Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome
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 co...
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Wolters Kluwer
2021
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Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 |
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Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Tariq A. Dam, MD Harm-Jan de Grooth, MD, PhD Thomas Klausch, PhD Lucas M. Fleuren, MD Daan P. de Bruin, MSc Robert Entjes, MD Thijs C. D. Rettig, MD, PhD Dave A. Dongelmans, MD, PhD Age D. Boelens, MD Sander Rigter, MD Stefaan H. A. Hendriks, MD Remko de Jong, MD Marlijn J. A Kamps, MD Marco Peters, MD A. Karakus, MD Diederik Gommers, MD, PhD Dharmanand Ramnarain, MD Evert-Jan Wils, MD, PhD Sefanja Achterberg, MD, PhD Ralph Nowitzky, MD Walter van den Tempel, MD Cornelis P. C. de Jager, MD, PhD Fleur G. C. A. Nooteboom, MD Evelien Oostdijk, MD, PhD Peter Koetsier, MD Alexander D. Cornet, MD, PhD, FRCP Auke C. Reidinga, MD Wouter de Ruijter, MD, PhD Rob J. Bosman, MD Tim Frenzel, MD, PhD Louise C. Urlings-Strop, MD, PhD Paul de Jong, MD Ellen G. M. Smit, MD Olaf L. Cremer, MD, PhD D. Jannet Mehagnoul-Schipper, MD, PhD Harald J. Faber, MD Judith Lens, MD Gert B. Brunnekreef, MD Barbara Festen-Spanjer, MD Tom Dormans, MD, PhD Annemieke Dijkstra, MD Bram Simons, MD A. A. Rijkeboer, MD Sesmu Arbous, MD, PhD Marcel Aries, MD, PhD Menno Beukema, MD Daniël Pretorius, MD Rutger van Raalte, MD Martijn van Tellingen, MD, EDIC Niels C. Gritters van den Oever, MD Robbert C. A. Lalisang, MD Michele Tonutti, MRes Armand R. J. Girbes, MD, PhD, EDIC Mark Hoogendoorn, PhD Patrick J. Thoral, MD, EDIC Paul W. G. Elbers, MD, PhD, EDIC on behalf of the Dutch ICU Data Sharing Against COVID-19 Collaborators Remko van den Akker Tom A. Rijpstra M. C. Reuland Klaas Sierk Arnold Arend Jan Meinders Nicolas Schroten Laura van Manen Leon Montenij Julia Koeter J. W. Fijen Jasper van Bommel Roy van den Berg Martha de Bruin Roger van Rietschote Ellen van Geest Koen S. Simons Anisa Hana Joost Labout Michael Kuiper Albertus Beishuizen Bart van de Gaauw Roos Renckens B. van den Bogaard Peter Pickkers Pim van der Heiden Dennis Geutjes Claudia (C. W.) van Gemeren Emma Rademaker Frits H. M. van Osch Johan Lutisan Jacomar J. M. van Koesveld Bart P. Grady Martijn de Kruif Martin E. Haan Luca Roggeveen Dagmar M. Ouweneel Ronald Driessen Jan Peppink G. J. Zijlstra A. J. van Tienhoven Evelien van der Heiden Jan Jaap Spijkstra Hans van der Spoel Angelique de Man Heder J. de Vries Fuda van Diggelen Ali el Hassouni David Romero Guzman Sandjai Bhulai Sebastiaan J. J. Vonk Mattia Fornasa Tomas Machado Adam Izdebski Taco Houwert Hidde Hovenkamp Roberto Noorduijn Londono Davide Quintarelli Martijn G. Scholtemeijer Aletta A. de Beer Giovanni Cinà Willem E. Herter Michael de Neree tot Babberich Olivier Thijssens Lot Wagemakers Hilde G. A. van der Pol Tom Hendriks Julie Berend Virginia Ceni Silva Robert F. J. Kullberg Leo Heunks Nicole Juffermans Arjen J. C. Slooter Martijn Beudel Nicolet F. de Keizer Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| description |
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. |
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article |
| author |
Tariq A. Dam, MD Harm-Jan de Grooth, MD, PhD Thomas Klausch, PhD Lucas M. Fleuren, MD Daan P. de Bruin, MSc Robert Entjes, MD Thijs C. D. Rettig, MD, PhD Dave A. Dongelmans, MD, PhD Age D. Boelens, MD Sander Rigter, MD Stefaan H. A. Hendriks, MD Remko de Jong, MD Marlijn J. A Kamps, MD Marco Peters, MD A. Karakus, MD Diederik Gommers, MD, PhD Dharmanand Ramnarain, MD Evert-Jan Wils, MD, PhD Sefanja Achterberg, MD, PhD Ralph Nowitzky, MD Walter van den Tempel, MD Cornelis P. C. de Jager, MD, PhD Fleur G. C. A. Nooteboom, MD Evelien Oostdijk, MD, PhD Peter Koetsier, MD Alexander D. Cornet, MD, PhD, FRCP Auke C. Reidinga, MD Wouter de Ruijter, MD, PhD Rob J. Bosman, MD Tim Frenzel, MD, PhD Louise C. Urlings-Strop, MD, PhD Paul de Jong, MD Ellen G. M. Smit, MD Olaf L. Cremer, MD, PhD D. Jannet Mehagnoul-Schipper, MD, PhD Harald J. Faber, MD Judith Lens, MD Gert B. Brunnekreef, MD Barbara Festen-Spanjer, MD Tom Dormans, MD, PhD Annemieke Dijkstra, MD Bram Simons, MD A. A. Rijkeboer, MD Sesmu Arbous, MD, PhD Marcel Aries, MD, PhD Menno Beukema, MD Daniël Pretorius, MD Rutger van Raalte, MD Martijn van Tellingen, MD, EDIC Niels C. Gritters van den Oever, MD Robbert C. A. Lalisang, MD Michele Tonutti, MRes Armand R. J. Girbes, MD, PhD, EDIC Mark Hoogendoorn, PhD Patrick J. Thoral, MD, EDIC Paul W. G. Elbers, MD, PhD, EDIC on behalf of the Dutch ICU Data Sharing Against COVID-19 Collaborators Remko van den Akker Tom A. Rijpstra M. C. Reuland Klaas Sierk Arnold Arend Jan Meinders Nicolas Schroten Laura van Manen Leon Montenij Julia Koeter J. W. Fijen Jasper van Bommel Roy van den Berg Martha de Bruin Roger van Rietschote Ellen van Geest Koen S. Simons Anisa Hana Joost Labout Michael Kuiper Albertus Beishuizen Bart van de Gaauw Roos Renckens B. van den Bogaard Peter Pickkers Pim van der Heiden Dennis Geutjes Claudia (C. W.) van Gemeren Emma Rademaker Frits H. M. van Osch Johan Lutisan Jacomar J. M. van Koesveld Bart P. Grady Martijn de Kruif Martin E. Haan Luca Roggeveen Dagmar M. Ouweneel Ronald Driessen Jan Peppink G. J. Zijlstra A. J. van Tienhoven Evelien van der Heiden Jan Jaap Spijkstra Hans van der Spoel Angelique de Man Heder J. de Vries Fuda van Diggelen Ali el Hassouni David Romero Guzman Sandjai Bhulai Sebastiaan J. J. Vonk Mattia Fornasa Tomas Machado Adam Izdebski Taco Houwert Hidde Hovenkamp Roberto Noorduijn Londono Davide Quintarelli Martijn G. Scholtemeijer Aletta A. de Beer Giovanni Cinà Willem E. Herter Michael de Neree tot Babberich Olivier Thijssens Lot Wagemakers Hilde G. A. van der Pol Tom Hendriks Julie Berend Virginia Ceni Silva Robert F. J. Kullberg Leo Heunks Nicole Juffermans Arjen J. C. Slooter Martijn Beudel Nicolet F. de Keizer |
| author_facet |
Tariq A. Dam, MD Harm-Jan de Grooth, MD, PhD Thomas Klausch, PhD Lucas M. Fleuren, MD Daan P. de Bruin, MSc Robert Entjes, MD Thijs C. D. Rettig, MD, PhD Dave A. Dongelmans, MD, PhD Age D. Boelens, MD Sander Rigter, MD Stefaan H. A. Hendriks, MD Remko de Jong, MD Marlijn J. A Kamps, MD Marco Peters, MD A. Karakus, MD Diederik Gommers, MD, PhD Dharmanand Ramnarain, MD Evert-Jan Wils, MD, PhD Sefanja Achterberg, MD, PhD Ralph Nowitzky, MD Walter van den Tempel, MD Cornelis P. C. de Jager, MD, PhD Fleur G. C. A. Nooteboom, MD Evelien Oostdijk, MD, PhD Peter Koetsier, MD Alexander D. Cornet, MD, PhD, FRCP Auke C. Reidinga, MD Wouter de Ruijter, MD, PhD Rob J. Bosman, MD Tim Frenzel, MD, PhD Louise C. Urlings-Strop, MD, PhD Paul de Jong, MD Ellen G. M. Smit, MD Olaf L. Cremer, MD, PhD D. Jannet Mehagnoul-Schipper, MD, PhD Harald J. Faber, MD Judith Lens, MD Gert B. Brunnekreef, MD Barbara Festen-Spanjer, MD Tom Dormans, MD, PhD Annemieke Dijkstra, MD Bram Simons, MD A. A. Rijkeboer, MD Sesmu Arbous, MD, PhD Marcel Aries, MD, PhD Menno Beukema, MD Daniël Pretorius, MD Rutger van Raalte, MD Martijn van Tellingen, MD, EDIC Niels C. Gritters van den Oever, MD Robbert C. A. Lalisang, MD Michele Tonutti, MRes Armand R. J. Girbes, MD, PhD, EDIC Mark Hoogendoorn, PhD Patrick J. Thoral, MD, EDIC Paul W. G. Elbers, MD, PhD, EDIC on behalf of the Dutch ICU Data Sharing Against COVID-19 Collaborators Remko van den Akker Tom A. Rijpstra M. C. Reuland Klaas Sierk Arnold Arend Jan Meinders Nicolas Schroten Laura van Manen Leon Montenij Julia Koeter J. W. Fijen Jasper van Bommel Roy van den Berg Martha de Bruin Roger van Rietschote Ellen van Geest Koen S. Simons Anisa Hana Joost Labout Michael Kuiper Albertus Beishuizen Bart van de Gaauw Roos Renckens B. van den Bogaard Peter Pickkers Pim van der Heiden Dennis Geutjes Claudia (C. W.) van Gemeren Emma Rademaker Frits H. M. van Osch Johan Lutisan Jacomar J. M. van Koesveld Bart P. Grady Martijn de Kruif Martin E. Haan Luca Roggeveen Dagmar M. Ouweneel Ronald Driessen Jan Peppink G. J. Zijlstra A. J. van Tienhoven Evelien van der Heiden Jan Jaap Spijkstra Hans van der Spoel Angelique de Man Heder J. de Vries Fuda van Diggelen Ali el Hassouni David Romero Guzman Sandjai Bhulai Sebastiaan J. J. Vonk Mattia Fornasa Tomas Machado Adam Izdebski Taco Houwert Hidde Hovenkamp Roberto Noorduijn Londono Davide Quintarelli Martijn G. Scholtemeijer Aletta A. de Beer Giovanni Cinà Willem E. Herter Michael de Neree tot Babberich Olivier Thijssens Lot Wagemakers Hilde G. A. van der Pol Tom Hendriks Julie Berend Virginia Ceni Silva Robert F. J. Kullberg Leo Heunks Nicole Juffermans Arjen J. C. Slooter Martijn Beudel Nicolet F. de Keizer |
| author_sort |
Tariq A. Dam, MD |
| title |
Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| title_short |
Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| title_full |
Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| title_fullStr |
Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| title_full_unstemmed |
Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome |
| title_sort |
some patients are more equal than others: variation in ventilator settings for coronavirus disease 2019 acute respiratory distress syndrome |
| publisher |
Wolters Kluwer |
| publishDate |
2021 |
| url |
https://doaj.org/article/32f239460e134af0a3cea6a1b4ef0a1c |
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oai:doaj.org-article:32f239460e134af0a3cea6a1b4ef0a1c2021-11-25T07:56:43ZSome Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome2639-802810.1097/CCE.0000000000000555https://doaj.org/article/32f239460e134af0a3cea6a1b4ef0a1c2021-10-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000555https://doaj.org/toc/2639-8028OBJECTIVES:. 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.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 KeizerWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 10, p e0555 (2021) |