Median SAPS 3 score was 62 (52 to 72) points and the probability of death estimated by the global equation was 40 �� 24%. Using the customized equation for countries from Central and South America, the probability of death estimated by SAPS 3 was 52 �� 26%. Most patients (67%) used vasopressors during their stay in the ICU and 19% Seliciclib price required renal replacement therapy (RRT).Figure 1Flowchart of the study.Table 1Patients’ characteristics and univariate analysis of factors associated with hospital mortalityVentilatory supportInvasive MV was initially used in 80% (n = 622) of the patients and NIV was used in the remaining 20% (n = 151) of the patients as the initial ventilatory support (Table (Table11 and Figure Figure2).2). Of the later, 81 (54%) patients failed NIV support and were subsequently intubated for invasive MV.
Ventilatory modes used initially in patients who received invasive MV were pressure-controlled ventilation (n = 371, 60%), volume-controlled ventilation (n = 186, 30%), pressure-support ventilation (n = 54, 9%) and others (n = 11, 1%). Median tidal volume was 7.5 (6.1 to 8.7) mL/kg of predicted body weight and plateau pressures were below 30 cmH2O in the vast majority of the patients.Figure 2ICU and hospital mortality rates according to ventilatory support, ARDS diagnosis and NIV failure. ARDS, acute respiratory distress syndrome; ICU, intensive care unit; MV, mechanical ventilation.Outcome analysisThe overall ICU and hospital mortality rates were 34% and 42%, respectively (Figure (Figure22 and Table Table1).1).
In the univariate analysis, age, ideal body weight, SOFA score at day 1, SAPS 3 score, Charlson comorbidity index, hospital length of stay before ICU, admission from the emergency room and from the operating room were associated with hospital mortality. Additionally, NIV failure, lower PaO2/FiO2 ratio, ARDS diagnosis, tracheostomy, duration of ventilatory support, need for vasopressors and renal replacement therapy (RRT), cumulative fluid balance and maximal blood lactate concentrations were also associated with hospital mortality (Table (Table1).1). In multivariate analysis, older age, higher SOFA scores (without respiratory component at Day 1), Charlson comorbidity index > 2, moderate to severe ARDS, NIV failure, use of invasive MV, higher lactate concentrations and both very negative or positive cumulative fluid balance over the first 72 hours of ICU stay were independently associated with increased hospital mortality (Table (Table22).
Table 2Factors associated with hospital mortality in a multivariate analysisARDS diagnosis according to the Berlin definitionARDS was diagnosed in 242 (31%) patients (Figure (Figure2).2). Of these, 77% were supported with invasive MV and 23% received NIV as the initial ventilatory support. The rate of NIV failure in ARDS patients Cilengitide was 69%, as compared to 45% in non-ARDS patients (P = 0.007).
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