dc.contributor.author
Raymondos, Konstantinos
dc.contributor.author
Dirks, Tamme
dc.contributor.author
Quintel, Michael
dc.contributor.author
Molitoris, Ulrich
dc.contributor.author
Ahrens, Joerg
dc.contributor.author
Dieck, Thorben
dc.contributor.author
Johanning, Kai
dc.contributor.author
Weber-Carstens, Steffen [u.a.]
dc.date.accessioned
2018-06-08T10:22:32Z
dc.date.available
2017-06-26T11:31:12.735Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/20322
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-23625
dc.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.
en
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject
Acute respiratory distress syndrome
dc.subject
Mechanical ventilation
dc.subject
Driving pressure
dc.subject
Biphasic positive airway pressure
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit
dc.title
Outcome of acute respiratory distress syndrome in university and non-
university hospitals in Germany
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation
Critical Care. - 21 (2017), Artikel Nr. 122
dcterms.bibliographicCitation.doi
10.1186/s13054-017-1687-0
dcterms.bibliographicCitation.url
http://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1687-0
refubium.affiliation
Charité - Universitätsmedizin Berlin
de
refubium.mycore.fudocsId
FUDOCS_document_000000027249
refubium.note.author
Der Artikel wurde in einer reinen Open-Access-Zeitschrift publiziert.
refubium.resourceType.isindependentpub
no
refubium.mycore.derivateId
FUDOCS_derivate_000000008368
dcterms.accessRights.openaire
open access