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

被引:100
作者
Azevedo, Luciano C. P. [1 ,2 ]
Park, Marcelo [1 ,2 ]
Salluh, Jorge I. F. [3 ]
Rea-Neto, Alvaro [4 ]
Souza-Dantas, Vicente C. [5 ,6 ]
Varaschin, Pedro [6 ]
Oliveira, Mirella C. [4 ]
Tierno, Paulo Fernando G. M. M. [7 ]
dal-Pizzol, Felipe [8 ]
Silva, Ulysses V. A. [9 ]
Knibel, Marcos [10 ]
Nassar, Antonio P., Jr. [11 ]
Alves, Rossine A. [12 ]
Ferreira, Juliana C. [13 ]
Teixeira, Cassiano [14 ]
Rezende, Valeria [15 ]
Martinez, Amadeu [16 ]
Luciano, Paula M. [17 ]
Schettino, Guilherme [1 ]
Soares, Marcio [3 ]
机构
[1] Hosp Sirio Libanes, Res & Educ Inst, BR-01308060 Sao Paulo, Brazil
[2] Univ Sao Paulo, Fac Med, Hosp Clin, Dept Emergency Med,ICU, BR-05403000 Sao Paulo, Brazil
[3] DOr Inst Res & Educ, BR-22281100 Rio De Janeiro, Brazil
[4] CEPETI Ctr Estudos & Pesquisas Terapia Intens, BR-82530200 Curitiba, Parana, Brazil
[5] Hosp Canc I, Inst Nacl Canc, ICU, BR-20230130 Rio De Janeiro, Brazil
[6] Pasteur Hosp, ICU, BR-20735040 Rio De Janeiro, Brazil
[7] Univ Sao Paulo, Fac Med, Hosp & Clin, Surg Emergency Dept,ICU, BR-05403000 Sao Paulo, Brazil
[8] Hosp Sao Jose, ICU, BR-88801250 Criciuma, Brazil
[9] Hosp Canc Barretos, Fdn Pio XII, ICU, BR-14780000 Barretos, Brazil
[10] Hosp Sao Lucas, ICU, BR-22061080 Rio De Janeiro, Brazil
[11] Hosp Sao Camilo Pompeia, ICU, BR-05024000 Sao Paulo, Brazil
[12] Hosp Reg Publ Araguaia, ICU, BR-68552735 Redencao, Brazil
[13] Hosp AC Camargo Fund Antonio Prudente, ICU, BR-01509010 Sao Paulo, Brazil
[14] Hosp Moinhos Vento, ICU, BR-90035001 Porto Alegre, RS, Brazil
[15] Hosp Geral Roraima, ICU, BR-69305284 Boa Vista, Brazil
[16] Hosp Espanhol, ICU, BR-40140110 Salvador, BA, Brazil
[17] Hosp Estadual Amer Brasiliense, ICU, BR-14802520 Amer Brasiliense, Brazil
来源
CRITICAL CARE | 2013年 / 17卷 / 02期
关键词
RESPIRATORY-DISTRESS-SYNDROME; POSITIVE-PRESSURE VENTILATION; CRITICALLY-ILL PATIENTS; MECHANICAL VENTILATION; NONINVASIVE VENTILATION; PROTECTIVE-VENTILATION; FLUID BALANCE; FAILURE; MORTALITY; SEPSIS;
D O I
10.1186/cc12594
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
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页数:13
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