{"pk":10647,"title":"Duration of Mechanical Ventilation in the Emergency Department","subtitle":null,"abstract":"Introduction:\n Due to hospital crowding, mechanically ventilated patients are increasinglyspending 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 inhospitalmortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).\nMethods:\n This was a multi-center, prospective, observational study of patients ventilated in theED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. Allconsecutive adult patients on invasive mechanical ventilation were eligible for enrollment. Weperformed a Cox regression to assess for a mortality effect for mechanically ventilated patientswith each hour of increasing LOS in the ED and multivariable regression analyses to assessfor independently significant contributors to in-hospital mortal ity. Our primary outcome was inhospitalmortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. Wefurther commented on use of lung protective ventilation and frequency of ventilator changesmade in this cohort.\nResults:\n We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental statuswithout respiratory pathology was the most common reason for intubation, followed by traumaand respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time ofmechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer totalduration of intubation. However, adjusted multivariable regression analysis demonstrated onlyolder age and admission to the neurosciences ICU as independently associated with increasedmortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours hadchanges made to their ventilator.\nConclusion:\n In a prospective observational study of patients mechanically ventilated in the ED,there was a significant mortality benefit to expedited transfer o f patients into an appropriate ICUsetting. [West J Emerg Med. 2017;18(5)972-979.]","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Mechanical ventilation, ICU outcomes, length of stay, critical care, endotracheal intubation, hospital mortality"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8q27h6k2","frozenauthors":[{"first_name":"Lauren","middle_name":"B.","last_name":"Angotti","name_suffix":"","institution":"Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina","department":"None"},{"first_name":"Jeremy","middle_name":"","last_name":"Richards","name_suffix":"","institution":"Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina","department":"None"},{"first_name":"Daniel","middle_name":"F.","last_name":"Fisher","name_suffix":"","institution":"Massachusetts General Hospital, Respiratory Care Services, Boston, Massachusetts","department":"None"},{"first_name":"Jeffrey","middle_name":"D.","last_name":"Sankoff","name_suffix":"","institution":"University of Colorado at Denver, School of Medicine, Department of Emergency Medicine, Denver, Colorado","department":"None"},{"first_name":"Todd","middle_name":"A.","last_name":"Seigel","name_suffix":"","institution":"Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, Department of Emergency Medicine and Critical Care, Oakland, California","department":"None"},{"first_name":"Haitham","middle_name":"S.","last_name":"Al Ashry","name_suffix":"","institution":"Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina","department":"None"},{"first_name":"Susan","middle_name":"R.","last_name":"Wilcox","name_suffix":"","institution":"Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina\nMedical University of South Carolina, Division of Emergency Medicine, Charleston, South Carolina","department":"None"}],"date_submitted":"2017-03-01T20:58:49Z","date_accepted":"2017-03-01T20:58:49Z","date_published":"2017-07-11T14:21:43Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10647/galley/5831/download/"}]}