Do Thresholds for Invasive Ventilation in Hypoxemic Respiratory Failure Exist? A Cohort Study

医学 通风(建筑) 队列 呼吸衰竭 队列研究 重症监护医学 呼吸系统 无创通气 急诊医学 机械通风 内科学 机械工程 工程类
作者
Christopher J. Yarnell,Alistair E. W. Johnson,Tariq A. Dam,Annemijn H. Jonkman,Kuan Liu,Hannah Wunsch,Laurent Brochard,Leo Anthony Celi,Harm‐Jan de Grooth,Paul Elbers,Sangeeta Mehta,Laveena Munshi,Robert Fowler,Lillian Sung,George Tomlinson
出处
期刊:American Journal of Respiratory and Critical Care Medicine [American Thoracic Society]
卷期号:207 (3): 271-282 被引量:21
标识
DOI:10.1164/rccm.202206-1092oc
摘要

Rationale: Invasive ventilation is a significant event for patients with respiratory failure. Physiologic thresholds standardize the use of invasive ventilation in clinical trials, but it is unknown whether thresholds prompt invasive ventilation in clinical practice. Objectives: To measure, in patients with hypoxemic respiratory failure, the probability of invasive ventilation within 3 hours after meeting physiologic thresholds. Methods: We studied patients admitted to intensive care receiving FiO2 of 0.4 or more via nonrebreather mask, noninvasive positive pressure ventilation, or high-flow nasal cannula, using data from the Medical Information Mart for Intensive Care (MIMIC)–IV database (2008–2019) and the Amsterdam University Medical Centers Database (AmsterdamUMCdb) (2003–2016). We evaluated 17 thresholds, including the ratio of arterial to inspired oxygen, the ratio of saturation to inspired oxygen ratio, composite scores, and criteria from randomized trials. We report the probability of invasive ventilation within 3 hours of meeting each threshold and its association with covariates using odds ratios (ORs) and 95% credible intervals (CrIs). Measurements and Main Results: We studied 4,726 patients (3,365 from MIMIC, 1,361 from AmsterdamUMCdb). Invasive ventilation occurred in 28% (1,320). In MIMIC, the highest probability of invasive ventilation within 3 hours of meeting a threshold was 20%, after meeting prespecified neurologic or respiratory criteria while on vasopressors, and 19%, after a ratio of arterial to inspired oxygen of <80 mm Hg. In AmsterdamUMCdb, the highest probability was 34%, after vasopressor initiation, and 25%, after a ratio of saturation to inspired oxygen of <90. The probability after meeting the threshold from randomized trials was 9% (MIMIC) and 13% (AmsterdamUMCdb). In MIMIC, a race/ethnicity of Black (OR, 0.75; 95% CrI, 0.57–0.96) or Asian (OR, 0.6; 95% CrI, 0.35–0.95) compared with White was associated with decreased probability of invasive ventilation after meeting a threshold. Conclusions: The probability of invasive ventilation within 3 hours of meeting physiologic thresholds was low and associated with patient race/ethnicity.
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