Impact of post-intubation interventions on mortality in patients boarding in the emergency department
Bhooshan, Anu
Dubin, Jeffrey S
Frohna, Bill
Goyal, Munish
Tefera, Eshetu
Wilson, Matthew D
text
xx
2014
monographic
en
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.
English
*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 Volume
MedStar Health Research Institute
MedStar Washington Hospital Center
Emergency Medicine
1936-900X
http://dx.doi.org/10.5811/westjem.2014.7.22292
http://dx.doi.org/10.5811/westjem.2014.7.22292
Ovid MEDLINE(R)
160113