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Open Access 01-04-2013 | Research

Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study

Authors: Luciano CP Azevedo, Marcelo Park, Jorge IF Salluh, Alvaro Rea-Neto, Vicente C Souza-Dantas, Pedro Varaschin, Mirella C Oliveira, Paulo Fernando GMM Tierno, Felipe dal-Pizzol, Ulysses VA Silva, Marcos Knibel, Antonio P Nassar Jr, Rossine A Alves, Juliana C Ferreira, Cassiano Teixeira, Valeria Rezende, Amadeu Martinez, Paula M Luciano, Guilherme Schettino, Marcio Soares, The ERICC (Epidemiology of Respiratory Insufficiency in Critical Care) investigators

Published in: Critical Care | Issue 2/2013

Abstract

Introduction

Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU).

Methods

In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure.

Results

Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30).

Conclusions

Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.

Trial registration

ClinicalTrials.gov NCT01268410.

Available only for authorised users

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Title: Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study
Authors: Luciano CP Azevedo
Marcelo Park
Jorge IF Salluh
Alvaro Rea-Neto
Vicente C Souza-Dantas
Pedro Varaschin
Mirella C Oliveira
Paulo Fernando GMM Tierno
Felipe dal-Pizzol
Ulysses VA Silva
Marcos Knibel
Antonio P Nassar Jr
Rossine A Alves
Juliana C Ferreira
Cassiano Teixeira
Valeria Rezende
Amadeu Martinez
Paula M Luciano
Guilherme Schettino
Marcio Soares
The ERICC (Epidemiology of Respiratory Insufficiency in Critical Care) investigators
Publication date: 01-04-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12594

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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