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Transfusion Is Associated With Worse Outcomes in Patients Requiring Noninvasive Ventilation FREE TO VIEW

Vincent Scott; Adam Hayek; Anas Al Sadi; Shekhar Ghamande; Peter Yau; Alejandro C Arroliga
Author and Funding Information

Baylor Scott and White Health, Central Division, Temple, TX

Chest. 2014;146(4_MeetingAbstracts):900A. doi:10.1378/chest.1991491
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients with acute lung injury on invasive mechanical ventilation have worse outcomes with transfusion and increased tidal volume. Our hypothesis was that outcomes would be similarly affected in patients on non-invasive ventilation (NIV).

METHODS: Prospective, observational study of consecutive in-patients on NIV over nine months. Patients were then categorized into three groups based on blood gas values, BNP, and hypoxemia. A generalized linear model was used to assess the relationship among the groups. Multivariable logistic regression analyses were performed.

RESULTS: Among 437 patients, the median age was 68(23-103) years, 236(54%) female. Median BMI was 31.5(14.7-90.0) with median 4.0(0-18) comorbid conditions per the Charleston comorbidity index. 159(36%) were admitted to the ICU with median LOS of 2.8(0.2-44.1) days. The intubation rate was (15.8%), transfusion (17.9%), 30-day readmission (18.1%), and inpatient death (8.2%). Transfusion was associated with longer LOS (RR=2.66, 95% CI: 2.27-3.16; p<0.01), ICU LOS (RR=3.42, 95% CI: 2.46-4.76; p<0.01), higher mortality (OR=2.82; 95% CI: 1.32-6.04; p<0.01) and intubation (OR=4.22; 95% CI: 2.36-7.55; p<0.01). Tidal volume/IBW was not associated with LOS, intubation rate, or mortality. Male patients were at an increased risk of in-hospital mortality (OR=2.10; 95% CI: >1.0-4.41; p<0.05). For each decade increase in age, the odds of inpatient death increase by 70% (OR=1.70; 95% CI: 1.25-2.32; p<0.01). We stratified our patients into Group 1: 180 patients (41%) with ABG pCO2 > 45 mm Hg or VBG pH < 7.20 and pCO2 > 50 mm Hg, Group 2: 186 patients (43%) had BNP > 150 without hypercapnia, and Group 3: 71 patients (16%) with hypoxemia only. There were no significant differences among the groups in terms of intubation, mortality or 30-day readmission. Compared to Group 1, Group 2 was at greater risk for increased ICU LOS (RR=1.38, 95% CI: 1.01-1.90; p=0.04). Group 3 had lower LOS (RR=0.70, 95% CI: 0.57-0.87; p<0.01).

CONCLUSIONS: Among patients started on NIV, transfusion was associated with twofold increase in LOS, threefold increase in ICU LOS, fourfold increase in intubation, and nearly threefold increase in mortality. Tidal volume was not associated with mortality, LOS, or intubation rate. Each decade of age led to increased mortality.

CLINICAL IMPLICATIONS: We highlight the negative impact of transfusion but not tidal volumes in patients with respiratory failure treated with NIV. Age should play a role in risk stratification in these patients.

DISCLOSURE: The following authors have nothing to disclose: Vincent Scott, Adam Hayek, Anas Al Sadi, Shekhar Ghamande, Peter Yau, Alejandro C Arroliga

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