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Non-invasive ventilation in the emergency department from 2004-2015

Marion Christine Carteciano, Irwani Ibrahim, Y.H. Chan, Malcolm Mahadevan, Tow Keang Lim
European Respiratory Journal 2016 48: PA3575; DOI: 10.1183/13993003.congress-2016.PA3575
Marion Christine Carteciano
1Department of Emergency Medicine, National University Hospital, National University Health System, National University Hospital, Singapore, Singapore
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Irwani Ibrahim
1Department of Emergency Medicine, National University Hospital, National University Health System, National University Hospital, Singapore, Singapore
4Department of Surgery, Young Loo Lin School of Medicine, Singapore, Singapore
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Y.H. Chan
2Biostatistics Unit, Young Loo Lin School of Medicine, Singapore, Singapore
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Malcolm Mahadevan
1Department of Emergency Medicine, National University Hospital, National University Health System, National University Hospital, Singapore, Singapore
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Tow Keang Lim
3Respiratory & Critical Care Medicine, National University Hospital, Singapore, Singapore
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Abstract

Background: Little is known of long term patterns of non-invasive ventilation (NIV) initiated in the emergency department (ED) setting.

Aim: To determine the trends and outcomes for patients who had NIV initiated in the ED for acute respiratory failure (ARF).

Methods: We enrolled consecutive patients who had received NIV in the ED from January 2004 to December 2015 to assess disease trends and hospital outcomes.

Results: There were 849 episodes of ARF requiring NIV in the ED with an increasing trend [increase of 7 (95% CI 3 to 12 cases per year, p = 0.006]. The top causes of ARF were COPD 317 (37.3%) and acute pulmonary edema (APO) 292 (34.4%). Initially COPD was the most frequent cause of ARF requiring NIV but, by 2009, APO had overtaken COPD as the most frequent cause. The overall in-hospital mortality was 8.7%. Adjusting for case load, there was decrease in mortality of 0.732% (95% CI 0.2% to 1.4%) per year (p=0.04). The overall endotracheal intubation (ETI) rate was 10.8%. There is no difference in the mortality and ETI rates for COPD versus other causes of ARF (p> 0.05). In COPD patients who were for active resuscitation, the in-hospital mortality was 3.6% (5/165) with zero mortality in the last 3 years and the ETI rate was 15.2% (25/165).

Conclusion: Despite the increasing usage of NIV in the ED, we observed a decrease in mortality. APO has overtaken COPD as the most frequent cause of ARF towards the latter half of the study. For COPD patients, there was consistently low in-hospital mortality.

  • Non-invasive ventilation - acute respiratory failure
  • Airway management
  • COPD - management
  • Copyright ©the authors 2016
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Non-invasive ventilation in the emergency department from 2004-2015
Marion Christine Carteciano, Irwani Ibrahim, Y.H. Chan, Malcolm Mahadevan, Tow Keang Lim
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3575; DOI: 10.1183/13993003.congress-2016.PA3575

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Non-invasive ventilation in the emergency department from 2004-2015
Marion Christine Carteciano, Irwani Ibrahim, Y.H. Chan, Malcolm Mahadevan, Tow Keang Lim
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3575; DOI: 10.1183/13993003.congress-2016.PA3575
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