Author
Affilliation
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 twomonth 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.
Publisher
BMC
Citation
AZEVEDO, Luciano C. P. et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Critical Care, v. 17, p. 1-13, 2013.
DOI
10.1186/cc12594
ISSN
1364-8535
Notes
André Miguel Japiassu. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas.
The authors would like to thank the following sites and investigators: Bahia: Hospital Espanhol - Salvador (Amadeu Martinez, Lívia Leal, Antonio Jorge Pereira). Distrito Federal: Hospital Santa Luzia - Brasilia (Marcelo de Oliveira Maia, José Aires Neto). Espírito Santo: Vitória Apart Hospital - Vitória (Claudio Piras), Centro Integrado de Atenção à Saude (CIAS) Unimed Vitória - Vitória (Eliana Bernadete Caser, Cora Lavigne Moreira), Hospital Meridional - Cariacica (Pablo Braga Gusman, Dyanne Moysés Dalcomune). Maranhão: UDI Hospital - São Luís (Alexandre Guilherme Ribeiro de Carvalho, Louise Aline Romão Gondim, Lívia Mariane Castelo Branco Reis) Minas Gerais: Hospital Madre Tereza - Belo Horizonte (Daniel da Cunha Ribeiro, Leonardo de Assis Simões, Rafaela Siqueira Campos, José Carlos Fernandez Versiani dos Anjos), Hospital Mater Dei - Belo Horizonte (Frederico Bruzzi Carvalho). Pará: Hospital Regional Público do Araguaia - Redenção (Rossine Ambrosio Alves, Lilian Batista Nunes). Paraná: Hospital do Trabalhador - Curitiba (Álvaro Réa-Neto, Mirella Cristine de Oliveira), Hospital Vita Batel - Curitiba (Álvaro Réa-Neto, Mirella Cristine de Oliveira), Hospital Universitario Cajuru - Curitiba (Álvaro Réa-Neto, Luana Tannous), Instituto de Neurologia de Curitiba (INC) - Curitiba (Álvaro Réa-Neto, Brenno Cardoso Gomes). Rio de Janeiro: Instituto Nacional de Câncer - Hospital do Câncer I - Rio de Janeiro (Vicente Cés de Souza Dantas), Hospital de Clínicas de Niterói - Niterói (Fernando Borges Rodriguez, Priscila Abelha); Hospital de Clínicas Mario Lioni - Duque de Caxias (Marcelo E. Lugarinho); Instituto de Pesquisa Clínica Evandro Chagas (IPEC) - Rio de Janeiro (Andre Japiassu), Hospital da Mulher Heloneida Studart - Rio de Janeiro (Hélder Konrad de Melo, Elton Afonso Lopes), Hospital Pasteur - Rio de Janeiro (Pedro Varaschin, Vicente Cés de Souza Dantas), Hospital São Lucas - Rio de Janeiro (Marcos Freitas Knibel, Micheli Ponte, Pedro Mendes de Azambuja Rodrigues), Hospital Pro-Cardiaco - Rio de Janeiro (Rubens Carmo Costa Filho, Felipe Saddy, Théia Forny Wanderley Castellões, Suzana Alves Silva), Nortecor Hospital de Clínica - Rio de Janeiro (Luiz Antonio Gomes Osorio, Dora Mannarino), Hospital Copa D’Or - Rio de Janeiro (Rodolfo Espinoza, Cassia Righy, Marcio Soares, Jorge Salluh, Lilian Tanaka, Daniel Aragão, Maria Eduarda Tavares, Maura Goncalves Pereira Kehdi). Roraima: Hospital Geral de Roraima - Boa Vista (Valéria Maria Campos Rezende, Roberto Carlos Cruz Carbonell). Rio Grande do Sul: Hospital Moinhos de Vento - Porto Alegre (Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Juçara Gasparetto Maccari, Priscylla Souza Castro), Santa Casa de Misericórdia de Porto Alegre - Pavilhão Pereira Filho (Paula Berto, Patricia Schwarz); Santa Casa de Misericórdia de Porto Alegre - Hospital Santa Rita (André Peretti Torelly, Thiago Lisboa, Paula Berto, Edison Moraes). Santa Catarina: Hospital São José - Criciúma (Felipe Dal-Pizzol, Cristiane Tomasi Damiani, Cristiane Ritter). São Paulo: Hospital A. C. Camargo - São Paulo (Juliana Carvalho Ferreira, Ramon Teixeira Costa, Pedro Caruso); Fundação Pio XII - Hospital de Câncer de Barretos - Barretos (Cristina Prata Amendola, Amanda Maria R. R. de Oliveira, Ulysses V. A. Silva, Luciana Coelho Sanches, Rosana D. S. Almeida); Hospital Sírio Libanês - São Paulo (Luciano Cesar Azevedo, Marcelo Park, Guilherme Schettino), Hospital Israelita Albert Einstein - São Paulo (Murillo Santucci Assunção, Eliezer Silva), Hospital São Camilo Santana - São Paulo (Carlos Eduardo Barboza, Antonio Paulo Nassar Junior), Hospital São Camilo Pompéia - São Paulo (Antonio Table 4 Weaning variables of patients under invasive mechanical ventilation (Continued) Shock 20 (3) 3 (1) 17 (6) 8.86 (2.56 to 30.6) < 0.001 Ventilator-associated pneumonia 13 (2) 6 (2) 7 (3) 1.73 (0.57 to 5.21) 0.330 Dyspnea 50 (8) 31 (9) 19 (7) 0.88 (0.49 to 1.61) 0.697 Cardiac dysfunction 7 (1) 2 (0.8) 5 (2) 3.71 (0.71 to 19.3) 0.118 Hypoxemia/Hypercapnia 36 (6) 16 (5) 20 (7) 1.91 (0.97 to 3.76) 0.063 Excessive respiratory secretions 24 (4) 14 (4) 10 (4) 1.05 (0.45 to 2.40) 0.912 Azevedo et al. Critical Care 2013, 17:R63 http://ccforum.com/content/17/2/R63 Page 11 of 13 Paulo Nassar Junior), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Emergências Clinicas - São Paulo (Luciano Cesar Azevedo, Marcelo Park), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Emergências Cirurgicas - São Paulo (Paulo Fernando Guimarães Morando Marzocchi Tierno, Luis Marcelo Malbouisson, Lucas Oliveira), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Anestesiologia - São Paulo (Davi Cristovao), Hospital Ipiranga - Rede Amil - São Paulo (Manoel Leitão Neto, Ênio Rego, Fernanda Eugênia Fernandes), Hospital Do Coração - São Paulo (Marcelo Luz Pereira Romano, Alexandre Biasi Cavalcanti, Dalton de Souza Barros, Érica Aranha Suzumura, Karla Loureiro Meira, Gustavo Affonso de Oliveira), Hospital Estadual de Américo Brasiliense - Américo Brasiliense (Paula Menezes Luciano, Evelin Drociunas Pacheco), Hospital São Paulo da Universidade Federal de São Paulo - São Paulo (Bruno Franco Mazza, Flavia Ribeiro Machado, Elaine Ferreira), Hospital Universitário da Universidade de São Paulo - São Paulo (Ronaldo Batista dos Santos, Alexandra Siqueira Colombo, Antonio Carlos Nogueira, Juliana Baroni Fernandes, Raquel Siqueira Nóbrega, Barbara do C.S. Martins, Francisco Soriano), Hospital São Luiz Jardim Anália Franco - São Paulo (Rafaela Deczka Morsch, Andre Luiz Baptiston Nunes), Instituto do Câncer do Estado de São Paulo (ICESP) - São Paulo (Juliano Pinheiro de Almeida, Ludhmila Hajjar, Sílvia Moulin), Hospital e Maternidade São Luiz - Unidade Itaim - São Paulo (Fábio Poianas Giannini, Andre Luiz Baptiston Nunes).
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