학술논문

Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome
Document Type
article
Author
Tariq A. Dam, MDHarm-Jan de Grooth, MD, PhDThomas Klausch, PhDLucas M. Fleuren, MDDaan P. de Bruin, MScRobert Entjes, MDThijs C. D. Rettig, MD, PhDDave A. Dongelmans, MD, PhDAge D. Boelens, MDSander Rigter, MDStefaan H. A. Hendriks, MDRemko de Jong, MDMarlijn J. A Kamps, MDMarco Peters, MDA. Karakus, MDDiederik Gommers, MD, PhDDharmanand Ramnarain, MDEvert-Jan Wils, MD, PhDSefanja Achterberg, MD, PhDRalph Nowitzky, MDWalter van den Tempel, MDCornelis P. C. de Jager, MD, PhDFleur G. C. A. Nooteboom, MDEvelien Oostdijk, MD, PhDPeter Koetsier, MDAlexander D. Cornet, MD, PhD, FRCPAuke C. Reidinga, MDWouter de Ruijter, MD, PhDRob J. Bosman, MDTim Frenzel, MD, PhDLouise C. Urlings-Strop, MD, PhDPaul de Jong, MDEllen G. M. Smit, MDOlaf L. Cremer, MD, PhDD. Jannet Mehagnoul-Schipper, MD, PhDHarald J. Faber, MDJudith Lens, MDGert B. Brunnekreef, MDBarbara Festen-Spanjer, MDTom Dormans, MD, PhDAnnemieke Dijkstra, MDBram Simons, MDA. A. Rijkeboer, MDSesmu Arbous, MD, PhDMarcel Aries, MD, PhDMenno Beukema, MDDaniël Pretorius, MDRutger van Raalte, MDMartijn van Tellingen, MD, EDICNiels C. Gritters van den Oever, MDRobbert C. A. Lalisang, MDMichele Tonutti, MResArmand R. J. Girbes, MD, PhD, EDICMark Hoogendoorn, PhDPatrick J. Thoral, MD, EDICPaul W. G. Elbers, MD, PhD, EDICon behalf of the Dutch ICU Data Sharing Against COVID-19 CollaboratorsRemko van den AkkerTom A. RijpstraM. C. ReulandKlaas Sierk ArnoldArend Jan MeindersNicolas SchrotenLaura van ManenLeon MontenijJulia KoeterJ. W. FijenJasper van BommelRoy van den BergMartha de BruinRoger van RietschoteEllen van GeestKoen S. SimonsAnisa HanaJoost LaboutMichael KuiperAlbertus BeishuizenBart van de GaauwRoos RenckensB. van den BogaardPeter PickkersPim van der HeidenDennis GeutjesClaudia (C. W.) van GemerenEmma RademakerFrits H. M. van OschJohan LutisanJacomar J. M. van KoesveldBart P. GradyMartijn de KruifMartin E. HaanLuca RoggeveenDagmar M. OuweneelRonald DriessenJan PeppinkG. J. ZijlstraA. J. van TienhovenEvelien van der HeidenJan Jaap SpijkstraHans van der SpoelAngelique de ManHeder J. de VriesFuda van DiggelenAli el HassouniDavid Romero GuzmanSandjai BhulaiSebastiaan J. J. VonkMattia FornasaTomas MachadoAdam IzdebskiTaco HouwertHidde HovenkampRoberto Noorduijn LondonoDavide QuintarelliMartijn G. ScholtemeijerAletta A. de BeerGiovanni CinàWillem E. HerterMichael de Neree tot BabberichOlivier ThijssensLot WagemakersHilde G. A. van der PolTom HendriksJulie BerendVirginia Ceni SilvaRobert F. J. KullbergLeo HeunksNicole JuffermansArjen J. C. SlooterMartijn BeudelNicolet F. de Keizer
Source
Critical Care Explorations, Vol 3, Iss 10, p e0555 (2021)
Subject
Medical emergencies. Critical care. Intensive care. First aid
RC86-88.9
Language
English
ISSN
2639-8028
00000000
Abstract
OBJECTIVES:. As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients. DESIGN:. Multicenter retrospective cohort study. SETTING:. Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020. PATIENTS:. One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded. MEASUREMENTS AND MAIN RESULTS:. We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio2, set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao2/Fio2 ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant (p ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves. CONCLUSIONS:. This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under direct control by intensivists. Their effect on clinical outcomes for both coronavirus disease 2019 and other critically ill mechanically ventilated patients could have widespread implications for the practice of intensive care medicine and should be investigated further by causal inference models and clinical trials.