TY  - BOOK
AU  - Bhooshan, Anu
AU  - Dubin, Jeffrey S
AU  - Frohna, Bill
AU  - Goyal, Munish
AU  - Tefera, Eshetu
AU  - Wilson, Matthew D
TI  - Impact of post-intubation interventions on mortality in patients boarding in the emergency department
SN  - 1936-900X
PY  - 2014///
KW  - *Emergency Service, Hospital/sn [Statistics & Numerical Data]
KW  - *Hospital Mortality
KW  - *Intubation, Intratracheal/mo [Mortality]
KW  - Adult
KW  - Blood Gas Analysis/mo [Mortality]
KW  - Capnography/mo [Mortality]
KW  - Conscious Sedation/mo [Mortality]
KW  - Humans
KW  - Intensive Care Units/sn [Statistics & Numerical Data]
KW  - Intubation, Intratracheal/sn [Statistics & Numerical Data]
KW  - Length of Stay/sn [Statistics & Numerical Data]
KW  - Pneumonia, Ventilator-Associated/mo [Mortality]
KW  - Radiography, Thoracic/mo [Mortality]
KW  - Respiration, Artificial/mo [Mortality]
KW  - Respiration, Artificial/sn [Statistics & Numerical Data]
KW  - Retrospective Studies
KW  - Tidal Volume
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Emergency Medicine
KW  - Journal Article
KW  - Observational Study
N2  - 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
UR  - http://dx.doi.org/10.5811/westjem.2014.7.22292
ER  -