Outcome of mechanically ventilated patients with predominantly cardiovascular and pulmonary diseases: results of the German Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte multicenter BEAT Registry

Objectives

Little is known about the outcome in mechanically ventilated patients with predominantly cardiovascular and pulmonary disorders. The multicenter BEAT Registry assessed the outcome of all mechanically ventilated patients treated in 45 German coronary intensive care units (CICU) (33 community and 12 university hospitals).

Methods

All mechanically ventilated patients admitted to the participating CICUs and all patients intubated and ventilated during the CICU were included in the registry between September 2001 and June 2002. Causes for mechanical ventilation (MV), clinical course and hospital mortality (HM) were assessed for all patients. Noninvasive ventilated patients were excluded.

Results

A total of 2372 mechanically ventilated patients were included (mean age 68 years, 62% male, 42% cardiovascular, 22% pulmonary, 8% neurologic and 28% other reasons for MV), in 74% intubation (ITN) and MV was performed emergently. On the first day 44% of the patients were ventilated with the bilevel positive airway pressure modus and 39% with the continuous positive pressure ventilation modus. Duration of MV was 2 (1–7) days, and length of CICU stay 20.5 (13–32) days. Overall, 47.3% patients died. Figure 1 shows the distribution of HM in 21 CICUs including > 50 patients in the registry (range HM 33–70%). Emergent ITN, cardiopulmonary resuscitation, ITN in hospital, shock, sepsis, pneumonia, ventricular tachycardia/fibrillation and sudden cardiac death were associated with HM in an univariate analysis.

Figure 1

Limitations

Admission severity of illness was not assessed as well as organ dysfunction during the CICU stay and causes of death.

Conclusion

Mortality is high in mechanically ventilated patients with cardiovascular and pulmonary disorders. The BEAT registry provides important data for benchmarking and is a first step towards quality improvement in this subset of critically ill patients with high mortality and morbidity.