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. 2020 Jun;46(6):1204-1212.
doi: 10.1007/s00134-020-05999-3. Epub 2020 Mar 17.

Pre-admission air pollution exposure prolongs the duration of ventilation in intensive care patients

Annick De Weerdt  1   2 , Bram G Janssen  3 , Bianca Cox  3 , Esmée M Bijnens  3 , Charlotte Vanpoucke  4 , Wouter Lefebvre  5 , Omar El Salawi  6 , Margot Jans  6 , Walter Verbrugghe  7   6 , Tim S Nawrot  3   8 , Philippe G Jorens  7   6
Affiliations

Pre-admission air pollution exposure prolongs the duration of ventilation in intensive care patients

Annick De Weerdt et al. Intensive Care Med. 2020 Jun.

Abstract

Purpose: Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. The impact of pre-intensive care ambient air pollutant exposure on the duration of artificial ventilation was, however, not yet established.

Methods: The medical records of 2003 patients, admitted to the intensive care unit (ICU) of the Antwerp University Hospital (Flanders, Belgium), who were artificially ventilated on ICU admission or within 48 h after admission, for the duration of at least 48 h, were analyzed. For each patient's home address, daily air pollutant exposure [particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) and ≤ 10 µm (PM10), nitrogen dioxide (NO2) and black carbon (BC)] up to 10 days prior to hospital admission was modeled using a high-resolution spatial-temporal model. The association between duration of artificial ventilation and air pollution exposure during the last 10 days before ICU admission was assessed using distributed lag models with a negative binomial regression fit.

Results: Controlling for pre-specified confounders, an IQR increment in BC (1.2 µg/m3) up to 10 days before admission was associated with an estimated cumulative increase of 12.4% in ventilation duration (95% CI 4.7-20.7). Significant associations were also observed for PM2.5, PM10 and NO2, with cumulative estimates ranging from 7.8 to 8.0%.

Conclusion: Short-term ambient air pollution exposure prior to ICU admission represents an unrecognized environmental risk factor for the duration of artificial ventilation in the ICU.

Keywords: Air pollution; Artificial ventilation; Critical care; Intensive care; Mechanical ventilation.

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Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart depicting the selection procedure of patients admitted to the intensive care unit of the Antwerp University Hospital located in Belgium between June 6, 2010, and April 15, 2017
Fig. 2
Fig. 2
Lag-specific DLM estimates of the association between mechanical ventilation duration and exposure to air pollutants up to 10 days before ICU admission (lag0 to lag10). Estimates are presented for an IQR increment in BC (1.2 µg/m3), PM2.5 (11.4 µg/m3), PM10 (12.8 µg/m3) and NO2 (17.5 µg/m3). Models were adjusted for ambient temperature up to 10 days before admission, long-term trends and seasonality, age, sex, BMI, smoking status, SAPS3, day of the week, ICU origin and admission diagnosis. PM2.5, PM10 = particulate matter with an aerodynamic diameter ≤ 2.5 and 10 μm, respectively; BC black carbon, NO2 = nitrogen dioxide
See this image and copyright information in PMC

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