Raymondos, Konstantinos and Dirks, Tamme and Quintel, Michael and Molitoris, Ulrich and Ahrens, Joerg and Dieck, Thorben and Johanning, Kai and Henzler, Dietrich and Rossaint, Rolf and Putensen, Christian and Wrigge, Hermann and Wittich, Ralph and Ragaller, Maximilian and Bein, Thomas and Beiderlinden, Martin and Sanmann, Maxi and Rabe, Christian and Schlechtweg, Joern and Holler, Monika and Frutos-Vivar, Fernando and Esteban, Andres and Hecker, Hartmut and Rosseau, Simone and von Dossow, Vera and Spies, Claudia and Welte, Tobias and Piepenbrock, Siegfried and Weber-Carstens, Steffen (2017) Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany. CRITICAL CARE, 21: 122. ISSN 1466-609X, 1364-8535
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Background: This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods: This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g., driving pressure), complications, and care settings-for example, case volume of ventilated patients, size/type of intensive care unit (ICU), and type of hospital (university/non-university hospital). To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis. Results: Of the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals (39.3% vs 57.5%; p = 0.012). Treatment in non-university hospitals was independently associated with increased mortality (OR (95% CI): 2.89 (1.31-6.38); p = 0.008). This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures (OR 1.10; 1 cmH(2)O increments) were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure (PEEP) (mean +/- SD: 11.7 +/- 4.7 vs 9.7 +/- 3.7 cmH(2)O; p = 0.005) and lower driving pressures (15.1 +/- 4.4 vs 17.0 +/- 5.0 cmH(2)O; p = 0.02) were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long (median (IQR): 16 (9-29) vs 8 (3-16) days; p < 0.001). Conclusions: Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE LUNG INJURY; END-EXPIRATORY PRESSURE; EXTRACORPOREAL MEMBRANE-OXYGENATION; RECEIVING MECHANICAL VENTILATION; RANDOMIZED CONTROLLED-TRIAL; CRITICALLY-ILL PATIENTS; INTENSIVE-CARE UNITS; TIDAL VOLUMES; MORTALITY; EPIDEMIOLOGY; Acute respiratory distress syndrome; Care setting; Mechanical ventilation; Driving pressure; Biphasic positive airway pressure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:10 |
| Last Modified: | 20 Feb 2019 14:27 |
| URI: | https://pred.uni-regensburg.de/id/eprint/859 |
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