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Abstract
BACKGROUND: We aimed to investigate the association between noninvasive ventilation (NIV) initiated in the emergency department and patient outcomes for those requiring invasive mechanical ventilation so that we could understand the effect of extended NIV use (ie, > 4 h) prior to invasive mechanical ventilation on patient outcomes.
METHODS: We conducted a retrospective single-center cohort study at an academic tertiary care hospital center. All emergency department patients with acute respiratory failure requiring invasive mechanical ventilation and admission to the ICU within 48 h of initial presentation over a 24-month period were included.
RESULTS: Subject characteristics, ventilator parameters, and clinical course were captured via electronic query, respiratory billing data, and standardized chart abstraction. A total of 431 subjects with acute respiratory failure requiring invasive mechanical ventilation within 48 h of arrival were identified, of whom 115 (26.7%) were exposed to NIV prior to invasive mechanical ventilation, with a median duration of 4 h (interquartile range 1.9–9.3). Based on a multivariable model controlling for covariates, any NIV exposure prior to invasive mechanical ventilation was not associated with an increased odds of persistent organ dysfunction or death. However, in the subset of subjects exposed to NIV, extended NIV use (ie, > 4 h) prior to invasive mechanical ventilation was associated with increased odds of persistent organ dysfunction or death (odds ratio 4.11, 95% CI 1.51–11.19). Extended NIV use was also associated with increased odds of in-hospital mortality (odds ratio 4.02, 95% CI 1.51–10.74).
CONCLUSIONS: Although any exposure to NIV prior to invasive mechanical ventilation did not appear to affect morbidity and mortality, extended NIV use prior to invasive mechanical ventilation was associated with worse patient outcomes, suggesting a need for additional study to better understand the ramifications of duration of NIV use prior to failure on outcomes. Given this early timeframe for intervention, future studies should be collaborations between the emergency department and ICU.
- emergency department
- critically ill
- noninvasive ventilation
- bi-level
- respiratory failure
- mechanical ventilation
Footnotes
- Correspondence: Neha N Goel MD, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1232, New York, NY 10029. E-mail: neha.goel{at}mountsinai.org.
Dr Goel presented a version of this paper was presented at the American Thoracic Society 2018 International Conference, held May 18-23, 2018, in San Diego, California.
Dr Goel is partially supported by National Institutes of Health (NIH) National Heart, Lung, and Blood Institute Award DHHS – 1T32 HL129974-PI: Richardson. Dr Mathews is partially supported by NIH National Heart, Lung, and Blood Institute Award 1K23HL130648-PI: Mathews. This work was supported in part through the Mount Sinai Data Warehouse resources and staff expertise provided by Scientific Computing at the Icahn School of Medicine at Mount Sinai. The other authors have disclosed no conflicts of interest.
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2020 by Daedalus Enterprises
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