Abstract Background Gastroparesis (GP) leads to delayed gastric emptying and increased risk of micro-aspiration, impaired secretion clearance, and ventilator weaning difficulty. Aspiration pneumonia and ventilator-associated pneumonia (VAP) are well-recognized factors associated with prolonged mechanical ventilation (MV), however the independent contribution of GP to MV duration has not been examined in a national population. The objective of this study was to determine if GP was independently associated with prolonged invasive MV (96 h) among a national cohort of hospitalized adults with acute respiratory failure (ARF). Methods We performed a cross-sectional study using data from the Nationwide Inpatient Sample (2017-2022). Included patients were adult (≥18 y) non-elective admissions with acute respiratory failure (J96. x) who received invasive MV (5A1935Z/5A1945Z/5A1955Z). Exposure: Gastroparesis (K31. 84). Outcome Prolonged MV 96 h (5A1955Z). NISSTRATUM, HOSPNIS, and DISCWT were used for survey design with single-unit centering. Multivariable survey-weighted logistic regression was performed adjusting for age, sex, race, payer, income quartile, obesity, diabetes, obstructive sleep apnea, hiatal hernia, sepsis, shock, aspiration pneumonia, VAP, hospital region, teaching status, bed size, rurality, and year. Sensitivity analyses were performed, excluding VAP and stratifying on aspiration status. Results The analytic subpopulation comprised 1. 09 million unweighted discharges (≈ 5. 4 million weighted), of whom 3. 7% had gastroparesis among all ventilated ARF hospitalizations. Rates of prolonged MV (96 h) were 36. 3% overall, but significantly higher in patients with GP (41. 7% vs 36. 2%, P 0. 001). Weighted characterists and outcomes are listed in Table 1. In adjusted analyses, GP was independently associated with prolonged MV as stated in Table 2. Marginal analysis: estimated probability of prolonged MV = 39. 8 % (GP) vs 36. 3 % (no GP) ; absolute difference = +3. 5 % (95 % CI 2. 3-4. 7; P 0. 001). The difference was significant after excluding VAP (OR 1. 17, P 0. 001) and in the strata of patients with aspiration (OR 1. 18) and without aspiration (OR 1. 18). Discussion In this national population-based sample of hospitalizations for ARF that required MV, gastroparesis was independently associated with a 17 % higher adjusted odds and a 3-4 % higher absolute probability of prolonged ventilation, after adjustment for aspiration and sepsis. These results are compatible with the hypothesis that delayed gastric emptying may have effects on weaning and ventilator dependence beyond the mechanical obstruction associated with overt aspiration. Recognition that GP may be a potentially modifiable barrier to successful extubation may lead to new strategies for prevention and treatment in the ICU setting. This abstract is funded by: None
Lim et al. (Fri,) studied this question.