Intubated Patients with Respiratory Failure under Mechanical Ventilation in Emergency Department
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Abstract
Background: Acute respiratory failure (ARF) is an important presentation in emergency department (ED). Intubation and mechanical ventilation (MV) are sometimes the ultimate decisions in such emergent situations. Many of these patients are unfortunately managed in an ED. This may endanger their outcome.
This study was aimed to compare the outcome of critically ill patients with ARF under MV admitted to ED with patients admitted to ICU.
Methods: All critically ill patients with ARF who were intubated and placed under MV were enrolled in this study. Cases were either admitted to ED or ICU. Demographic data, initial diagnosis, final diagnosis, length of hospital stay, one-month mortality rate, number of times patient was intubated and number of times patient was resuscitated were all recorded and compared between the 2 groups.
Results: Out of all 172 patients admitted to ED and ICU, 74 (43%) were females and 98 (57%) were males. Patients had a mean±SD age of 64.2±18.1 years. ICU patients (85 patients (49.4%)) had a significantly longer hospital stay (p=0.048). ICU patients had significantly more resuscitation process (p=0.006). Mortality rate in ICU was significantly higher than ED. In the meanwhile, more patients in ED finally survived (p=0.004).
Conclusion: In the present study, ICU patients were admitted longer to the ward than ED patients. Overall, ED mortality rate was lower than ICU. More patients finally survived in ED in comparison to ICU.
[2] Fowler RA, Guest CB, Lapinsky SE, Sibbald WJ, Louie M, Tang P, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med. 2004;169(11):1198-202.
[3] Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest. 2000; 118(4):1100-5.
[4] Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. Jama. 2002;287(3):345-55.
[5] Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005; 353(16):1685-93.
[6] Fader DJ, Kang S. Bedsore of an unknown primary site. Arch Dermatol. 1995;131(10):1115-6.
[7] Witting MD. “You wanna do what?!” Modern indications for nasogastric intubation. J Emerg Med. 2007;33(1):61-4.
[8] Lewin Group. The results of the American Hospital Association survey of emergency department (ED) and hospital capacity: American Hospital Association. [Available from: http://www.hospitalconnect.com/aha/press_roominfo/content/EdoCrisisSlides.pdf.
[9] The future of emergency care in the United States health care system: Institute of Medicine [Available from: http://www.iom.edu.
[10] Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003; 20(5):402-5.
[11] Magid DJ, Asplin BR, Wears RL. The quality gap: searching for the consequences of emergency department crowding. Ann Emerg Med. 2004; 44(6):586-8.
[12] Engebretsen S, Bogstrand ST, Jacobsen D, Rimstad R. Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. Int Emerg Nurs. 2021; 54:100939.
[13] Bauer PR, Gajic O, Nanchal R, Kashyap R, Martin-Loeches I, Sakr Y, et al. Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit. J Crit Care. 2017; 42:1-5.
[14] Hsiao Y-J, Chen C-Y, Hung H-T, Lee C-H, Su Y-Y, Ng C-J, et al. Comparison of the outcome of emergency endotracheal intubation in the general ward, intensive care unit and emergency department. Biomedical Journal. 2020.
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| Issue | Vol 8 No 2 (2022): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i2.9155 | |
| Keywords | ||
| Mortality Intubated Mechanical ventilation Acute respiratory failure Emergency department (ED) Intensive care unit (ICU) | ||
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