Acute Respiratory Distress Syndrome Cases Volume and ICU Mortality in Medical Patients

Martin Dres; Peter C Austin; Tài Pham; Philippe Aegerter; Bertrand Guidet; Alexandre Demoule; Antoine Vieillard-Baron; Laurent Brochard; Guillaume Geri; CUB-REA Group

doi:10.1097/CCM.0000000000002816

Acute Respiratory Distress Syndrome Cases Volume and ICU Mortality in Medical Patients

Crit Care Med. 2018 Jan;46(1):e33-e40. doi: 10.1097/CCM.0000000000002816.

Authors

Martin Dres^{1

2

3}, Peter C Austin^{4

5}, Tài Pham^{3

6}, Philippe Aegerter^{7

8}, Bertrand Guidet^{9

10}, Alexandre Demoule^{1

2}, Antoine Vieillard-Baron^{8

11

12}, Laurent Brochard^{3

6}, Guillaume Geri^{8

11

12}; CUB-REA Group

Collaborators

CUB-REA Group:
F Brivet, J P Bedos, A Vieillard-Baron, Y Cohen, C Richard, M Wolff, D Caen, J P Mira, B Verdière, J Y Fagon, T Marsepoil, C Brun-Buisson, A Rabbat, F Blot, G Dhonneur, D Dreyfus, F Baud, J M Coulaud, J L Pallot, H Bismuth, T Similowski, J Chastre, F Bolgert, H Outin, J L Ricome, F Santoli, D Annane, B Guidet, B Misset, E Azoulay, M Fartoukh, H Mentec

Affiliations

¹ Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.
² Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale ("Département 'R3S'"), F-75013, Paris, France.
³ St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto Faculty of Medicine, 12366, Toronto, ON, Canada.
⁷ Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France.
⁸ Université de Versailles Saint Quentin, UFR des Sciences de la Santé Simone Veil, Saint Quentin en Yvelines, France.
⁹ Service de réanimation médicale, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
¹⁰ Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
¹¹ Service de Réanimation médico-chirurgicale, Pôle Thorax-Maladies Cardiovasculaires-Abdomen-Métabolisme, Hôpital Ambroise Paré, Boulogne Billancourt, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹² INSERM U 1018, CESP, Equipe 5 (EpReC, Epidémiologie Rénale et Cardiovasculaire), Villejuif, France.

PMID: 29095203
DOI: 10.1097/CCM.0000000000002816

Abstract

Objectives: To determine whether ICUs caring for higher volumes of acute respiratory distress syndrome patients would be associated with lower ICU mortality.

Design: A 9-year multicenter retrospective cohort study of prospectively collected data.

Setting: French medical ICUs.

Patients: From 2004 to 2012, acute respiratory distress syndrome cases were identified from a coding system through a regional database (Collège des Utilisateurs de Données en Réanimation).

Interventions: None.

Measurements and main results: Volume was calculated as the cumulative annual mean number of acute respiratory distress syndrome cases. Severity (Simplified Acute Physiology Score 2) and ICU mortality between categories (low, medium, and high) of acute respiratory distress syndrome cases volume were analyzed. Multivariable analysis using mixed effects models was performed to adjust for severity of illness and confounding factors. Over the study period, 8,383 acute respiratory distress syndrome patients among 31 ICUs met the study inclusion criteria. Overall, Simplified Acute Physiology Score 2 (median [interquartile]) was 58 (43-74), whereas ICU mortality was 53.7%. Severity as assessed by Simplified Acute Physiology Score 2 (median [interquartile]) was significantly higher in high-volume ICUs (> 65 acute respiratory distress syndrome per year) as compared to low (≤ 29 acute respiratory distress syndrome per year) and medium-volume ICUs (> 29-65 acute respiratory distress syndrome per year): 61 (46-77) versus 55 (41-72) and 55.0 (40-72), respectively (p < 0.01). ICU mortality was similar across the acute respiratory distress syndrome volume categories (53.6%, 54.1%, and 53.3% in low-, medium-, and high-volume categories ICUs, respectively). After adjustment for confounders, acute respiratory distress syndrome case volume was independently associated with ICU mortality (odds ratio for log-transformed volume: 0.77 [95% CI, 0.62-0.96]; p = 0.02).

Conclusions: ICUs caring for higher volumes of acute respiratory distress syndrome cases were associated with lower ICU mortality.

Publication types

Comparative Study

MeSH terms

Aged
Female
Hospital Mortality
Hospitals, High-Volume*
Hospitals, Low-Volume*
Humans
Intensive Care Units*
Male
Middle Aged
Paris
Respiratory Distress Syndrome / mortality*