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Critical Care |

Impact of Initial Management on Respiratory Complications in Emergency Department Patients Requiring Mechanical Ventilation

Ye Ryung Jung, MD; Seok Jeong Lee, MD; Won-Yeon Lee, MD; Suk Joong Yong, MD; Sang-Ha Kim, MD
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Wonju Severance Christian Hospital/ Wonju, Korea, Wonju-Si, Korea (the Republic of)


Chest. 2015;148(4_MeetingAbstracts):303A. doi:10.1378/chest.2278669
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Outcomes of patients with acute respiratory distress syndrome (ARDS) show a trend of improvement with the lung protective strategy including low tidal volume. Recently, the focus turns to how to prevent ARDS in critically ill patients. We designed this study to investigate risk factors for respiratory complications in patients without initial lung injury admitted to intensive care unit (ICU) through emergency department (ED).

METHODS: Following a retrospective review of clinical data and radiographic findings of the patients admitted to the ED from April to December, 2014, 100 patients who required MV at least one day for non-thoracic causes were enrolled. Respiratory outcomes for during one week after admission was described and the risk factors for respiratory complications were analyzed.

RESULTS: The median age of the patients was 64 year (21-99) and 41% (n=41) was female. Of total 100 Patients requiring invasive MV, 43 cases (43%) were drug or chemical intoxication, 41% neurologic cause, 16% trauma. Mean tidal volume and PEEP of initial ventilator mode with and without respiratory complications was 7.61 ± 1.49 mL/kg and 7.12 ± 2.14 mL/kg (p = 0.24), 6.06 ± 0.62 cmH2O and 6.00 ± 1.10 cmH2O (p = 0.46). Respiratory complications including ARDS (n=4), pneumonia (n=25), pulmonary embolism (n=2), and atelectasis (n=11) developed in 32 patients (32%). In-hospital mortality developed in 12 patients (12%). The factor associated with respiratory complications in logistic regression with multivariate analysis was the use of inotropes only (OR 3.66, 95% CI 1.24 - 10.80, p = 0.019).

CONCLUSIONS: Requiring inotropes during care in ED was an independent risk factor for respiratory complications including ARDS, while tidal volume was not associated with the outcomes. This finding might be resulted from routine apply of low tidal volume even in patients without lung injury in our ED.

CLINICAL IMPLICATIONS: Reviewing initial management of patients requiring mechanical ventilation without lung injury in ED can give a guide to physicians to predict respiratory complications and perform a preventative management. Further studies suggesting proper ventilator setting will be needed

DISCLOSURE: The following authors have nothing to disclose: Ye Ryung Jung, Seok Jeong Lee, Won-Yeon Lee, Suk Joong Yong, Sang-Ha Kim

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