Impact of post-intubation interventions on mortality in patients boarding in the emergency department.Citation: The Western Journal of Emergency Medicine. 15(6):708-11, 2014 Sep.PMID: 25247049Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational StudySubject headings: *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Hospital Mortality | *Intubation, Intratracheal/mo [Mortality] | Adult | Blood Gas Analysis/mo [Mortality] | Capnography/mo [Mortality] | Conscious Sedation/mo [Mortality] | Humans | Intensive Care Units/sn [Statistics & Numerical Data] | Intubation, Intratracheal/sn [Statistics & Numerical Data] | Length of Stay/sn [Statistics & Numerical Data] | Pneumonia, Ventilator-Associated/mo [Mortality] | Radiography, Thoracic/mo [Mortality] | Respiration, Artificial/mo [Mortality] | Respiration, Artificial/sn [Statistics & Numerical Data] | Retrospective Studies | Tidal VolumeYear: 2014ISSN:
|Item type||Current library||Collection||Call number||Status||Date due||Barcode|
|Journal Article||MedStar Authors Catalog||Article||25247049||Available||25247049|
CONCLUSION: 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.
INTRODUCTION: Emergency 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).
METHODS: 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.
RESULTS: 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.