Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study.
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Gómez-Morán Quintana Marina, Horrillo García Cristina, Gutiérrez Misis Alicia, Quesada-Cubo Víctor, Torres Poza Ana, Cintora Sanz Ana, Carrillo Fernández Óscar, Rendo Murillo Joaquín Antonio, Pérez Alonso Ana María, Pastor Cabanillas Laura, Leco Gil Natasha, Chaya Romero Carolina, Parejo García Leticia, Rubio Riballo Ana Belén, Canales Corcho Isabel, Rodríguez Rodríguez Óscar, Gómez de la Oliva Soledad, García Benavent Eva, Antiqueira Pérez Armando, González Viñolis Manuel, Aranda García Yolanda, Albiñana Pérez Alberto, Rincón Francés Marta, Martín Jiménez María Luisa, Fernández Del Blanco Camino, Barros González Raquel
Аннотация
MATERIAL AND METHODS: Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission.
RESULTS: A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11-5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26-5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19-33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62-6.45) and prior dependence (OR, 2.08; 95% CI, 1.02-4.22).
CONCLUSION: Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52, and discontinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.