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Abstract
BACKGROUND: Unanticipated respiratory compromise that lead to unplanned intubations is a known phenomenon in hospitalized patients. Most events occur in patients at high risk in well-monitored units; less is known about the incidence, risk factors, and trajectory of patients thought at low risk on lightly monitored general care wards. The aims of our study were to quantify demographic and clinical characteristics associated with unplanned intubations on general care floors and to analyze the medications administered, monitoring strategies, and vital-sign trajectories before the event.
METHODS: We performed a multicenter retrospective cohort study of hospitalized subjects on the general floor who had unanticipated, unplanned intubations on general care floors from August 2014 to February 2018.
RESULTS: We identified 448 unplanned intubations. The incidence rate was 0.420 per 1,000 bed-days (95% CI 0.374–0.470) in the academic hospital and was 0.430 (95% CI 0.352–0.520) and 0.394 per 1,000 bed-days (95% CI 0.301–0.506) at our community hospitals. Extrapolating these rates to total hospital admissions in the United States, we estimate 64,000 events annually. The mortality rate was 49.1%. Within 12 h preceding the event, 35.3% of the subjects received opiates. All received vital-sign assessments. Most were monitored with pulse oximetry. In contrast, 2.5% were on cardiac telemetry, and only 4 subjects used capnography; 53.7% showed significant vital-sign changes in the 24 h before the event. However, 46.3% had no significant change in any vital signs.
CONCLUSIONS: Our study showed unanticipated respiratory compromise that required an unplanned intubation of subjects on the general care floor, although not common, carried a high mortality. Besides pulse oximetry and routine vital-sign assessments, very little monitoring was in use. A significant portion of the subjects had no vital-sign abnormalities leading up to the event. Further research is needed to determine the phenotype of the different etiologies of unexpected acute respiratory failure to identify better risk stratification and monitoring strategies.
Footnotes
- Correspondence: Armando Bedoya MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, DUMC Box 102349 Hanes House, 330 Trent Drive, Room 117 Durham, NC 27710. E-mail: armando.bedoya{at}duke.edu
This research was supported by an investigator-initiated grant from the Respiratory Compromise Institute (RCI). RCI had no role in the design, analysis, or interpretation of the results in this study. RCI was given the opportunity to review the manuscript for medical and scientific accuracy before publication.
Dr Bhavsar: National Heart, Lung, and Blood Institute (K01HL140146).
Dr Goldstein: National Institute of Diabetes and Digestive and Kidney Disease (K25DK097279).
Supplementary material related to this paper is available at http://www.rcjournal.com.
Dr MacIntyre discloses a relationship with the Respiratory Compromise Institute. The remaining authors have disclosed no conflicts of interest.
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