Epidemiology of mechanical ventilation in Argentina. The EpVAr multicenter observational study

Abstract

Objetive: To describe mechanical ventilation (MV) practices in Argentina, and to explore factors associated with ICU mortality in this population.

Design: A prospective, multicenter, observational study was carried out.

Setting: Intensive Care.

Patients: We enrolled patients above 18 years old admitted to any of the participating ICUs requiring invasive MV for at least 12 h since the admission to the healthcare institution, including MV initiation in emergency department, operating room or other hospitals.

Interventions: None.

Variables: All variables were classified into three categories: variables related to demographic and clinical factors before the MV, factors related to the first day on MV, and factors related to events happening during the MV (complications and weaning from MV). Mechanical ventilation weaning and mortality were classified according to WIND.

Results: The primary analysis included 950 patients. The main indication for MV was acute respiratory failure (58% of patients). Initial ventilation mode was volume control-continuous mandatory ventilation in 75% of cases. ICU and hospital mortality were 44.6% and 47.9% respectively. The variables identified as independent predictors of mortality in ICU were age (OR 3.48 IC 95% 1.22-11.66; p = 0.028), failure to implement NIV before MV (OR 2.76 IC 95% 1.02-7.10; p = 0.038), diagnosis of sepsis (OR 2.46 IC 95% 1.09-5.47; p = 0.027) and extubation failure (OR 4.50 IC 95% 2.05-9.90; p < 0.001).

Conclusions: The present study allowed us to describe the characteristics and clinical course of the patients who received mechanical ventilation in Argentina, finding as the main result that mortality was higher than that reported in international studies.

Keywords: Destete de la ventilación mecánica; Epidemiology; Epidemiología; Intensive Care Unit; Mechanical ventilation; Mortalidad; Mortality; Unidad de Cuidados Intensivos; Ventilación mecánica; Weaning mechanical ventilation.