by Ricard Mellado-Artigas, Carlos Ferrando, Frédéric
Martino, Agathe Delbove, Bruno L. Ferreyro, Cedric Darreau, Sophie Jacquier,
Laurent Brochard and Nicolas Lerolle
Critical Care volume 26,
Article number: 163 (2022) Published: 07
June 2022
Purpose
Despite the benefits of mechanical ventilation, its use in
critically ill patients is associated with complications and had led to the
growth of noninvasive techniques. We assessed the effect of early intubation
(first 8 h after vasopressor start) in septic shock patients, as compared
to non-early intubated subjects (unexposed), regarding in-hospital mortality,
intensive care and hospital length of stay.
Methods
This study involves secondary analysis of a multicenter
prospective study. To adjust for baseline differences in potential confounders,
propensity score matching was carried out. In-hospital mortality was analyzed
in a time-to-event fashion, while length of stay was assessed as a median
difference using bootstrapping.
Results
A total of 735 patients (137 intubated in the first
8 h) were evaluated. Propensity score matching identified 78 pairs with
similar severity and characteristics on admission. Intubation was used in all
patients in the early intubation group and in 27 (35%) subjects beyond 8 h
in the unexposed group. Mortality occurred in 35 (45%) and in 26 (33%) subjects
in the early intubation and unexposed groups (hazard ratio 1.44 95% CI
0.86–2.39, p = 0.16). ICU and hospital length of stay were not different
among groups [9 vs. 5 (95% CI 1 to 7) and 14 vs. 16 (95% CI − 7 to 8) days].
All sensitivity analyses confirmed the robustness of our findings.
Conclusions
An early approach to invasive mechanical ventilation did not
improve outcomes in this matched cohort of patients. The limited number of
patients included in these analyses out the total number included in the study
may limit generalizability of these findings.
No comments:
Post a Comment