Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Abstract

Background: Sepsis is a significant cause of mechanical ventilation in hospitalized patients.Objective: The aim of our study was to recognize the demographic and clinical characteristics associated with an increased need for invasive mechanical ventilation in hospitalized sepsis patients.Methods: We used National Inpatient Sample database from the years 2009–2011 to identify sepsis patients requiring invasive mechanical ventilation. We compared demographic and clinical characteristics of sepsis patients requiring and not requiring ventilator support and conducted univariate and multivariate analyses to determine odds ratio (OR) of association.Results: A total of 4,827,769 sepsis patients were identified among which 21.38% required invasive ventilation. Multivariate logistic regression [OR (95% CI), p<0.001] determined the following to be associated with increased odds of ventilator use: morbid obesity [1.37 (1.31–1.42)] and age group 35-64 years [1.18 (1.14–1.22)] compared to 18–34 years, whereas females [0.90 (0.88–0.91)] and age >85 years [0.49 (0.47–0.52)] had reduced odds of invasive ventilation. Hyperkalemia [1.12 (1.09–1.16)] and hypernatremia [2.26 (2.16–2.36)] were associated with increased odds while hypokalemia [0.94 (0.91–0.97)] had reduced odds of invasive ventilation. Septic patients requiring IMV had higher length of stay by 9.72 ± 0.17 days, hospitalization cost by US $ 43010.31 ± 988.24 and in-hospital mortality (41.33% vs 8.91%). Conclusion: Sepsis is a major cause of intensive care unit admission and initiation of invasive ventilation. Baseline demographic and clinical features affect the need for invasive ventilation. A clear understanding of these risk factors is integral for an appropriate and timely management.

Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis

“…Nevertheless, the mortality for patients with COVID-19 requiring IMV is worse than most common medical conditions requiring ICU admission. The reported ICU mortality from sepsis is 40% [ 33 ], severe COPD 30% [ 34 ] and pancreatitis 25% [ 35 ], all lower than COVID-19 patients requiring IMV in our study.…”

The Effect of Dexmedetomidine as a Sedative Agent for Mechanically Ventilated Patients With Sepsis: A Systematic Review and Meta-Analysis

“…Sepsis, defined as a life-threatening organ dysfunction due to a dysregulated immune response to infection, affects millions of patients per year and carries a high risk of mortality, becoming a major global health problem ( 1 , 2 ). According to the Global Burden of Diseases Study, in 2017, an estimated 48.9 million incident cases of sepsis were reported worldwide with nearly 11.0 million patients dying, accounting for 19.7% of all global deaths ( 3 ).On the other hand, sepsis is often complicated with acute respiratory distress syndrome that requires mechanical ventilatory support ( 4 , 5 ), research showed that more than 20% of septic patients needed invasive ventilation in the USA ( 6 ).…”

Dexmedetomidine Versus Propofol for Patients With Sepsis Requiring Mechanical Ventilation: A Systematic Review and Meta-Analysis

“…According to the recent reports, approximately 21% of septic patients required mechanical ventilation in the United States ( Rashmi et al, 2018 ). As we all know, patients with prolonged mechanical ventilation suffer from higher mortality and hospital costs ( Goligher Ewan et al, 2018 ; Louise, 2020 ).…”