6533b85ffe1ef96bd12c11f2

RESEARCH PRODUCT

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

Tejerina E. E.Pelosi P.Robba C.Penuelas O.Muriel A.Barrios D.Frutos-vivar F.Raymondos K.Du B.Thille A. W.Rios F.Gonzalez M.Del-sorbo L.Marin M. D. C.Valle Pinheiro B.Soares M. A.Nin N.Maggiore S. M.Bersten A.Amin P.Cakar N.Young Suh G.Abroug F.Jibaja M.Matamis D.Ali Zeggwagh A.Sutherasan Y.Anzueto A.Esteban AFernando RíosDamian VioliMarisol Rodríguez-goñiRoger LamoglieFernando VillarejoNorberto TiribelliSantiago IlutovichMatías BrizuelaMariana MonllauFernando SaldariniSilvina BorelloAlberto MarinoNorberto TiribelliMauricio VinzioKarina BonaseglaJulián HernándezMaría Belén YapurMaría Eugenia GonzálezSebastián E MareJudith SagardíaMarco BezziCecilia PereyraJulian StratiDaniel VargasClaudia DiazPablo GómezMarcelo PalavecinoGraciela ElizabethAguilera GarcíaM EugeniaLuis Pablo CardonnetLisandro BetttiniHernán NuñezLucas VallejoFernando FernándezJorge ArroyoDaniel DuarteGerardo FilippaCayetano GalettiHernan NuniaFernando LambertElisa EstenssoroMarina BusicoFernando VillarejoJavier Horacio ÁLvarezAlejandro RaimondiGustavo BadariottiMartín LugaroFernando LipovestkyAlan Javier ZazuHugo CapponcelliPatricia VoglCristina OrlandiAlejandro GómezGustavo JannelloAlejandro RissoLeticia 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subject

Malemedicine.medical_treatmentpulmonary complicationsRESPIRATORY-DISTRESS-SYNDROMECritical Care and Intensive Care MedicineCASE-FATALITY0302 clinical medicineRisk FactorsBrain Injuries TraumaticMulticenter Studies as TopicHospital MortalityProspective StudiesSimplified Acute Physiology ScoreStrokePOPULATIONSimplified Acute Physiology ScoreAge FactorsANEURYSMAL SUBARACHNOID HEMORRHAGEMiddle AgedHemorrhagic StrokeIntensive Care UnitsObservational Studies as TopicAnesthesiaBreathingFemalemedicine.symptomVentilator WeaningCohort studyAdultTRAUMATIC BRAIN-INJURYPressure support ventilationmechanical ventilationprognosis factorsACUTE LUNG INJURY03 medical and health sciencesmedicineHumansAgedIschemic StrokeMechanical ventilationNoninvasive Ventilationbusiness.industryMORTALITYneurologic patientsOrgan dysfunction030208 emergency & critical care medicineLength of Staymedicine.diseaseTRENDSRespiration Artificial030228 respiratory systemEtiologyNEUROCRITICAL CARENervous System DiseasesTracheotomybusiness

description

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.

yearjournalcountryeditionlanguage
2021-07-01Critical Care Medicine
https://doi.org/10.1097/ccm.0000000000004921