Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease.

Autor:	Tejerina EE; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain., Pelosi P; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa & San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy., Robba C; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa & San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy., Peñuelas O; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain., Muriel A; Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain., Barrios D; Servicio de Neumología, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Universidad de Alcalá, Madrid, Spain., Frutos-Vivar F; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain., Raymondos K; Medizinische Hochschule Hannover, Hannover, Germany., Du B; Peking Union Medical College Hospital, Beijing, People's Republic of China., Thille AW; University Hospital of Poitiers, Poitiers, France., Ríos F; Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina., González M; Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia., Del-Sorbo L; Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada., Marín MDC; Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México., Valle Pinheiro B; Pulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil., Soares MA; Hospital Universitario Sao Jose, Belo Horizonte, Brazil., Nin N; Hospital Universitario de Montevideo, Montevideo, Uruguay., Maggiore SM; Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy., Bersten A; Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia., Amin P; Bombay Hospital Institute of Medical Sciences, Mumbai, India., Cakar N; Istanbul Faculty of Medicine, Istanbul, Turkey., Young Suh G; Center for Clinical Epidemiology of Samsung Medical Center, Seoul, South Korea., Abroug F; Hospital Fattouma Bourguina, Monastir, Tunisia., Jibaja M; Hospital de Especialidades Eugenio Espejo, Quito, Ecuador., Matamis D; Papageorgiou Hospital, Thessaloniki, Greece., Ali Zeggwagh A; Centre Hospitalier Universitarie Ibn Sina-Mohammed V University, Rabat, Morocco., Sutherasan Y; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Anzueto A; South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX., Esteban A; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2021 Jul 01; Vol. 49 (7), pp. 1095-1106.
DOI:	10.1097/CCM.0000000000004921
Abstrakt:	Objectives: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. Design: Secondary analysis of three prospective, observational, multicenter studies. Setting: Cohort studies conducted in 2004, 2010, and 2016. Patients: Adult patients who received mechanical ventilation for more than 12 hours. Interventions: None. Measurements and Main Results: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. Conclusions: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease. Competing Interests: Dr. Thille received funding from Fisher & Paykel, GE Healthcare, Maquet-Getinge, and Covidien. Dr. Amin received funding from CIPLA, Sanofi, and Fresenius. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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