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A 28-Day International Study

Andrés Esteban, MD,PhD; Antonio Anzueto, MD; Fernando Frutos, MD; Inmaculada Alía, MD; Laurent Brochard, MD; Thomas E. Stewart, MD; Salvador Benito, MD; Scott K. Epstein, MD; Carlos Apezteguía, MD; Peter Nightingale, MD; Alejandro C. Arroliga, MD; Martin J. Tobin, MD; for the Mechanical Ventilation International Study Group

JAMA. 2002;287:345-355.

Context  The outcome of patients receiving mechanical ventilation for particular indications has been studied, but the outcome in a large number of unselected, heterogeneous patients has not been reported.

Objective  To determine the survival of patients receiving mechanical ventilation and the relative importance of factors influencing survival.

Design, Setting, and Subjects  Prospective cohort of consecutive adult patients admitted to 361 intensive care units who received mechanical ventilation for more than 12 hours between March 1, 1998, and March 31, 1998. Data were collected on each patient at initiation of mechanical ventilation and daily throughout the course of mechanical ventilation for up to 28 days.

Main Outcome Measure  All-cause mortality during intensive care unit stay.

Results  Of the 15 757 patients admitted, a total of 5183 (33%) received mechanical ventilation for a mean (SD) duration of 5.9 (7.2) days. The mean (SD) length of stay in the intensive care unit was 11.2 (13.7) days. Overall mortality rate in the intensive care unit was 30.7% (1590 patients) for the entire population, 52% (120) in patients who received ventilation because of acute respiratory distress syndrome, and 22% (115) in patients who received ventilation for an exacerbation of chronic obstructive pulmonary disease. Survival of unselected patients receiving mechanical ventilation for more than 12 hours was 69%. The main conditions independently associated with increased mortality were (1) factors present at the start of mechanical ventilation (odds ratio [OR], 2.98; 95% confidence interval [CI], 2.44-3.63; P<.001 for coma), (2) factors related to patient management (OR, 3.67; 95% CI, 2.02-6.66; P<.001 for plateau airway pressure >35 cm H₂O), and (3) developments occurring over the course of mechanical ventilation (OR, 8.71; 95% CI, 5.44-13.94; P<.001 for ratio of PaO₂ to fraction of inspired oxygen <100).

Conclusion  Survival among mechanically ventilated patients depends not only on the factors present at the start of mechanical ventilation, but also on the development of complications and patient management in the intensive care unit.

Author Affiliations: Hospital Universitario de Getafe, Madrid, Spain (Drs Esteban, Frutos, and Alía); University of Texas Health Science Center, San Antonio (Dr Anzueto); Hôpital Henri Mondor, Créteil, France (Dr Brochard); Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Dr Stewart); Hospital Sant Pau, Barcelona, Spain (Dr Benito); Tupper Research Institute, New England Medical Center, Boston, Mass (Dr Epstein); Hospital Profesor Posadas, Buenos Aires, Argentina (Dr Apezteguía); South Manchester University Hospital, Manchester, England (Dr Nightingale); The Cleveland Clinic Foundation, Cleveland, Ohio (Dr Arroliga); and Loyola University of Chicago and Hines Veterans Affairs Hospital, Maywood, Ill (Dr Tobin).

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