The potential adverse effects associated with invasive mechanical ventilation (MV) can lead to delayed decisions on starting MV. We aimed to explore the association between the timing of MV and the clinical outcomes in patients with sepsis ventilated in intensive care unit (ICU). We analyzed data of adult patients with sepsis between September 2019 and December 2021. Data was collected through the Korean Sepsis Alliance from 20 hospitals in Korea. Patients who were admitted to ICU and received MV were included in the study. Patients were divided into ‘early MV’ and ‘delayed MV’ groups based on whether they were on MV on the first day of ICU admission or later. Propensity score matching was applied, and patients in the two groups were compared on a 1:1 ratio to overcome bias between the groups. Outcomes including ICU mortality, hospital mortality, length of hospital and ICU stay, and organ failure at ICU discharge were compared. Out of 2440 patients on MV during ICU stay, 2119 ‘early MV’ and 321 ‘delayed MV’ cases were analyzed. The propensity score matching identified 295 patients in each group with similar baseline characteristics. ICU mortality was lower in ‘early MV’ group than ‘delayed MV’ group (36.3% vs. 46.4%; odds ratio, 0.66; 95% confidence interval, 0.47–0.93; p = 0.015). ‘Early MV’ group had lower in-hospital mortality, shorter ICU stay, and required tracheostomy less frequently than ‘delayed MV’ group. Multivariable logistic regression model identified ‘early MV’ as associated with lower ICU mortality (odds ratio, 0.38; 95% confidence interval, 0.29–0.50; p < 0.001). In patients with sepsis ventilated in ICU, earlier start (first day of ICU admission) of MV may be associated with lower mortality.

中文翻译：

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有创机械通气时机对脓毒症患者的影响：一项多中心队列研究


与有创机械通气 (MV) 相关的潜在不利影响可能导致延迟开始 MV 的决定。我们的目的是探讨 MV 时机与重症监护病房 (ICU) 通气脓毒症患者临床结局之间的关系。我们分析了 2019 年 9 月至 2021 年 12 月期间成年脓毒症患者的数据。数据是通过韩国脓毒症联盟从韩国 20 家医院收集的。研究纳入了入住 ICU 并接受 MV 的患者。根据患者是否在入住 ICU 的第一天或更晚接受 MV，将患者分为“早期 MV”和“延迟 MV”组。采用倾向评分匹配，将两组患者按1:1的比例进行比较，以克服组间偏差。比较了 ICU 死亡率、住院死亡率、住院和 ICU 住院时间以及 ICU 出院时器官衰竭等结果。在 ICU 住院期间接受 MV 的 2440 名患者中，分析了 2119 名“早期 MV”和 321 名“延迟 MV”病例。倾向评分匹配确定了每组中 295 名具有相似基线特征的患者。 “早期 MV”组的 ICU 死亡率低于“延迟 MV”组（36.3% vs. 46.4%；比值比，0.66；95% 置信区间，0.47–0.93；p = 0.015）。与“延迟 MV”组相比，“早期 MV”组的院内死亡率较低，ICU 停留时间较短，并且需要气管切开术的频率较低。多变量逻辑回归模型确定“早期 MV”与较低的 ICU 死亡率相关（比值比，0.38；95% 置信区间，0.29–0.50；p < 0.001）。在 ICU 通气的脓毒症患者中，较早开始（入住 ICU 的第一天）MV 可能与较低的死亡率相关。