Noninvasive ventilation for critically ill subjects with acute respiratory failure in the emergency department

Neha N. Goel, Clark Owyang, Shamsuddoha Ranginwala, George T. Loo, Lynne D. Richardson, Kusum S. Mathews

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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.

Original languageEnglish
Pages (from-to)82-90
Number of pages9
JournalRespiratory Care
Volume65
Issue number1
DOIs
StatePublished - 1 Jan 2020

Keywords

  • Bi-level
  • Critically ill
  • Emergency department
  • Mechanical ventilation
  • Noninvasive ventilation
  • Respiratory failure

Fingerprint

Dive into the research topics of 'Noninvasive ventilation for critically ill subjects with acute respiratory failure in the emergency department'. Together they form a unique fingerprint.

Cite this