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. 2024 Nov 1;52(11):1739-1749.
doi: 10.1097/CCM.0000000000006400. Epub 2024 Aug 21.

The Impact of Delayed Transition From Noninvasive to Invasive Mechanical Ventilation on Hospital Mortality in Immunocompromised Patients With Sepsis

Yang Xu  1   2 , Yi-Fan Wang  3 , Yi-Wei Liu  1   4 , Run Dong  3 , Yan Chen  3 , Yi Wang  5 , Li Weng  3 , Bin Du  3 ; China Critical Care Clinical Trials Group (CCCCTG) and China National Critical Care Quality Control Center Group
Collaborators, Affiliations

The Impact of Delayed Transition From Noninvasive to Invasive Mechanical Ventilation on Hospital Mortality in Immunocompromised Patients With Sepsis

Yang Xu et al. Crit Care Med. .

Abstract

Objective: To determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis.

Design: Retrospective analysis using the National Data Center for Medical Service claims data in China from 2017 to 2019.

Setting: A total of 3530 hospitals across China.

Patients: A total of 36,187 adult immunocompromised patients with sepsis requiring ventilation.

Interventions: None.

Measurements and main results: The primary outcome was hospital mortality. Patients were categorized into NIV initiation or IMV initiation groups based on first ventilation. NIV patients were further divided by time to IMV transition: no transition, immediate (≤ 1 d), early (2-3 d), delayed (4-7 d), or late (≥ 8 d). Mortality was compared between groups using weighted Cox models. Over the median 9-day follow-up, mortality was similar for initial NIV versus IMV (adjusted hazard ratio [HR] 1.006; 95% CI, 0.959-1.055). However, among NIV patients, a longer time to IMV transition is associated with stepwise increases in mortality, from immediate transition (HR 1.65) to late transition (HR 2.51), compared with initial IMV. This dose-response relationship persisted across subgroups and sensitivity analyses.

Conclusions: Prolonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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