by Ricard
Mellado-Artigas, Xavier Borrat, Bruno L. Ferreyro, Christopher Yarnell, Sicheng
Hao, Kerollos N. Wanis, Enric Barbeta, Antoni Torres, Carlos Ferrando and
Laurent Brochard
Critical Care volume 28,
Article number: 157, Published: 10 May 2024
Purpose
Invasive ventilation is a fundamental treatment in intensive
care but its precise timing is difficult to determine. This study aims at
assessing the effect of initiating invasive ventilation versus waiting, in
patients with hypoxemic respiratory failure without immediate reason for
intubation on one-year mortality.
Methods
Emulation of a target trial to estimate the benefit of
immediately initiating invasive ventilation in hypoxemic respiratory failure,
versus waiting, among patients within the first 48-h of hypoxemia. The eligible
population included non-intubated patients with SpO2/FiO2 ≤ 200 and SpO2 ≤ 97%.
The target trial was emulated using a single-center database (MIMIC-IV) which
contains granular information about clinical status. The hourly probability to
receive mechanical ventilation was continuously estimated. The hazard ratios
for the primary outcome, one-year mortality, and the secondary outcome, 30-day
mortality, were estimated using weighted Cox models with stabilized inverse
probability weights used to adjust for measured confounding.
Results
2996 Patients fulfilled the inclusion criteria of whom 792
were intubated within 48 h. Among the non-invasive support devices, the
use of oxygen through facemask was the most common (75%). Compared to patients
with the same probability of intubation but who were not intubated, intubation
decreased the hazard of dying for the first year after ICU admission HR 0.81
(95% CI 0.68–0.96, p = 0.018). Intubation was associated with a 30-day
mortality HR of 0.80 (95% CI 0.64–0.99, p = 0.046).
Conclusion
The initiation of mechanical ventilation in patients with
acute hypoxemic respiratory failure reduced the hazard of dying in this
emulation of a target trial.
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