• Joshua A Krieger, Michael A Hernandez, Jordan C Sheehan, Steven H Mitchell, David J Carlbom, Ellen F Robinson, James A Town, Maralyssa A Bann, Matthew R Thau, Pavan K Bhatraju, RobinsonBryce R HBRHDepartment of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington., and Nicholas J Johnson.
• Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington.
• J Emerg Med. 2023 May 1; 64 (5): 574583574-583.

BackgroundPatients admitted to an intensive care unit (ICU) requiring invasive mechanical ventilation who are discharged alive from the ICU within 24 h are poorly characterized in the literature.ObjectiveOur aim was to characterize a cohort of intubated emergency department (ED) patients who are extubated and discharged from the ICU within 24 h.MethodsWe conducted a retrospective, observational cohort study at a single level I trauma center from January 2017 to December 2019. We included adults who were admitted to an ICU from the ED requiring invasive mechanical ventilation. Our primary outcome was the proportion of patients who were discharged from the ICU alive within 24 h.ResultsOf 13,374 ED patients admitted to an ICU during the study period, 2871 patients were intubated and ventilated in the prehospital or ED settings. Of these, 14% were discharged alive from the ICU within 24 h of admission. Only 21% of these patients were intubated in the ED. We identified the following two distinct subpopulations comprising 62% of this short-stay group: patients with a primary discharge diagnosis of intoxication (47%) and minimally injured trauma patients (53%), with 4% of patients in both subgroups.ConclusionsA total of 14% of patients receiving intubation with mechanical ventilation in the prehospital environment or in the ED were discharged alive from the ICU within 24 h. We identified two distinct subgroups of patients with a short stay in intensive care who may be candidates for ED extubation, including patients with intoxication and minimally injured trauma patients.Published by Elsevier Inc.

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