Background: Patients admitted to an intensive care unit (ICU) requiring invasive mechanical ventilation who are discharged alive from the ICU within 24 h are poorly characterized in the literature. Objective: Our aim was to characterize a cohort of intubated emergency department (ED) patients who are extubated and discharged from the ICU within 24 h. Methods: We conducted a retrospective, observational cohort study at a single level I trauma center from January 2017 to December 2019. We included adults who were admitted to an ICU from the ED requiring invasive mechanical ventilation. Our primary outcome was the proportion of patients who were discharged from the ICU alive within 24 h. Results: Of 13,374 ED patients admitted to an ICU during the study period, 2871 patients were intubated and ventilated in the prehospital or ED settings. Of these, 14% were discharged alive from the ICU within 24 h of admission. Only 21% of these patients were intubated in the ED. We identified the following two distinct subpopulations comprising 62% of this short-stay group: patients with a primary discharge diagnosis of intoxication (47%) and minimally injured trauma patients (53%), with 4% of patients in both subgroups. 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 h. We identified two distinct subgroups of patients with a short stay in intensive care who may be candidates for ED extubation, including patients with intoxication and minimally injured trauma patients.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).2017 (Updated August 18Accessed March 11, 2023)
- Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (Injury Severity Score >15).J Am Coll Surg. 2006; 20: 212-215
- In-hospital mortality from femoral shaft fracture depends on the initial delay to fracture fixation and Injury Severity Score: a retrospective cohort study from the NTDB 2002-2006.J Trauma Acute Care Surg. 2014; 76: 1433-1440
- Serial evaluation of the SOFA score to predict outcome in critically ill patients.JAMA. 2001; 286: 1754-1758
- Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review.Crit Care. 2008; 12: R161
- Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working Group on “Sepsis-Related Problems” of the European Society of Intensive Care Medicine.Crit Care Med. 1998; 26: 1793-1800
- Characteristics of short-stay critical care admissions from emergency departments in Maryland.Acad Emerg Med. 2017; 24: 1204-1211
- The characteristics of very short stay ICU admissions and implications for optimizing ICU resource utilization: the Saudi experience.Int J Qual Health Care. 2004; 16: 149-155
- Trauma patients can be safely extubated in the emergency department.J Emerg Med. 2011; 40: 235-239
- Descriptive analysis of extubations performed in an emergency department-based intensive care unit.West J Emerg Med. 2020; 21: 532-537
- Extubation in the emergency department and resuscitative unit setting.Emerg Med Clin North Am. 2019; 37: 557-568
- Palliative care in the emergency department as seen by providers and users: a qualitative study.Scand J Trauma Resusc Emerg Med. 2019; 27: 88
- The palliative care model for emergency department patients with advanced illness.J Palliat Med. 2011; 14: 945-950
- Promoting dignified end-of-life care in the emergency department: a qualitative study.Int Emerg Nurs. 2018; 37: 23-28
- Association of an emergency department-based intensive care unit with survival and inpatient intensive care unit admissions.JAMA Netw Open. 2019; 2e197584https://doi.org/10.1001/jamanetworkopen.2019.7584
- Initiating end-of-life care at the emergency department: an observational study.Am J Hosp Palliat Care. 2019; 36: 941-946
- Advances in prehospital airway management.Int J Crit Illn Inj Sci. 2014; 4: 57-64
- The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less.Prehosp Emerg Care. 2011; 15: 184-192
- Seattle and King County setting standard in prehospital ETI.Journal of Emergency Medical Services. January 31, 2011; (PublishedAccessed XXXX)
King County Emergency Medical Services 2019 Annual Report; September 2019 Published onlineAccessed XXXX https://kingcounty.gov/depts/health/emergency- medical-services/.../media/depts/health/emergency-medical-services/documents/reports/2019-Annual-Report.ashx.
Published online: March 04, 2023
Accepted: February 17, 2023
Received in revised form: February 4, 2023
Received: November 17, 2022
Publication stageIn Press Uncorrected Proof
Abstract presented at the Society of Critical Care Medicine Critical Care Congress, April 18–22, 2022, held virtually.
Published by Elsevier Inc.