Steven Mitchell, MD
Associate Professor
Harborview Medical Center, United States
Disclosure information not submitted.
David Carlbom, MD
Associate Professor
Harborview Medical Center, United States
Disclosure information not submitted.
Ellen Robinson
Clinical Quality Analyst
Harborview Medical Center, United States
Disclosure information not submitted.
James Town, MD
Assistant Professor
Harborview Medical Center, United States
Disclosure information not submitted.
Maralyssa Bann, MD
Assistant Professor
Harborview Medical Center, United States
Disclosure information not submitted.
Astrid Schreuder, PhD
Biostatistician
Harborview Medical Center, United States
Disclosure information not submitted.
Bryce Robinson, MD, MS
Associate Professor
Harborview Medical Center, United States
Disclosure information not submitted.
Pavan Bhatraju, MD, MS
Assistant Professor, Pulmonary, Critical Care
University of Washington Medical Center
Seattle
Disclosure information not submitted.
Nicholas Johnson, MD, FCCM
UW Medicine Harborview Medical Center
Seattle, Washington
Disclosure information not submitted.
Title: Potential for extubation in the emergency department to reduce brief intensive care unit admissions
Introduction: We describe a population of intubated and mechanically ventilated patients requiring brief critical care admission who may be candidates for extubation in the emergency department (ED).
Methods: This is a retrospective, observational cohort study of adults receiving either prehospital or emergency department (ED) intubation with mechanical ventilation who were admitted to an intensive care unit (ICU) at a single, urban, academic Level I trauma center from January 2017 to December 2019.
Results: Of 13,374 ED patients admitted to an ICU over the study period, 2,871 patients were intubated and ventilated in the pre-hospital or ED settings. Of these, 14% were discharged alive from the ICU within 24 hours of admission to the ICU. Patients discharged from the ICU ≤ 24 hours were predominantly male (74%) with a median age of 43 (inter-quartile range [IQR] 29 - 58). A majority of patients were intubated in the pre-hospital setting (79%) with only 21% of patients intubated in the ED. We identified two distinct subgroups who might be candidates for extubation in the ED: 1) patients with acute intoxication (n=323, 38% of whom were discharged alive from the ICU within 24 hours) and 2) minimally-injured trauma patients (n=431, 33% of whom were discharged alive from the ICU within 24 hours).
Conclusions: A total of 14% of patients receiving intubation with mechanical ventilation in the prehospital environment or in the ED were discharged alive from the ICU within 24 hours. Among these patients there were two distinct patient subgroups (acute intoxication and minimally-injured trauma), each with opportunities to perform extubation in the ED and reduce short-stay ICU admissions.