Evolution of Mortality over Time in Patients Receiving Mechanical Ventilation

• DOI: 10.1164/rccm.201212-2169oc
• Publication Date: 2013-04-30T17:14:35Z
• Authors: Andrés Esteban; Fernando Frutos-V...; Alfonso Muriel; Niall D. Ferguson; Oscar Peñuelas; Victor Abraira; Konstantinos Raym...; Fernando Rios; Nicolas Nin; Carlos Apezteguía; Damian A. Violi; Arnaud W. Thille; Laurent Brochard; Marco González; Asisclo J. Villag...; Javier Hurtado; Andrew R. Davies; Bin Du; Salvatore M. Magg...; Paolo Pelosi; Luis Soto; Vinko Tomicic; Gabriel D’Empaire; Dimitrios Matamis; Fekri Abroug; Rui P. Moreno; Marco Antonio Soares; Yaseen Arabi; Freddy Sandi; Manuel Jibaja; Pravin Amin; Younsuck Koh; Michael A. Kuiper; Hans-Henrik Bülow; Amine Ali Zeggwagh; Antonio Anzueto
• Keywords: Plateau pressure

Baseline characteristics and management have changed over time in patients requiring mechanical ventilation; however, the impact of these changes on patient outcomes is unclear.To estimate whether mortality mechanically ventilated has time.Prospective cohort studies conducted 1998, 2004, 2010, including receiving ventilation for more than 12 hours a 1-month period, from 927 units 40 countries. To examine effects intensive care units, we performed generalized estimating equation models.We included 18,302 patients. The reasons initiating varied significantly among cohorts. Ventilatory (P < 0.001), with increased use noninvasive positive-pressure (5% 1998 to 14% 2010), decrease tidal volume (mean 8.8 ml/kg actual body weight [SD = 2.1] 6.9 1.9] an increase applied positive end-expiratory pressure 4.2 cm H2O 3.8] 7.0 3.0] 2010). Crude unit decreased 2010 compared (28 versus 31%; odds ratio, 0.87; 95% confidence interval, 0.80-0.94), despite similar complication rate. Hospital similarly. After adjusting baseline variables, this difference remained significant (odds 0.78; 0.67-0.92).Patient practices time, improved. Clinical trials registered www.clinicaltrials.gov (NCT01093482).