Relationship between Volume and Survival in Closed Intensive Care Units Is Weak and Apparent Only in Mechanically Ventilated Patients

Abstract Background: Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. Methods: Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. Results: The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14–46%). Observed hospital mortality was 19% (range at hospital level: 11–35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5–1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14–60%) and observed hospital mortality was 30% (12–61%), resulting in a standardized mortality ratio of 0.96 (0.5–1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. Conclusion: In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.

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Treatment with Neuromuscular Blocking Agents and the Risk of In-hospital Mortality among Mechanically Ventilated Patients with Severe Sepsis

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.02.018 ◽

2014 ◽

Vol 46 (4) ◽

pp. 601

Author(s):

Cory Siebe

Keyword(s):

Severe Sepsis ◽

Hospital Mortality ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Blocking Agents ◽

Ventilated Patients

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IN-HOSPITAL MORTALITY IN MECHANICALLY VENTILATED PATIENTS WITH COVID-19 WITH DIFFERENT ARDS PHENOTYPES

CHEST Journal ◽

10.1016/j.chest.2021.07.498 ◽

2021 ◽

Vol 160 (4) ◽

pp. A509

Author(s):

Jooseob Lee ◽

Mariam Charkviani ◽

Harvey Friedman ◽

Guillermo Rodriguez-Nava ◽

Maria Yanez-Bello ◽

...

Keyword(s):

Hospital Mortality ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Management of hypercapnia in critically ill mechanically ventilated patients—A narrative review of literature

Journal of the Intensive Care Society ◽

10.1177/1751143720915666 ◽

2020 ◽

Vol 21 (4) ◽

pp. 327-333

Author(s):

Ravindranath Tiruvoipati ◽

Sachin Gupta ◽

David Pilcher ◽

Michael Bailey

Keyword(s):

Mechanical Ventilation ◽

Tidal Volume ◽

Dead Space ◽

Hypercapnic Acidosis ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Low Tidal Volume ◽

Volume Ventilation ◽

Low Volume ◽

Ventilated Patients

The use of lower tidal volume ventilation was shown to improve survival in mechanically ventilated patients with acute lung injury. In some patients this strategy may cause hypercapnic acidosis. A significant body of recent clinical data suggest that hypercapnic acidosis is associated with adverse clinical outcomes including increased hospital mortality. We aimed to review the available treatment options that may be used to manage acute hypercapnic acidosis that may be seen with low tidal volume ventilation. The databases of MEDLINE and EMBASE were searched. Studies including animals or tissues were excluded. We also searched bibliographic references of relevant studies, irrespective of study design with the intention of finding relevant studies to be included in this review. The possible options to treat hypercapnia included optimising the use of low tidal volume mechanical ventilation to enhance carbon dioxide elimination. These include techniques to reduce dead space ventilation, and physiological dead space, use of buffers, airway pressure release ventilation and prone positon ventilation. In patients where hypercapnic acidosis could not be managed with lung protective mechanical ventilation, extracorporeal techniques may be used. Newer, minimally invasive low volume venovenous extracorporeal devices are currently being investigated for managing hypercapnia associated with low and ultra-low volume mechanical ventilation.

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Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.

10.21203/rs.3.rs-58841/v1 ◽

2020 ◽

Author(s):

Xueshu Yu ◽

Hao Jiang ◽

Wenjing Chen ◽

Lingling Pan ◽

Zhendong Fang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Propensity Score ◽

Hospital Mortality ◽

Transthoracic Echocardiography ◽

Favourable Effect ◽

Research Database ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

Abstract Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

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