• Marina Gómez-Morán Quintana, Cristina Horrillo García, Alicia Gutiérrez Misis, Víctor Quesada-Cubo, Ana Torres Poza, Ana Cintora Sanz, Óscar Carrillo Fernández, Joaquín Antonio Rendo Murillo, Ana María Pérez Alonso, Laura Pastor Cabanillas, Natasha Leco Gil, Carolina Chaya Romero, Leticia Parejo García, Ana Belén Rubio Riballo, Isabel Canales Corcho, Óscar Rodríguez Rodríguez, Soledad Gómez de la Oliva, Eva García Benavent, Armando Antiqueira Pérez, Manuel González Viñolis, Yolanda Aranda García, Alberto Albiñana Pérez, Marta Rincón Francés, María Luisa Martín Jiménez, Camino Fernández Del Blanco, and Raquel Barros González.
• Servicio de Urgencias Médicas de la Comunidad de Madrid (SUMMA 112), Madrid, España.
• Emergencias. 2022 Feb 1; 34 (1): 7-14.

ObjectivesTo 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).Material And MethodsMulticenter, 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.ResultsA 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).ConclusionPatients 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.

20 keywords...

hide…