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{
    "pk": 8195,
    "title": "Impact of Post-Intubation Interventions on Mortality in Patients Boarding in the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nEmergency physicians frequently perform endotracheal intubation and mechanical ventilation. The impact of instituting early post-intubation interventions on patients boarding in the emergency department (ED) is not well studied. We sought to determine the impact of post-intubation interventions (arterial blood gas sampling, obtaining a chest x-ray (CXR), gastric decompression, early sedation, appropriate initial tidal volume, and quantitative capnography) on outcomes of mortality, ventilator-associated pneumonia (VAP), ventilator days, and intensive care unit (ICU) length-of-stay (LOS).\nMethods:\n This was an observational, retrospective study of patients intubated in the ED at a large tertiary-care teaching hospital and included patients in the ED for greater than two hours post-intubation.  We excluded them if they had incomplete data, were designated “do not resuscitate,” were managed primarily by the trauma team, or had surgery within six hours after intubation.\nResults:\n Of 169 patients meeting criteria, 15 died and 10 developed VAP.  The mortality odds ratio (OR) in patients receiving CXR was 0.10 (95% CI 0.01 to 0.98), and 0.11 (95% CI 0.03 to 0.46) in patients receiving early sedation. The mortality OR for patients with 3 or fewer interventions was 4.25 (95% CI 1.15 to 15.75) when compared to patients with 5 or more interventions.  There was no significant relationship between VAP rate, ventilator days, or ICU LOS and any of the intervention groups.\nConclusion:\n The performance of a CXR and early sedation as well as performing five or more vs. three or fewer post-intubation interventions in boarding adult ED patients was associated with decreased mortality. [West J Emerg Med. 2014;15(6):-0]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 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\nNonCommercial — You may not use the material for commercial purposes.\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-nc/4.0"
    },
    "keywords": [
        {
            "word": "critical care, post intubation, ventilator management"
        }
    ],
    "section": "Patient Safety",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/4ms77447",
    "frozenauthors": [
        {
            "first_name": "Rahul",
            "middle_name": "",
            "last_name": "Bhat",
            "name_suffix": "",
            "institution": "MedStar Georgetown University Hospital, Department of Emergency Medicine, Washington, DCr",
            "department": "None"
        },
        {
            "first_name": "Munish",
            "middle_name": "",
            "last_name": "Goyal",
            "name_suffix": "",
            "institution": "MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Shannon",
            "middle_name": "",
            "last_name": "Graf",
            "name_suffix": "",
            "institution": "MedStar Union Memorial Hospital, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Anu",
            "middle_name": "",
            "last_name": "Bhooshan",
            "name_suffix": "",
            "institution": "MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Eshetu",
            "middle_name": "",
            "last_name": "Teferra",
            "name_suffix": "",
            "institution": "MedStar Health Research Institute, Department of Biostatistics and Bioinformatics, Hyattsville, Maryland",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Dubin",
            "name_suffix": "",
            "institution": "MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Bill",
            "middle_name": "",
            "last_name": "Frohna",
            "name_suffix": "",
            "institution": "MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, DC",
            "department": "None"
        }
    ],
    "date_submitted": "2014-04-04T01:44:58Z",
    "date_accepted": "2014-04-04T01:44:58Z",
    "date_published": "2014-08-13T15:44:02Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8195/galley/4715/download/"
        }
    ]
}