Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study.
Journal
American journal of critical care : an official publication, American Association of Critical-Care Nurses
ISSN: 1937-710X
Titre abrégé: Am J Crit Care
Pays: United States
ID NLM: 9211547
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
pmc-release:
01
09
2024
medline:
4
9
2023
pubmed:
1
9
2023
entrez:
31
8
2023
Statut:
ppublish
Résumé
Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time. Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time. Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion. Mechanical ventilation was initiated within 30 days after sepsis onset in 3891 patients (13.5%). Factors that were independently associated with increased likelihood of receipt of mechanical ventilation were race (White: adjusted hazard ratio [HR], 1.59; 95% CI, 1.39-1.83; other/unknown: adjusted HR, 1.97; 95% CI, 1.54-2.52), systemic inflammatory response syndrome (adjusted HR [per point], 1.23; 95% CI, 1.17-1.28), Sequential Organ Failure Assessment score (adjusted HR [per point], 1.28; 95% CI, 1.26-1.31), and congestive heart failure (adjusted HR, 1.30; 95% CI, 1.17-1.45). Hazard ratios decreased with time for Sequential Organ Failure Assessment score and congestive heart failure and varied with time for 4 comorbidities and 3 culture results. The risk for mechanical ventilation associated with different factors varied with time after sepsis onset, increasing for some factors and decreasing for others. Through a better understanding of risk factors for initiation of mechanical ventilation in patients with sepsis, targeted interventions may be tailored to high-risk patients.
Sections du résumé
BACKGROUND
Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time.
METHODS
Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time.
RESULTS
Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion. Mechanical ventilation was initiated within 30 days after sepsis onset in 3891 patients (13.5%). Factors that were independently associated with increased likelihood of receipt of mechanical ventilation were race (White: adjusted hazard ratio [HR], 1.59; 95% CI, 1.39-1.83; other/unknown: adjusted HR, 1.97; 95% CI, 1.54-2.52), systemic inflammatory response syndrome (adjusted HR [per point], 1.23; 95% CI, 1.17-1.28), Sequential Organ Failure Assessment score (adjusted HR [per point], 1.28; 95% CI, 1.26-1.31), and congestive heart failure (adjusted HR, 1.30; 95% CI, 1.17-1.45). Hazard ratios decreased with time for Sequential Organ Failure Assessment score and congestive heart failure and varied with time for 4 comorbidities and 3 culture results.
CONCLUSIONS
The risk for mechanical ventilation associated with different factors varied with time after sepsis onset, increasing for some factors and decreasing for others. Through a better understanding of risk factors for initiation of mechanical ventilation in patients with sepsis, targeted interventions may be tailored to high-risk patients.
Identifiants
pubmed: 37652887
pii: 32171
doi: 10.4037/ajcc2023299
pmc: PMC10577809
mid: NIHMS1935513
doi:
Types de publication
Observational Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
358-367Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL148640
Pays : United States
Informations de copyright
©2023 American Association of Critical-Care Nurses.
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