Abstract
BackgroundThe prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor. Our aim was to evaluate the 30-d hospitalization mortality of subjects undergoing ETI during daytime or off-hours and to analyze the possible risk factors affecting mortality.MethodsA single-center retrospective study was performed at a university teaching facility from January 2015 to December 2018. All adult inpatients who received ETI in the general ward were included. Information on patient demographics, vital signs, ICU (Intensive care unit) admission, intubation time (daytime or off-hours), the department in which ETI was performed (surgical ward or medical ward), intubation reasons, and 30-d hospitalization mortality after ETI were obtained from a database.ResultsOver a four-year period, 558 subjects were analyzed. There were more male than female in both groups (115 [70.1%] vs 275 [69.8%]; P = 0.939). A total of 394 (70.6%) patients received ETI during off-hours. The patients who received ETI during the daytime were older than those who received ETI during off-hours (64.95 ± 17.54 vs 61.55 ± 17.49; P = 0.037). The BMI of patients who received ETI during the daytime was also higher than that of patients who received ETI during off-hours (23.08 ± 3.38 vs 21.97 ± 3.25; P < 0.001). The 30-d mortality after ETI was 66.8% (373), which included 68.0% (268) during off-hours and 64.0% (105) during the daytime (P = 0.361). Multivariate Cox regression analysis found that the significant factors for the risk of death within 30 days included ICU admission (HR 0.312, 0.176–0.554) and the department in which ETI was performed (HR 0.401, 0.247–0.653).ConclusionsThe 30-d hospitalization mortality after ETI was 66.8%, and off-hours presentation was not significantly associated with mortality. ICU admission and ETI performed in the surgical ward were significant factors for decreasing the risk of death within 30 days.Trial registrationThis trial was retrospectively registered with the registration number of ChiCTR2000038549.
Highlights
The prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor
Study setting and design This single-center retrospective cohort study was undertaken to explore the outcomes of inpatients following ETI from January 2015 to December 2018 in the general ward of the Union Hospital, Fujian Medical University, China. (ChiCTR2000038549) The hospital has 2500 beds and serves as a university teaching facility
The 30-d hospitalization mortality after ETI was as high as 66.8%, and off-hours presentation was not significantly associated with mortality
Summary
The prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor. Emergent endotracheal intubation (ETI) for most hospitalized patients with critical illnesses is often performed to stabilize patients’ vital signs. Along with for the primary disease of the patient, some factors may affect prognosis, such as performing endotracheal intubation at the opportune moment and location, performance by a sophisticated anesthesiologist, and emergency treatments after ETI. At most medical institutions, including our own, staffing levels dramatically decrease during off-hours. At these times, staff performance may be impaired because of fatigue and disrupted circadian rhythms [5]. A difference in human and technical resources during different times is possible, and the problem might be that there are fewer trained health providers and that professionals are tired and that there are other factors influencing prognosis [8]
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