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Title: Inter-country variability over time in the mortality of mechanically ventilated patients
Authors: Oscar Peñuelas
Alfonso Muriel
Victor Abraira
Fernando Frutos-Vivar
Jordi Mancebo
Konstantinos Raymondos
Bin Du
Arnaud W. Thille
Fernando Ríos
Marco González
Lorenzo del-Sorbo
Niall D. Ferguson
Maria del Carmen Marín
Bruno Valle Pinheiro
Marco Antonio Soares
Nicolas Nin
Salvatore M. Maggiore
Andrew Bersten
Pravin Amin
Nahit Cakar
Gee Young Suh
Fekri Abroug
Manuel Jibaja
Dimitros Matamis
Amine Ali Zeggwagh
Yuda Sutherasan
Antonio Anzueto
Andrés Esteban
Hospital Regional 1° de Octubre ISSSTE
CHU Fattouma-Bourguiba
Universidad Pontificia Bolivariana
Medizinische Hochschule Hannover (MHH)
Hospital Ramon y Cajal
Centre Hospitalier Universitaire de Poitiers
Samsung Medical Center, Sungkyunkwan University
Flinders University
Mohammed V University in Rabat
University of Texas Health Science Center at San Antonio
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Papageorgiou General Hospital
Istanbul Üniversitesi Tıp Fakültesi
Bombay Hospital and Medical Research Centre
Hospital de La Santa Creu I Sant Pau
Peking Union Medical College Hospital
Hospital Nacional Professor Dr. Alejandro Posadas
University of G. d'Annunzio Chieti and Pescara
Hospital Universitario de Getafe
Universidade Federal de Juiz de Fora
Hospital Universitario de Montevideo
Hospital de Especialidades Eugenio Espejo
Interdepartmental Division of Critical Care Medicine
Hospital Universitário São José
Keywords: Medicine
Issue Date: 1-Jan-2020
Citation: Intensive Care Medicine. (2020)
Abstract: © 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Variations in clinical characteristics and management and in the mortality of mechanically ventilated patients have not been sufficiently evaluated. We hypothesized that mortality shows a variability associated with country after adjustment for clinical characteristics and management. Methods: Analysis of four studies carried out at 6-year intervals over an 18-year period. The studies included 26,024 patients (5183 in 1998, 4968 in 2004, 8108 in 2010, and 7765 in 2016) admitted to 1253 units from 38 countries. The primary outcome was 28-day mortality. We performed analyses using multilevel logistic modeling with mixed-random effects, including country as a random variable. To evaluate the effect of management strategies on mortality, a mediation analysis was performed. Results: Adjusted 28-day mortality decreased significantly over time (first study as reference): 2004: odds ratio 0.82 (95% confidence interval [CI] 0.72–0.93); 2010: 0.63 (95% CI 0.53–0.75); 2016: 0.49 (95% CI 0.39–0.61). A protective ventilatory strategy and the use of continuous sedation mediated a moderate fraction of the effect of time on mortality in patients with moderate hypoxemia and without hypoxemia, respectively. Logistic multilevel modeling showed a significant effect of country on mortality: median odds ratio (MOR) in 1998: 2.02 (95% CI 1.57–2.48); in 2004: 1.76 (95% CI 1.47–2.06); in 2010: 1.55 (95% CI 1.37–1.74), and in 2016: 1.39 (95% CI 1.25–1.54). Conclusions: These findings suggest that country could contribute, independently of confounder variables, to outcome. The magnitude of the effect of country decreased over time. Clinical trials registered with (NCT02731898).
ISSN: 14321238
Appears in Collections:Scopus 2020

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