Related Experiment Video
Updated: Apr 3, 2026
Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Prognostic factors for in-hospital mortality in elderly patients undergoing emergency intubation and invasive
1Department of Emergency, Beijing Jishuitan Hospital, Capital Medical University, Beijing City, China.
Background:
Elderly patients requiring emergency intubation and invasive mechanical ventilation (IMV) in the emergency department (ED) face substantial mortality risk. However, prediction models utilizing only ED-obtainable variables for early prognostication remain limited.
Objective:
To develop and internally validate a prognostic model using variables available at ED intubation to predict in-hospital mortality in elderly patients.
Methods:
This retrospective cohort study included 273 patients aged ⩾ 65 years who underwent emergency intubation and IMV initiation in the ED of a tertiary hospital between June 2019 and June 2024. Candidate predictors included demographics, comorbidities, Glasgow Coma Scale (GCS), vasopressor use, admission lactate, PaO2/FiO2 ratio, shock index, and baseline laboratory values. Multiple imputation addressed missing data. Least absolute shrinkage and selection operator (LASSO) logistic regression identified optimal predictors, followed by multivariate logistic regression. Internal validation employed bootstrap resampling (1000 iterations). Model performance was assessed via discrimination (C-statistic), calibration (calibration plot, Brier score), and clinical utility (decision curve analysis).
Results:
The overall in-hospital mortality rate was 72.2% (197/273). After LASSO selection and clinical adjudication, the final model included age, GCS score, admission lactate, and vasopressor requirement as independent predictors. The model demonstrated excellent discrimination (C-statistic 0.834, 95% CI: 0.784-0.884), good calibration, and superior net benefit across threshold probabilities of 0.3-0.8 compared to default strategies. Bootstrap-corrected optimism was minimal (optimism-corrected C-statistic 0.827). Sensitivity analyses confirmed model robustness.
Conclusions:
A parsimonious model incorporating age, GCS score, admission lactate, and vasopressor use accurately predicts in-hospital mortality in elderly patients undergoing emergency intubation and IMV, using only variables readily available at the time of ED presentation. This tool has the potential to facilitate early, evidence-informed shared decision-making.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:29Mechanical Ventilation I: Indication and Settings
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...