Key result
Early administration of noninvasive positive pressure ventilation within 30 minutes of emergency department arrival was associated with significantly lower 30-day mortality (adjusted OR 0.19) compared to delayed administration.
Why the study?
Although noninvasive positive pressure ventilation is crucial for treating acute decompensated heart failure, the earliest time point for administering it remains unknown.
Does early administration of noninvasive positive pressure ventilation (<30 minutes) reduce 30-day mortality in patients with acute decompensated heart failure in the emergency department?
Cohort (n=115)
No
Does early administration of noninvasive positive pressure ventilation (<30 minutes) reduce 30-day mortality in patients with acute decompensated heart failure in the emergency department?
Early administration of noninvasive positive pressure ventilation (within 30 minutes of arrival) in the emergency department is associated with reduced 30-day mortality and shorter duration of oxygenation in patients with acute decompensated heart failure.
Answers are grounded in this paper and cite their sources.
Early ED NPPV for ADHF was associated with lower 30-day mortality; hypothesis-generating and requires prospective confirmation before practice change.
Background Acute decompensated heart failure (ADHF) is a life-threatening disease that requires emergent intervention. Although noninvasive positive pressure ventilation (NPPV) is crucial for treating ADHF, the earliest time point for administering NPPV remains unknown. In this study, we hypothesized that early NPPV administration for patients with acute heart failure in the emergency department (ED) would lead to a better outcome. Methodology This is a single-center retrospective cohort study at an ED of a community hospital in Japan. The data were collected from consecutive patients who were administered NPPV for ADHF in the ED from April 2016 to September 2018. The primary exposure was the timing of NPPV administration (within 30 minutes versus over 30 minutes after arrival). The primary outcome was 30-day mortality. Results A total of 115 patients were included in this study. Overall, the median age was 78 (interquartile range [IQR] = 70-84 years), and 63 (54.9%) patients were male. The median time from the arrival at the ED to NPPV administration for the patients was 14 minutes (IQR = 8-30 minutes). Overall, 72% (83/115) of the patients were categorized as early administration group (<30 minutes). The total 30-day mortality was 7.0% (8/115), and the total tracheal intubation rate was 11% (13/115). Early NPPV administration for patients with ADHF was associated with lower 30-day mortality (3.6% vs. 16%; p = 0.04) and shorter length of oxygenation (four days vs. seven days; p < 0.01). Multivariate logistic regression test showed that 30-day mortality was significantly lower in the early treatment group (adjusted odds ratio = 0.19; 95% confidential interval = 0.04-0.90). Conclusions Although further investigation is needed, early NPPV administration for patients with ADHF in the ED was associated with lower 30-day mortality.
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Nakazawa et al. (2021) conducted a cohort in Acute decompensated heart failure (n=115). Early administration of noninvasive positive pressure ventilation (<30 minutes) vs. Delayed administration of noninvasive positive pressure ventilation (≥30 minutes) was evaluated on 30-day mortality (Adjusted OR 0.19, 95% CI 0.04-0.90, p=0.04). Early administration of noninvasive positive pressure ventilation within 30 minutes of emergency department arrival was associated with significantly lower 30-day mortality (adjusted OR 0.19) compared to delayed administration.
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