The following is a summary of “Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation,” published in the May 2024 issue of Critical Care by Mellado-Artigas et al.

Despite being a cornerstone of critical care, the optimal timing for initiating invasive mechanical ventilation remains a challenge.

Researchers conducted a retrospective analysis evaluating whether early invasive ventilation improves one-year survival rates in patients with hypoxemic respiratory failure who don’t require immediate intubation.

They emulated a target trial to gauge the advantages of immediately starting invasive ventilation in hypoxemic respiratory failure, compared to delaying it, among patients experiencing hypoxemia within the first 48 hours. Non-intubated patients with SpO₂/FiO₂ ≤ 200 and SpO₂ ≤ 97% were included. The target trial was emulated using a single-center database (MIMIC-IV) containing detailed clinical information. The hourly probability of receiving mechanical ventilation was continuously assessed. The HR for the primary outcome, one-year mortality, and the secondary outcome, 30-day mortality, were estimated using weighted Cox models with stabilized inverse probability weights to adjust for measured confounding.

The results showed 2,996 patients meeting the inclusion criteria, and 792 were intubated within 48 hours. Among non-invasive support devices, oxygen via a facemask was the most prevalent (75%). Intubation reduced the hazard of death within the first year after ICU admission (HR 0.81, 95% CI 0.68–0.96, P=0.018) compared to non-intubated patients with similar intubation probabilities. Intubation was linked to a 30-day mortality HR of 0.80 (95% CI 0.64–0.99, P=0.046).

Investigators found that initiating mechanical ventilation in patients with acute hypoxemic respiratory failure lowered the risk of death according to this target trial emulation.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04926-y