• John R Allegra, Barnet Eskin, Jeffery Kleinberg, and Dennis G Cochrane.
• Morristown Memorial Hospital Residency in Emergency Medicine, Morristown, NJ 07962, USA. johnalle@verizon.net
• Am J Emerg Med. 2010 Feb 1; 28 (2): 166-9.

PurposeA previous study showed that pulmonary edema patients presenting between noon and 4 pm have the highest rates of myocardial infarction and death. We hypothesized that the highest intubation rates would also occur at these times.Basic ProceduresWe performed a retrospective cohort study of consecutive patients seen by emergency department physicians in 15 hospital emergency departments (1996-2003).Main FindingsOf 3.6 million visits in the database, 39,795 (1.1%) patients had congestive heart failure. We found statistically significant circadian variations in intubation rates. Patients arriving between midnight and 4 am had the highest intubation rates (4.1%), and those arriving between noon and 4 pm had the lowest (1.2%) (difference, 2.9%; 95% confidence interval, 2.4%-3.4%; P < .0001).ConclusionWe found significant circadian variation in intubation rates, with a marked increase around midnight. Pathological mechanisms causing patients with congestive heart failure to require intubation may differ from those resulting in myocardial infarction or death.Copyright 2010 Elsevier Inc. All rights reserved.

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