Inter-country variability over time in the mortality of mechanically ventilated patients
Por:
Penuelas, O, Muriel, A, Abraira, V, Frutos-Vivar, F, Mancebo, J, Raymondos, K, Du, B, Thille, AW, Rios, F, Gonzalez, M, del-Sorbo, L, Ferguson, ND, Marin, MD, Pinheiro, BV, Soares, MA, Nin, N, Maggiore, SM, Bersten, A, Amin, P, Cakar, N, Suh, GY, Abroug, F, Jibaja, M, Matamis, D, Zeggwagh, AA, Sutherasan, Y, Anzueto, A, Esteban, A
Publicada:
1 mar 2020
Resumen:
Purpose Variations in clinical characteristics and management and in the mortality of mechanically ventilated patients have not been sufficiently evaluated. We hypothesized that mortality shows a variability associated with country after adjustment for clinical characteristics and management. Methods Analysis of four studies carried out at 6-year intervals over an 18-year period. The studies included 26,024 patients (5183 in 1998, 4968 in 2004, 8108 in 2010, and 7765 in 2016) admitted to 1253 units from 38 countries. The primary outcome was 28-day mortality. We performed analyses using multilevel logistic modeling with mixed-random effects, including country as a random variable. To evaluate the effect of management strategies on mortality, a mediation analysis was performed. Results Adjusted 28-day mortality decreased significantly over time (first study as reference): 2004: odds ratio 0.82 (95% confidence interval [CI] 0.72-0.93); 2010: 0.63 (95% CI 0.53-0.75); 2016: 0.49 (95% CI 0.39-0.61). A protective ventilatory strategy and the use of continuous sedation mediated a moderate fraction of the effect of time on mortality in patients with moderate hypoxemia and without hypoxemia, respectively. Logistic multilevel modeling showed a significant effect of country on mortality: median odds ratio (MOR) in 1998: 2.02 (95% CI 1.57-2.48); in 2004: 1.76 (95% CI 1.47-2.06); in 2010: 1.55 (95% CI 1.37-1.74), and in 2016: 1.39 (95% CI 1.25-1.54). Conclusions These findings suggest that country could contribute, independently of confounder variables, to outcome. The magnitude of the effect of country decreased over time. Clinical trials registered with (NCT02731898).
Filiaciones:
Penuelas, O:
Hosp Univ Getafe, Ctr Invest Red Enfermedades Resp CIBERES, Carretera Toledo Km 12, Madrid 28905, Spain
Muriel, A:
Clin Hosp Ramon y Cajal, IRYCIS, Ctr Invest Red Epidemiol & Salud Publ CIBERESP, Unidad Bioestadist, Madrid, Spain
Abraira, V:
Clin Hosp Ramon y Cajal, IRYCIS, Ctr Invest Red Epidemiol & Salud Publ CIBERESP, Unidad Bioestadist, Madrid, Spain
Frutos-Vivar, F:
Hosp Univ Getafe, Ctr Invest Red Enfermedades Resp CIBERES, Carretera Toledo Km 12, Madrid 28905, Spain
Mancebo, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Raymondos, K:
Hannover Med Sch, Hannover, Germany
Du, B:
Peking Union Med Coll Hosp, Beijing, Peoples R China
Thille, AW:
Univ Hosp Poitiers, Poitiers, France
Rios, F:
Hosp Nacl Alejandro Posadas, Buenos Aires, DF, Argentina
Gonzalez, M:
Clin Medellin, Medellin, Colombia
Univ Pontificia Bolivariana, Medellin, Colombia
del-Sorbo, L:
Interdept Div Crit Care Med, Toronto, ON, Canada
Ferguson, ND:
Interdept Div Crit Care Med, Toronto, ON, Canada
Marin, MD:
Hosp Reg 1 Octubre, ISSSTE, Mexico City, DF, Mexico
Pinheiro, BV:
Univ Fed Juiz de Fora, Pulm Res Lab, Juiz De Fora, Brazil
Soares, MA:
Hosp Univ Sao Jose, Belo Horizonte, MG, Brazil
Nin, N:
Hosp Univ Montevideo, Montevideo, Uruguay
Maggiore, SM:
Univ G dAnnunzio Chieti & Pescara, Chieti, Italy
Bersten, A:
Flinders Univ S Australia, Dept Crit Care Med, Adelaide, SA, Australia
Amin, P:
Bombay Hosp & Med Res Ctr, Inst Med Sci, Mumbai, Maharashtra, India
Cakar, N:
Istanbul Fac Med, Istanbul, Turkey
Suh, GY:
Samsung Med Ctr, Ctr Clin Epidemiol, Seoul, South Korea
Abroug, F:
Hosp Fattouma Bourguina, Monastir, Tunisia
Jibaja, M:
Hosp Especialidades Eugenio Espejo, Quito, Ecuador
Matamis, D:
Papageorgiou Hosp, Thessaloniki, Greece
Zeggwagh, AA:
Mohammed V Univ, Ctr Hosp Univ Ibn Sina, Rabat, Morocco
Sutherasan, Y:
Mahidol Univ, Ramathibodi Hosp, Fac Med, Bangkok, Thailand
Anzueto, A:
Univ Texas Hlth Sci Ctr San Antonio, South Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Esteban, A:
Hosp Univ Getafe, Ctr Invest Red Enfermedades Resp CIBERES, Carretera Toledo Km 12, Madrid 28905, Spain
Bronze, Green Published
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