Does ICU Volume Impact Mortality and Length of Stay in ARDS?

ICU overused for patients with heart or lung disease
ICU overused for patients with heart or lung disease
More than 300,000 individual ICU stays were examined to determine the benefit of ICU volume related to ARDS outcomes.

Patients admitted to high-volume intensive care units (ICUs) with acute respiratory distress syndrome (ARDS) were likely to experience a shorter hospital stay and  lower mortality rate, according to research presented at the American Thoracic Society (ATS) 2017 International Conference, held May 19-24 in Washington DC.1

Researchers in Paris, France used the French CUB-REA database to identify 316,000 ICU stays between 2000 and 2014 in patients with ARDS. This data was used to investigate whether a relationship exists between patient outcomes and case-volume ICUs.

Of all ICU stays examined, 18,022 were ARDS-related; overall prevalence of ARDS in ICU settings was 8.3%, with a progressive increase from 6.5% to 10.5% between 2000 and 2008 and a slight decrease to 7.2% in 2014 (P <.001). Simplified Acute Physiology Score 2 (SAPS2) increased from 52 to 58 during the study period, while both ICU and in-hospital mortality decreased from 57.9% to 45.5% and 59.1% to 48.4%, respectively (P <.0001 for both).

SAPS2 was “significantly higher” in high-volume (>68 admissions per year of patients with ARDS) vs low- and moderate-volume (≤37 and 38 to 67 admissions per year) ICU settings (61 vs 53 and 56, respectively; P <.001). In addition, high-volume ICUs were characterized by lower ICU mortality (51.5%) and shorter length of hospital (15 days) (P <.001 for both).

“[D]espite an increase in ARDS severity, ICU mortality decreased,” the researchers concluded. “There was a significantly lower ICU mortality in high-volume ICUs.”

“Further studies are warranted to confirm and delineate our results and determine whether regionalization of patients with ARDS should be recommended,” said lead investigator Martin Dres, MD, of the AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumonologie et Réanimation Médicale in Paris, France, in a press release.2

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  1. Dres M, Pham T, Aegerter P, et al. Effect of high volume ICUs on mortality in ARDS over 15 years. Presented at: 2017 American Thoracic Society (ATS) International Conference; Washington, DC; May 19-24. Abstract 6524.
  2. Mortality from acute respiratory distress syndrome found to be lower in high-volume ICUs [news release]. New York, NY: American Thoracic Society. Published May 17, 2017. Accessed June 23, 2017.