• J Emerg Med · Oct 2020

    Multicenter Study

    Characteristics and Prognosis of Patients Who Receive Noninvasive Ventilation and Present Limitation of Life Support Treatment: The LLST-NIVCat Multicenter Cohort Study.

    • María Arranz, Javier Jacob, Mariona Sancho-Ramoneda, Àngels Lopez, Ma Carmen Navarro-Sáez, Jose Ramon Cousiño-Chao, Xavier López-Altimiras, Francesc López I Vengut, Olivia García-Trallero, Antonio German, Jaume Farré-Cerdà, and José Zorrilla.
    • Emergency Department, Hospital de Viladecans, Barcelona, Spain.
    • J Emerg Med. 2020 Oct 1; 59 (4): 477-484.

    BackgroundPatients who receive noninvasive ventilation (NIV) in the emergency department (ED) sometimes have a limitation of life support treatment (LLST). The characteristics and prognosis in these patients may be worse, however, few studies have been carried out in this respect.ObjectiveAnalyze the differences between patients receiving NIV in the ED with LLST (NIV-LLST) or without LLST (NIV-noLLST) and their impact on in-hospital mortality, as well as investigate in-hospital mortality in the NIV-LLST group.MethodWe performed a secondary analysis of data from the NIVCat registry. This was a prospective, multicenter, analytical cohort study with consecutive inclusion of patients receiving NIV from February to March 2015 in 11 hospital EDs in Spain. Data on the baseline characteristics, the acute episode, and final patient destination were collected. The dependent variable was all-cause in-hospital mortality.ResultsWe analyzed 152 cases receiving NIV, 66 (43.4%) of whom had NIV-LLTS. Age ≥ 75 years was associated with NIV-LLST. In-hospital mortality was higher in the NIV-LLST group, with an adjusted hazard ratio of 2.50 (95% confidence interval [CI] 1.03-6.06). Patients with NIV-LLST presenting an exacerbation of chronic obstructive pulmonary disease (COPD) presented the lowest mortality, with an odds ratio of 0.27 (95% confidence interval 0.08-0.93), compared with the remaining patients.ConclusionIn our cohort of patients receiving NIV in the ED, the presence of LLST is frequent and is associated with high hospital mortality. The NIV-LLST patients with a COPD exacerbation have a better prognosis than NIV-LLST patients with other diseases.Copyright © 2020 Elsevier Inc. All rights reserved.

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