Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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1er cuartil (5 de 32)
Emergency Medicine
Resumen
< ReturnFactors 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
GĂłmez-Morán Quintana M, Horrillo GarcĂa C, GutiĂ©rrez Misis A, Quesada-Cubo V, Torres Poza A, Cintora Sanz A, Carrillo Fernández O, Rendo Murillo JA, PĂ©rez Alonso AM, Pastor Cabanillas L, Leco Gil N, Chaya Romero C, Parejo GarcĂa L, Rubio Riballo AB, Canales Corcho I, RodrĂguez RodrĂguez O, GĂłmez de la Oliva S, GarcĂa Benavent E, Antiqueira PĂ©rez A, González Viñolis M, Aranda GarcĂa Y, Albiñana PĂ©rez A, RincĂłn FrancĂ©s M, MartĂn JimĂ©nez ML, Fernández del Blanco C, Barros González R
Servicio de Urgencias MĂ©dicas de la Comunidad de Madrid (SUMMA 112), Madrid, España. Departamento de Medicina. Unidad ClĂnica departamental de Medicina de Familia y AP. Facultad de Medicina de la UAM, Madrid, Spain. Departamento de Medicina Preventiva, Hospital Gregorio Marañón, Madrid, Spain. Servicio de Urgencias, Hospital de Fuenlabrada, Madrid, Spain. Universidad PolitĂ©cnica de Madrid, Spain. Servicio de Urgencias, Hospital Infanta Leonor de Vallecas, Madrid, Spain. Servicio de Urgencias, Hospital La Paz, Madrid, Spain. Servicio de Urgencias, Hospital RamĂłn y Cajal, Madrid, Spain. Servicio de Urgencias, Hospital FundaciĂłn JimĂ©nez DĂaz, Madrid, Spain. Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, Spain. Servicio de Urgencias, Hospital Puerta de Hierro, Madrid, Spain. Servicio de Urgencias, Hospital FundaciĂłn AlcorcĂłn, Madrid, Spain. Servicio de Urgencias, Hospital del Henares-Coslada, Madrid, Spain.
Objective. To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs).
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).
Conclusions. 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.
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).
Conclusions. 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.
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