Andrés Esteban, Fernando Frutos-Vivar, Alfonso Muriel, Niall D. Ferguson, Oscar Peñuelas, Victor Abraira, Konstantinos Raymondos, Fernando Rios, Nicolas Nin, Carlos Apezteguía, Damian A. Violi, Arnaud W. Thille, Laurent Brochard, Marco González, Asisclo J. Villagomez, Javier Hurtado, Andrew R. Davies, Bin Du, Salvatore M. Maggiore, Paolo Pelosi, Luis Soto, Vinko Tomicic, Gabriel D’Empaire, Dimitrios Matamis, Fekri Abroug, Rui P. Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael A. Kuiper, Hans-Henrik Bülow, Amine Ali Zeggwagh, and Antonio Anzueto  Am. J. Resp. Crit. Care Med. July 15, 2013, vol. 188, no. 2: 220-230

Abstract

Rationale: Baseline characteristics and management have changed over time in patients requiring mechanical ventilation; however, the impact of these changes on patient outcomes is unclear.

Objectives: To estimate whether mortality in mechanically ventilated patients has changed over time.

Methods: Prospective cohort studies conducted in 1998, 2004, and 2010, including patients receiving mechanical ventilation for more than 12 hours in a 1-month period, from 927 units in 40 countries. To examine effects over time on mortality in intensive care units, we performed generalized estimating equation models.

Measurements and Main Results: We included 18,302 patients. The reasons for initiating mechanical ventilation varied significantly among cohorts. Ventilatory management changed over time (P < 0.001), with increased use of noninvasive positive-pressure ventilation (5% in 1998 to 14% in 2010), a decrease in tidal volume (mean 8.8 ml/kg actual body weight [SD = 2.1] in 1998 to 6.9 ml/kg [SD = 1.9] in 2010), and an increase in applied positive end-expiratory pressure (mean 4.2 cm H2O [SD = 3.8] in 1998 to 7.0 cm of H2O [SD = 3.0] in 2010). Crude mortality in the intensive care unit decreased in 2010 compared with 1998 (28 versus 31%; odds ratio, 0.87; 95% confidence interval, 0.80–0.94), despite a similar complication rate. Hospital mortality decreased similarly. After adjusting for baseline and management variables, this difference remained significant (odds ratio, 0.78; 95% confidence interval, 0.67–0.92).

Conclusions: Patient characteristics and ventilation practices have changed over time, and outcomes of mechanically ventilated patients have improved.

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