23 Relationship Between Rate of Intubation and CPAP Use in the Out-of-Hospital Setting

Abstract

Study Objective: To determine if out-of-hospital use of continuous positive airway pressure (CPAP) treatment is associated with endotracheal intubation, among patients brought to the emergency department (ED) with acute respiratory distress.Setting: Seven hundred seventy-five-bed tertiary care hospital.Design: Utilizing a retrospective cohort study design, we compared the rate of intubation in patients with acute respiratory distress, in the years (2004) preceding the availability of CPAP with the years after initiation of CPAP use (2010-2011).Methods: Medical records of patients with acute respiratory distress, who received CPAP treatment in mobile intensive care units (MICU) between January and December 2011 were compared to records of similar patients who received standard of care without CPAP in MICU between 1/2004 to 12/2004.Data Analysis: We reviewed medical records of patients with acute respiratory distress, who received CPAP in mobile intensive care units (MICU) from 1/2010-12/2010 and compared to records of similar patients who received standard of care without CPAP in MICU from 1/2004 to 12/2004. Categorical variables were summarized as frequencies and compared between groups using Fisher's exact test or Chi-square test. Continuous variables were summarized as median (intequartile range) and comparison between groups was performed using Wilcoxon rank sum test. Association between the use CPAP and rate of endotracheal intubation was examined using multivariable logistic regression analysis. Study results were presented as odds ratio (OR), corresponding 95% confidence interval (CI) and p-value for test effect. The adequacy of the model was calibrated using Hosmer and Lemeshow's goodness-of-fit test. P<0.05 was considered statistically significant.Results: Records of 775 patients (median age 78 years, 59% women) were reviewed. Of the 215 patients treated with CPAP in the MICU, 13% were intubated after admission. In contrast, of the 570 patients who did not receive CPAP, 28% were intubated after admission to the ED. Unadjusted logistic regression showed that patients who received CPAP were less likely to be intubated compared to patients without CPAP use [OR=0.37, 95% CI, 0.24 to 0.57, p<0.0001]. Adjusted (for age, sex and diagnosis) multivariate logistic regression showed that CPAP treatment was associated with a 66% reduced need for intubation [OR=0.34, 95% CI, 0.19 to 0.59, p=0.0001].Tabled 1 Study Objective: To determine if out-of-hospital use of continuous positive airway pressure (CPAP) treatment is associated with endotracheal intubation, among patients brought to the emergency department (ED) with acute respiratory distress. Setting: Seven hundred seventy-five-bed tertiary care hospital. Design: Utilizing a retrospective cohort study design, we compared the rate of intubation in patients with acute respiratory distress, in the years (2004) preceding the availability of CPAP with the years after initiation of CPAP use (2010-2011). Methods: Medical records of patients with acute respiratory distress, who received CPAP treatment in mobile intensive care units (MICU) between January and December 2011 were compared to records of similar patients who received standard of care without CPAP in MICU between 1/2004 to 12/2004. Data Analysis: We reviewed medical records of patients with acute respiratory distress, who received CPAP in mobile intensive care units (MICU) from 1/2010-12/2010 and compared to records of similar patients who received standard of care without CPAP in MICU from 1/2004 to 12/2004. Categorical variables were summarized as frequencies and compared between groups using Fisher's exact test or Chi-square test. Continuous variables were summarized as median (intequartile range) and comparison between groups was performed using Wilcoxon rank sum test. Association between the use CPAP and rate of endotracheal intubation was examined using multivariable logistic regression analysis. Study results were presented as odds ratio (OR), corresponding 95% confidence interval (CI) and p-value for test effect. The adequacy of the model was calibrated using Hosmer and Lemeshow's goodness-of-fit test. P<0.05 was considered statistically significant. Results: Records of 775 patients (median age 78 years, 59% women) were reviewed. Of the 215 patients treated with CPAP in the MICU, 13% were intubated after admission. In contrast, of the 570 patients who did not receive CPAP, 28% were intubated after admission to the ED. Unadjusted logistic regression showed that patients who received CPAP were less likely to be intubated compared to patients without CPAP use [OR=0.37, 95% CI, 0.24 to 0.57, p<0.0001]. Adjusted (for age, sex and diagnosis) multivariate logistic regression showed that CPAP treatment was associated with a 66% reduced need for intubation [OR=0.34, 95% CI, 0.19 to 0.59, p=0.0001].