Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study
Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study
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DOI：
10.1186/cc12594
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发表时间：
2013-01-01
期刊：
影响因子：
15.1
通讯作者：
Soares, Marcio
中科院分区：
文献类型：
--
作者：
Azevedo, Luciano C. P.;Park, Marcelo;Soares, Marcio
引言：目前关于新兴国家机械通气（MV）使用的信息有限。此外，大多数关于呼吸支持的流行病学研究都是在肺保护性通气或更广泛地应用无创通气（NIV）等重大发展之前进行的。我们的目的是评估的临床特点，结果和危险因素的医院死亡率和失败的NIV患者需要在巴西重症监护病房（ICU）的辅助支持：方法：在一项多中心，前瞻性，队列研究，共773名成年患者入院45个ICU超过两个月的时间内需要有创通气或NIV超过24小时进行了评估。评估了治疗支持的原因、既往慢性健康状况和生理数据。结果：622例（80%）和151例（20%）患者使用有创MV和NIV作为初始辅助治疗。54%的NIV患者随后插管失败。主要原因是肺炎（27%），神经系统疾病（19%）和非肺脓毒症（12%）。ICU和医院死亡率分别为34%和42%。使用柏林的定义，急性呼吸窘迫综合征（ARDS）的诊断率为31%，住院死亡率为52%。在多变量分析中，年龄（比值比（OR），1.03; 95%置信区间（CI），1.01 - 1.03），合并症（OR，2.30; 95% CI，1.28 - 3.17），相关器官衰竭（OR，1.12; 95% CI，1.05 - 1.20），中度（OR，1.92; 95% CI，1.10 ~ 3.35）（OR，2.12; 95% CI，1.01 - 4.41），ICU最初72小时内的累积液体平衡（OR，2.44; 95% CI，1.39 - 4.28），乳酸水平较高（OR，1.78; 95%CI，1.27至2.50）、侵入性MV（OR，2.67; 95%CI，1.32至5.39）和NIV失败（OR，3.95; 95%CI，1.74至8.99）与住院死亡率独立相关。NIV失败的预测因素是相关器官功能障碍的严重程度（OR，1.20; 95%CI，1.05至1.34），ARDS（OR，2.31; 95%CI，1.10至4.82）和液体正平衡（OR，2.09; 95%CI，1.02至4.30）。实施明智的液体治疗和NIV患者的观察和监测是改善这种情况下结局的潜在目标。
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.