Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation
Name
13054_2024_Article_4926.pdf
Size
1.14 MB
Format
Adobe PDF
Checksum (MD5)
e4dd24089aa313791c45c0ea193d1a92
Author(s)
Mellado-Artigas, Ricard
Borrat, Xavier
Ferreyro, Bruno L.
Yarnell, Christopher
Hao, Sicheng
Wanis, Kerollos N.
Barbeta, Enric
Torres, Antoni
Ferrando, Carlos
Brochard, Laurent
Date Issued
May 10, 2024
Journal
Critical Care
Publisher
Springer Science and Business Media LLC
Citation
Mellado-Artigas, R., Borrat, X., Ferreyro, B.L. et al. Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation. Crit Care 28, 157 (2024).
Version
Final published version
Abstract
Purpose
Invasive ventilation is a fundamental treatment in intensive care but its precise timing is difficult to determine. This study aims at assessing the effect of initiating invasive ventilation versus waiting, in patients with hypoxemic respiratory failure without immediate reason for intubation on one-year mortality.
Methods
Emulation of a target trial to estimate the benefit of immediately initiating invasive ventilation in hypoxemic respiratory failure, versus waiting, among patients within the first 48-h of hypoxemia. The eligible population included non-intubated patients with SpO2/FiO2 ≤ 200 and SpO2 ≤ 97%. The target trial was emulated using a single-center database (MIMIC-IV) which contains granular information about clinical status. The hourly probability to receive mechanical ventilation was continuously estimated. The hazard ratios for the primary outcome, one-year mortality, and the secondary outcome, 30-day mortality, were estimated using weighted Cox models with stabilized inverse probability weights used to adjust for measured confounding.
Results
2996 Patients fulfilled the inclusion criteria of whom 792 were intubated within 48 h. Among the non-invasive support devices, the use of oxygen through facemask was the most common (75%). Compared to patients with the same probability of intubation but who were not intubated, intubation decreased the hazard of dying for the first year after ICU admission HR 0.81 (95% CI 0.68–0.96, p = 0.018). Intubation was associated with a 30-day mortality HR of 0.80 (95% CI 0.64–0.99, p = 0.046).
Conclusion
The initiation of mechanical ventilation in patients with acute hypoxemic respiratory failure reduced the hazard of dying in this emulation of a target trial.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
Terms of Use
Creative Commons Attribution
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1186/s13054-024-04926-y
