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West J Emerg Med. 2017 Aug;18(5):972-979. doi: 10.5811/westjem.2017.5.34099. Epub 2017 Jul 11.

Duration of Mechanical Ventilation in the Emergency Department.

Author information

1
Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina.
2
Massachusetts General Hospital, Respiratory Care Services, Boston, Massachusetts.
3
University of Colorado at Denver, School of Medicine, Department of Emergency Medicine, Denver, Colorado.
4
Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, Department of Emergency Medicine and Critical Care, Oakland, California.
5
Medical University of South Carolina, Division of Emergency Medicine, Charleston, South Carolina.

Abstract

INTRODUCTION:

Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).

METHODS:

This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. All consecutive adult patients on invasive mechanical ventilation were eligible for enrollment. We performed a Cox regression to assess for a mortality effect for mechanically ventilated patients with each hour of increasing LOS in the ED and multivariable regression analyses to assess for independently significant contributors to in-hospital mortality. Our primary outcome was in-hospital mortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. We further commented on use of lung protective ventilation and frequency of ventilator changes made in this cohort.

RESULTS:

We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time of mechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer total duration of intubation. However, adjusted multivariable regression analysis demonstrated only older age and admission to the neurosciences ICU as independently associated with increased mortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours had changes made to their ventilator.

CONCLUSION:

In a prospective observational study of patients mechanically ventilated in the ED, there was a significant mortality benefit to expedited transfer of patients into an appropriate ICU setting.

PMID:
28874952
PMCID:
PMC5576636
DOI:
10.5811/westjem.2017.5.34099
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This study was funded in part by a university development grant. Dr. Sankoff is a section editor/decision editor/editorial board member of the Western Journal of Emergency Medicine. He had no role in the peer review process for this paper.

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