title: Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01268410.
authors.forename: Luciano C P
authors.initials: LC
authors.lastname: Azevedo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rea-Neto
authors.forename: Vicente C
authors.initials: VC
authors.lastname: Souza-Dantas
authors.forename: Pedro
authors.initials: P
authors.lastname: Varaschin
authors.forename: Mirella C
authors.initials: MC
authors.lastname: Oliveira
authors.forename: Paulo Fernando G M M
authors.initials: PF
authors.lastname: Tierno
authors.forename: Felipe
authors.initials: F
authors.lastname: dal-Pizzol
authors.forename: Ulysses V A
authors.initials: UV
authors.lastname: Silva
authors.forename: Marcos
authors.initials: M
authors.lastname: Knibel
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Nassar
authors.forename: Rossine A
authors.initials: RA
authors.lastname: Alves
authors.forename: Juliana C
authors.initials: JC
authors.lastname: Ferreira
authors.forename: Cassiano
authors.initials: C
authors.lastname: Teixeira
authors.forename: Valeria
authors.initials: V
authors.lastname: Rezende
authors.forename: Amadeu
authors.initials: A
authors.lastname: Martinez
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luciano
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000401:mortality / Q000639:trends; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000401:mortality* / Q000639:trends; D016896:Treatment Outcome
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