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Introduction: Due to hospital crowding, mechanically ventilated patients are increasinglyspending hours boarding in emergency departments (ED) before intensive care unit (ICU)admission. This study aims to evaluate the association between time ventilated in the ED and inhospitalmortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).Methods: This was a multi-center, prospective, observational study of patients ventilated in theED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. Allconsecutive adult patients on invasive mechanical ventilation were eligible for enrollment. Weperformed a Cox regression to assess for a mortality effect for mechanically ventilated patientswith each hour of increasing LOS in the ED and multivariable regression analyses to assessfor independently significant contributors to in-hospital mortal ity. Our primary outcome was inhospitalmortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. Wefurther commented on use of lung protective ventilation and frequency of ventilator changesmade in this cohort.Results: We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental statuswithout respiratory pathology was the most common reason for intubation, followed by traumaand respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time ofmechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer totalduration of intubation. However, adjusted multivariable regression analysis demonstrated onlyolder age and admission to the neurosciences ICU as independently associated with increasedmortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours hadchanges made to their ventilator.Conclusion: In a prospective observational study of patients mechanically ventilated in the ED,there was a significant mortality benefit to expedited transfer o f patients into an appropriate ICUsetting. [West J Emerg Med. 2017;18(5)972-979.]

BACKGROUND: Mechanically ventilated patients increasingly spend hours in emergency department beds before ICU admission. This study evaluated the performance of blood gases in mechanically ventilated subjects in the emergency department and subsequent changes to mechanical ventilation settings. METHODS: This was a multi-center, prospective, observational study of subjects ventilated in the emergency department, conducted at 3 academic emergency departments from July 2011 to March 2013. We measured the rate of arterial blood gas (ABG) and venous blood gas (VBG) analysis, and we assessed the associations between the conditions of hypoxemia, hyperoxia, hypercapnia, or acidemia and changes to mechanical ventilator settings. RESULTS: Of 292 ventilated subjects, 17.1% did not have a blood gas sent in the emergency department. Ventilator changes were made significantly more frequently for subjects who had an ABG as the initial blood gas sent in the emergency department (odds ratio 2.70, 95% CI 1.46-4.99, P = .002). However, findings of hypoxemia, hyperoxia, hypercapnia, or acidemia were not correlated with ventilator adjustments. CONCLUSIONS: In this prospective observational study of subjects mechanically ventilated in the emergency department, the majority had a blood gas checked while in the emergency department. While ABGs were associated with having changes made to ventilator settings in the emergency department, clinical findings of hypoxemia, hyperoxia, hypercapnia, and acidemia were not. Inattention to blood gas results may lead to missed opportunities in guiding ventilator changes in the emergency department. [ABSTRACT FROM AUTHOR]

Background: Mechanically ventilated patients increasingly spend hours in emergency department beds before ICU admission. This study evaluated the performance of blood gases in mechanically ventilated subjects in the emergency department and subsequent changes to mechanical ventilation settings., Methods: This was a multi-center, prospective, observational study of subjects ventilated in the emergency department, conducted at 3 academic emergency departments from July 2011 to March 2013. We measured the rate of arterial blood gas (ABG) and venous blood gas (VBG) analysis, and we assessed the associations between the conditions of hypoxemia, hyperoxia, hypercapnia, or acidemia and changes to mechanical ventilator settings., Results: Of 292 ventilated subjects, 17.1% did not have a blood gas sent in the emergency department. Ventilator changes were made significantly more frequently for subjects who had an ABG as the initial blood gas sent in the emergency department (odds ratio 2.70, 95% CI 1.46-4.99, P = .002). However, findings of hypoxemia, hyperoxia, hypercapnia, or acidemia were not correlated with ventilator adjustments., Conclusions: In this prospective observational study of subjects mechanically ventilated in the emergency department, the majority had a blood gas checked while in the emergency department. While ABGs were associated with having changes made to ventilator settings in the emergency department, clinical findings of hypoxemia, hyperoxia, hypercapnia, and acidemia were not. Inattention to blood gas results may lead to missed opportunities in guiding ventilator changes in the emergency department., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)