Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.
BACKGROUND
The outcome of patients receiving mechanical ventilation for particular indications has been studied, but the outcome in a large number of unselected, heterogeneous patients has not been reported.


OBJECTIVE
To determine the survival of patients receiving mechanical ventilation and the relative importance of factors influencing survival.


METHODS
Prospective cohort of consecutive adult patients admitted to 361 intensive care units who received mechanical ventilation for more than 12 hours between March 1, 1998, and March 31, 1998. Data were collected on each patient at initiation of mechanical ventilation and daily throughout the course of mechanical ventilation for up to 28 days.


METHODS
All-cause mortality during intensive care unit stay.


RESULTS
Of the 15 757 patients admitted, a total of 5183 (33%) received mechanical ventilation for a mean (SD) duration of 5.9 (7.2) days. The mean (SD) length of stay in the intensive care unit was 11.2 (13.7) days. Overall mortality rate in the intensive care unit was 30.7% (1590 patients) for the entire population, 52% (120) in patients who received ventilation because of acute respiratory distress syndrome, and 22% (115) in patients who received ventilation for an exacerbation of chronic obstructive pulmonary disease. Survival of unselected patients receiving mechanical ventilation for more than 12 hours was 69%. The main conditions independently associated with increased mortality were (1) factors present at the start of mechanical ventilation (odds ratio [OR], 2.98; 95% confidence interval [CI], 2.44-3.63; P<.001 for coma), (2) factors related to patient management (OR, 3.67; 95% CI, 2.02-6.66; P<.001 for plateau airway pressure >35 cm H(2)O), and (3) developments occurring over the course of mechanical ventilation (OR, 8.71; 95% CI, 5.44-13.94; P<.001 for ratio of PaO(2) to fraction of inspired oxygen <100).


CONCLUSIONS
Survival among mechanically ventilated patients depends not only on the factors present at the start of mechanical ventilation, but also on the development of complications and patient management in the intensive care unit.
Esteban
Andrés
A
Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Carretera de Toledo Km 12, 5, 28905 Getafe, Madrid, Spain. aesteban@hug.es
Anzueto
Antonio
A
Frutos
Fernando
F
Alía
Inmaculada
I
Brochard
Laurent
L
Stewart
Thomas E
TE
Benito
Salvador
S
Epstein
Scott K
SK
Apezteguía
Carlos
C
Nightingale
Peter
P
Arroliga
Alejandro C
AC
Tobin
Martin J
MJ
D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012121:Respiration, Artificial / Q000401:mortality*; D012128:Respiratory Distress Syndrome / Q000628:therapy; D016019:Survival Analysis