Summary

Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study

Gómez-Morán Quintana M, Horrillo García C, Gutiérrez Misis A, Quesada-Cubo V, Torres Poza A, Cintora Sanz A, Carrillo Fernández O, Rendo Murillo JA, Pérez Alonso AM, Pastor Cabanillas L, Leco Gil N, Chaya Romero C, Parejo García L, Rubio Riballo AB, Canales Corcho I, Rodríguez Rodríguez O, Gómez de la Oliva S, García Benavent E, Antiqueira Pérez A, González Viñolis M, Aranda García Y, Albiñana Pérez A, Rincón Francés M, Martín Jiménez ML, Fernández del Blanco C, Barros González R

Affiliation of the authors

Servicio de Urgencias Médicas de la Comunidad de Madrid (SUMMA 112), Madrid, España. Departamento de Medicina. Unidad Clínica departamental de Medicina de Familia y AP. Facultad de Medicina de la UAM, Madrid, Spain. Departamento de Medicina Preventiva, Hospital Gregorio Marañón, Madrid, Spain. Servicio de Urgencias, Hospital de Fuenlabrada, Madrid, Spain. Universidad Politécnica de Madrid, Spain. Servicio de Urgencias, Hospital Infanta Leonor de Vallecas, Madrid, Spain. Servicio de Urgencias, Hospital La Paz, Madrid, Spain. Servicio de Urgencias, Hospital Ramón y Cajal, Madrid, Spain. Servicio de Urgencias, Hospital Fundación Jiménez Díaz, Madrid, Spain. Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, Spain. Servicio de Urgencias, Hospital Puerta de Hierro, Madrid, Spain. Servicio de Urgencias, Hospital Fundación Alcorcón, Madrid, Spain. Servicio de Urgencias, Hospital del Henares-Coslada, Madrid, Spain.

DOI

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Gómez-Morán Quintana M, Horrillo García C, Gutiérrez Misis A, Quesada-Cubo V, Torres Poza A, Cintora Sanz A, et al. Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. Emergencias. 2022;34:7-14

Summary

Objective.

To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs).

Methods.

Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission.

Results.

A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11–5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26–5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19–33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62–6.45) and prior dependence (OR, 2.08; 95% CI, 1.02–4.22).

Conclusions.

Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although

acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital

mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52, and discontinuance of

NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.

 

More articles by the authors

Albiñana Pérez A, Antiqueira Pérez A, Aranda García Y, Barros González R, Canales Corcho I, Carrillo Fernández O, Chaya Romero C, Cintora Sanz A, Fernández del Blanco C, García Benavent E, González Viñolis M, Gutiérrez Misis A, Gómez de la Oliva S, Gómez-Morán Quintana M, Horrillo García C, Leco Gil N, Martín Jiménez ML, Parejo García L, Pastor Cabanillas L, Pérez-Alonso AM, Quesada-Cubo V, Rendo Murillo JA, Rincón Francés M, Rodríguez Rodríguez O, Rubio Riballo AB, Torres Poza A

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