Some Patients Are More Equal Than Others
| Autor: | Tariq A. Dam, MD, Harm-Jan de Grooth, MD, PhD, Thomas Klausch, PhD, Lucas M. Fleuren, MD, Daan P. de Bruin, MSc, Robert Entjes, MD, Thijs C. D. Rettig, MD, PhD, Dave A. Dongelmans, MD, PhD, Age D. Boelens, MD, Sander Rigter, MD, Stefaan H. A. Hendriks, MD, Remko de Jong, MD, Marlijn J. A Kamps, MD, Marco Peters, MD, A. Karakus, MD, Diederik Gommers, MD, PhD, Dharmanand Ramnarain, MD, Evert-Jan Wils, MD, PhD, Sefanja Achterberg, MD, PhD, Ralph Nowitzky, MD, Walter van den Tempel, MD, Cornelis P. C. de Jager, MD, PhD, Fleur G. C. A. Nooteboom, MD, Evelien Oostdijk, MD, PhD, Peter Koetsier, MD, Alexander D. Cornet, MD, PhD, FRCP, Auke C. Reidinga, MD, Wouter de Ruijter, MD, PhD, Rob J. Bosman, MD, Tim Frenzel, MD, PhD, Louise C. Urlings-Strop, MD, PhD, Paul de Jong, MD, Ellen G. M. Smit, MD, Olaf L. Cremer, MD, PhD, D. Jannet Mehagnoul-Schipper, MD, PhD, Harald J. Faber, MD, Judith Lens, MD, Gert B. Brunnekreef, MD, Barbara Festen-Spanjer, MD, Tom Dormans, MD, PhD, Annemieke Dijkstra, MD, Bram Simons, MD, A. A. Rijkeboer, MD, Sesmu Arbous, MD, PhD, Marcel Aries, MD, PhD, Menno Beukema, MD, Daniël Pretorius, MD, Rutger van Raalte, MD, Martijn van Tellingen, MD, EDIC, Niels C. Gritters van den Oever, MD, Robbert C. A. Lalisang, MD, Michele Tonutti, MRes, Armand R. J. Girbes, MD, PhD, EDIC, Mark Hoogendoorn, PhD, Patrick J. Thoral, MD, EDIC, Paul W. G. Elbers, MD, PhD, EDIC, on behalf of the Dutch ICU Data Sharing Against COVID-19 Collaborators, Remko van den Akker, Tom A. Rijpstra, M. C. Reuland, Klaas Sierk Arnold, Arend Jan Meinders, Nicolas Schroten, Laura van Manen, Leon Montenij, Julia Koeter, J. W. Fijen, Jasper van Bommel, Roy van den Berg, Martha de Bruin, Roger van Rietschote, Ellen van Geest, Koen S. Simons, Anisa Hana, Joost Labout, Michael Kuiper, Albertus Beishuizen, Bart van de Gaauw, Roos Renckens, B. van den Bogaard, Peter Pickkers, Pim van der Heiden, Dennis Geutjes, Claudia (C. W.) van Gemeren, Emma Rademaker, Frits H. M. van Osch, Johan Lutisan, Jacomar J. M. van Koesveld, Bart P. Grady, Martijn de Kruif, Martin E. Haan, Luca Roggeveen, Dagmar M. Ouweneel, Ronald Driessen, Jan Peppink, G. J. Zijlstra, A. J. van Tienhoven, Evelien van der Heiden, Jan Jaap Spijkstra, Hans van der Spoel, Angelique de Man, Heder J. de Vries, Fuda van Diggelen, Ali el Hassouni, David Romero Guzman, Sandjai Bhulai, Sebastiaan J. J. Vonk, Mattia Fornasa, Tomas Machado, Adam Izdebski, Taco Houwert, Hidde Hovenkamp, Roberto Noorduijn Londono, Davide Quintarelli, Martijn G. Scholtemeijer, Aletta A. de Beer, Giovanni Cinà, Willem E. Herter, Michael de Neree tot Babberich, Olivier Thijssens, Lot Wagemakers, Hilde G. A. van der Pol, Tom Hendriks, Julie Berend, Virginia Ceni Silva, Robert F. J. Kullberg, Leo Heunks, Nicole Juffermans, Arjen J. C. Slooter, Martijn Beudel, Nicolet F. de Keizer |
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| Přispěvatelé: | Intensive Care Medicine, APH - Quality of Care, Anesthesiology, Graduate School, AII - Inflammatory diseases, Intensive Care, General Practice, MUMC+: MA Medische Staf IC (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Intensive care medicine, VU University medical center, ACS - Microcirculation, Epidemiology and Data Science, APH - Methodology, General practice, Cardio-thoracic surgery, ACS - Diabetes & metabolism, AII - Infectious diseases |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population Observational Study mechanical ventilation coronavirus disease 2019 Intensive care Severity of illness medicine Intubation education Mechanical ventilation education.field_of_study business.industry RC86-88.9 Other Research Radboud Institute for Health Sciences [Radboudumc 0] Retrospective cohort study Medical emergencies. Critical care. Intensive care. First aid General Medicine acute respiratory distress syndrome clinical practice variation Emergency medicine Breathing ComputingMethodologies_DOCUMENTANDTEXTPROCESSING business Respiratory minute volume |
| Zdroj: | Critical Care Explorations, 3(10). Wolters Kluwer Health Critical Care Explorations, Vol 3, Iss 10, p e0555 (2021) Critical Care Explorations, 3, 10 Critical Care Explorations, 3 Critical Care Explorations Critical Care Explorations, 3(10):e0555. Lippincott Williams & Wilkins Critical care explorations, 3(10). Wolters Kluwer Critical care explorations, 3(10). Lippincott Williams and Wilkins Dam, T A, de Grooth, H-J, Klausch, T, Fleuren, L M, de Bruin, D P, Entjes, R, Rettig, T C D, Dongelmans, D A, Boelens, A D, Rigter, S, Hendriks, S H A, de Jong, R, Kamps, M J A, Peters, M, Karakus, A, Gommers, D, Ramnarain, D, Wils, E-J, Achterberg, S, Nowitzky, R, van den Tempel, W, de Jager, C P C, Nooteboom, F G C A, Oostdijk, E, Koetsier, P, Cornet, A D, Reidinga, A C, de Ruijter, W, Bosman, R J, Frenzel, T, Urlings-Strop, L C, de Jong, P, Smit, E G M, Cremer, O L, Mehagnoul-Schipper, D J, Faber, H J, Lens, J, Brunnekreef, G B, Festen-Spanjer, B, Dormans, T, Dijkstra, A, Simons, B, Rijkeboer, A A, Arbous, S, Aries, M, Beukema, M, Pretorius, D, van Raalte, R, van Tellingen, M, Gritters van den Oever, N C, Lalisang, R C A, Tonutti, M, Girbes, A R J, Hoogendoorn, M, Thoral, P J & Elbers, P W G 2021, ' Some Patients Are More Equal Than Others : Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome ', Critical care explorations, vol. 3, no. 10, pp. e0555 . https://doi.org/10.1097/CCE.0000000000000555 |
| ISSN: | 2639-8028 |
| DOI: | 10.1097/cce.0000000000000555 |
| Popis: | Supplemental Digital Content is available in the text. OBJECTIVES: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients. DESIGN: Multicenter retrospective cohort study. SETTING: Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020. PATIENTS: One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded. MEASUREMENTS AND MAIN RESULTS: We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio2, set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao2/Fio2 ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant (p ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves. CONCLUSIONS: This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under direct control by intensivists. Their effect on clinical outcomes for both coronavirus disease 2019 and other critically ill mechanically ventilated patients could have widespread implications for the practice of intensive care medicine and should be investigated further by causal inference models and clinical trials. |
| Databáze: | OpenAIRE |
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