UA Open Access Publishing Fund / Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with
respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding
the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The
objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV
compared to patients intubated primarily in the medical intensive care unit (ICU).
Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30
June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110
patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous
quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on
the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used,
and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication
(desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation.
Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of
intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute
respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts
and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79
(95% CI 1.03 to 3.12).
Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds
of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication
during intubation is associated with an increased odds of death in the ICU.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/621341 |
| Date | 06 March 2015 |
| Creators | Mosier, Jarrod M, Sakles, John C, Whitmore, Sage P, Hypes, Cameron D, Hallett, Danielle K, Hawbaker, Katharine E, Snyder, Linda S, Bloom, John W |
| Contributors | Department of Emergency Medicine, University of Arizona |
| Publisher | Springer |
| Source Sets | University of Arizona |
| Language | English |
| Detected Language | English |
| Type | Article |
| Rights | © 2015 Mosier et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. |
| Relation | http://www.annalsofintensivecare.com/content/5/1/4 |
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