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The Impact of Delayed Transition From Noninvasive to Invasive Mechanical Ventilation on Hospital Mortality in

Yang Xu^1,2, Yi-Fan Wang³, Yi-Wei Liu^1,4

¹Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.

Critical Care Medicine

|August 21, 2024

Abstract

Objective:

To determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis.

Design:

Retrospective analysis using the National Data Center for Medical Service claims data in China from 2017 to 2019.

Setting:

A total of 3530 hospitals across China.

Patients:

A total of 36,187 adult immunocompromised patients with sepsis requiring ventilation.

Interventions:

None.

Measurements And Main Results:

The primary outcome was hospital mortality. Patients were categorized into NIV initiation or IMV initiation groups based on first ventilation. NIV patients were further divided by time to IMV transition: no transition, immediate (≤ 1 d), early (2-3 d), delayed (4-7 d), or late (≥ 8 d). Mortality was compared between groups using weighted Cox models. Over the median 9-day follow-up, mortality was similar for initial NIV versus IMV (adjusted hazard ratio [HR] 1.006; 95% CI, 0.959-1.055). However, among NIV patients, a longer time to IMV transition is associated with stepwise increases in mortality, from immediate transition (HR 1.65) to late transition (HR 2.51), compared with initial IMV. This dose-response relationship persisted across subgroups and sensitivity analyses.

Conclusions:

Prolonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.

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