Anzueto, Andrés Esteban

Published in: Intensive Care Medicine | Issue 3/2020

Abstract

Purpose

Variations in clinical characteristics and management and in the mortality of mechanically ventilated patients have not been sufficiently evaluated. We hypothesized that mortality shows a variability associated with country after adjustment for clinical characteristics and management.

Methods

Analysis of four studies carried out at 6-year intervals over an 18-year period. The studies included 26,024 patients (5183 in 1998, 4968 in 2004, 8108 in 2010, and 7765 in 2016) admitted to 1253 units from 38 countries. The primary outcome was 28-day mortality. We performed analyses using multilevel logistic modeling with mixed-random effects, including country as a random variable. To evaluate the effect of management strategies on mortality, a mediation analysis was performed.

Results

Adjusted 28-day mortality decreased significantly over time (first study as reference): 2004: odds ratio 0.82 (95% confidence interval [CI] 0.72–0.93); 2010: 0.63 (95% CI 0.53–0.75); 2016: 0.49 (95% CI 0.39–0.61). A protective ventilatory strategy and the use of continuous sedation mediated a moderate fraction of the effect of time on mortality in patients with moderate hypoxemia and without hypoxemia, respectively. Logistic multilevel modeling showed a significant effect of country on mortality: median odds ratio (MOR) in 1998: 2.02 (95% CI 1.57–2.48); in 2004: 1.76 (95% CI 1.47–2.06); in 2010: 1.55 (95% CI 1.37–1.74), and in 2016: 1.39 (95% CI 1.25–1.54).

Conclusions

These findings suggest that country could contribute, independently of confounder variables, to outcome. The magnitude of the effect of country decreased over time.

Clinical trials registered with http://www.clinicaltrials.gov (NCT02731898).

Available only for authorised users

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Title: Inter-country variability over time in the mortality of mechanically ventilated patients
Authors: Oscar Peñuelas
Alfonso Muriel
Victor Abraira
Fernando Frutos-Vivar
Jordi Mancebo
Konstantinos Raymondos
Bin Du
Arnaud W. Thille
Fernando Ríos
Marco González
Lorenzo del-Sorbo
Niall D. Ferguson
Maria del Carmen Marín
Bruno Valle Pinheiro
Marco Antonio Soares
Nicolas Nin
Salvatore M. Maggiore
Andrew Bersten
Pravin Amin
Nahit Cakar
Gee Young Suh
Fekri Abroug
Manuel Jibaja
Dimitros Matamis
Amine Ali Zeggwagh
Yuda Sutherasan
Antonio Anzueto
Andrés Esteban
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 3/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05867-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Inter-country variability over time in the mortality of mechanically ventilated patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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