Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany
Abstract Background This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods This subanalysis of a prospective, observational cohort study was performed to i...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1687-0 |
| _version_ | 1829105202332958720 |
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| author | Konstantinos Raymondos Tamme Dirks Michael Quintel Ulrich Molitoris Jörg Ahrens Thorben Dieck Kai Johanning Dietrich Henzler Rolf Rossaint Christian Putensen Hermann Wrigge Ralph Wittich Maximilian Ragaller Thomas Bein Martin Beiderlinden Maxi Sanmann Christian Rabe Jörn Schlechtweg Monika Holler Fernando Frutos-Vivar Andres Esteban Hartmut Hecker Simone Rosseau Vera von Dossow Claudia Spies Tobias Welte Siegfried Piepenbrock Steffen Weber-Carstens |
| author_facet | Konstantinos Raymondos Tamme Dirks Michael Quintel Ulrich Molitoris Jörg Ahrens Thorben Dieck Kai Johanning Dietrich Henzler Rolf Rossaint Christian Putensen Hermann Wrigge Ralph Wittich Maximilian Ragaller Thomas Bein Martin Beiderlinden Maxi Sanmann Christian Rabe Jörn Schlechtweg Monika Holler Fernando Frutos-Vivar Andres Esteban Hartmut Hecker Simone Rosseau Vera von Dossow Claudia Spies Tobias Welte Siegfried Piepenbrock Steffen Weber-Carstens |
| author_sort | Konstantinos Raymondos |
| collection | DOAJ |
| description | Abstract Background This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g., driving pressure), complications, and care settings—for example, case volume of ventilated patients, size/type of intensive care unit (ICU), and type of hospital (university/non-university hospital). To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis. Results Of the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals (39.3% vs 57.5%; p = 0.012). Treatment in non-university hospitals was independently associated with increased mortality (OR (95% CI): 2.89 (1.31–6.38); p = 0.008). This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures (OR 1.10; 1 cmH2O increments) were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure (PEEP) (mean ± SD: 11.7 ± 4.7 vs 9.7 ± 3.7 cmH2O; p = 0.005) and lower driving pressures (15.1 ± 4.4 vs 17.0 ± 5.0 cmH2O; p = 0.02) were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long (median (IQR): 16 (9–29) vs 8 (3–16) days; p < 0.001). Conclusions Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals. |
| first_indexed | 2024-12-12T06:01:06Z |
| format | Article |
| id | doaj.art-a1b228354f3945228778f8baae58bc7c |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T06:01:06Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-a1b228354f3945228778f8baae58bc7c2022-12-22T00:35:24ZengBMCCritical Care1364-85352017-05-0121111710.1186/s13054-017-1687-0Outcome of acute respiratory distress syndrome in university and non-university hospitals in GermanyKonstantinos Raymondos0Tamme Dirks1Michael Quintel2Ulrich Molitoris3Jörg Ahrens4Thorben Dieck5Kai Johanning6Dietrich Henzler7Rolf Rossaint8Christian Putensen9Hermann Wrigge10Ralph Wittich11Maximilian Ragaller12Thomas Bein13Martin Beiderlinden14Maxi Sanmann15Christian Rabe16Jörn Schlechtweg17Monika Holler18Fernando Frutos-Vivar19Andres Esteban20Hartmut Hecker21Simone Rosseau22Vera von Dossow23Claudia Spies24Tobias Welte25Siegfried Piepenbrock26Steffen Weber-Carstens27Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment of Cardiology, KRH Klinikum Robert Koch GehrdenDepartment of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen University HospitalDepartment of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Klinikum Links der WeserDepartment of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment of Anaesthesiology, Herford HospitalDepartment of Anaesthesiology, RWTH Aachen University HospitalDepartment of Anaesthesiology and Surgical Intensive Care Medicine, Bonn University HospitalDepartment of Anaesthesiology and Intensive Care Medicine, Leipzig University HospitalDepartment of Anaesthesiology and Intensive Care Medicine, Carl Thieme HospitalDepartment of Anaesthesiology and Intensive Care Medicine, Carl Gustav Carus University HospitalDepartment of Anaesthesiology, Regensburg University HospitalDepartment of Anaesthesiology and Intensive Care Medicine, Essen University HospitalDepartment of Anaesthesiology, Dietrich-Bonhoeffer HospitalDepartment of Internal Medicine, Bonn University HospitalDepartment of Anaesthesiology, Klinikum Bad SalzungenDepartment of Anaesthesiology and Intensive Care Medicine, Municipal Hospital Martha-Maria Halle-DölauDepartment of Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades RespiratoriasDepartment of Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades RespiratoriasDepartment of Biometry, Hannover Medical SchoolDepartment of Internal Medicine, Division Infectiology and Pulmonology, Charité University HospitalDepartment of Anesthesiology and Intensive Care, Ludwig-Maximilians-Universität MünchenDepartment of Anaesthesiology and Intensive Care Medicine, Charité University HospitalDepartment of Respiratory Medicine, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Hannover Medical SchoolDepartment of Anaesthesiology and Intensive Care Medicine, Charité University HospitalAbstract Background This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g., driving pressure), complications, and care settings—for example, case volume of ventilated patients, size/type of intensive care unit (ICU), and type of hospital (university/non-university hospital). To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis. Results Of the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals (39.3% vs 57.5%; p = 0.012). Treatment in non-university hospitals was independently associated with increased mortality (OR (95% CI): 2.89 (1.31–6.38); p = 0.008). This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures (OR 1.10; 1 cmH2O increments) were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure (PEEP) (mean ± SD: 11.7 ± 4.7 vs 9.7 ± 3.7 cmH2O; p = 0.005) and lower driving pressures (15.1 ± 4.4 vs 17.0 ± 5.0 cmH2O; p = 0.02) were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long (median (IQR): 16 (9–29) vs 8 (3–16) days; p < 0.001). Conclusions Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals.http://link.springer.com/article/10.1186/s13054-017-1687-0Acute respiratory distress syndromeCare settingMechanical ventilationDriving pressureBiphasic positive airway pressure |
| spellingShingle | Konstantinos Raymondos Tamme Dirks Michael Quintel Ulrich Molitoris Jörg Ahrens Thorben Dieck Kai Johanning Dietrich Henzler Rolf Rossaint Christian Putensen Hermann Wrigge Ralph Wittich Maximilian Ragaller Thomas Bein Martin Beiderlinden Maxi Sanmann Christian Rabe Jörn Schlechtweg Monika Holler Fernando Frutos-Vivar Andres Esteban Hartmut Hecker Simone Rosseau Vera von Dossow Claudia Spies Tobias Welte Siegfried Piepenbrock Steffen Weber-Carstens Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany Critical Care Acute respiratory distress syndrome Care setting Mechanical ventilation Driving pressure Biphasic positive airway pressure |
| title | Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany |
| title_full | Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany |
| title_fullStr | Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany |
| title_full_unstemmed | Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany |
| title_short | Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany |
| title_sort | outcome of acute respiratory distress syndrome in university and non university hospitals in germany |
| topic | Acute respiratory distress syndrome Care setting Mechanical ventilation Driving pressure Biphasic positive airway pressure |
| url | http://link.springer.com/article/10.1186/s13054-017-1687-0 |
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