DIFFERENCES IN PROLONGED MECHANICAL VENTILATION ACROSS RACIAL IDENTITY

ABSTRACT

SESSION TITLE Sepsis Beyond 30cc/kg and Antibiotics SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/19/2022 1115 am - 1215 pm PURPOSE: Despite efforts for racial equality, racial disparities are evident in intensive care units. Numerous studies have demonstrated that Non-White patients have higher rates of sepsis, acute kidney injury, and overall mortality throughout different hospital settings. Mechanical ventilation is a common ICU intervention that has multiple associated complications. Prolonged mechanical ventilation (PMV) has been shown to have increased morbidity and resource utilization. In this study, we hypothesized that Non-White patients would experience PMV at higher rates than White patients. METHODS: The analysis cohort was filtered from de-identified administration registry containing inpatients admitted across a diverse five hospital health system between the years 2014 and 2021. Encounters coinciding with surges in COVID-19 were removed. The study group included discharged inpatients that were 18 years or older and experienced mechanical ventilation during their hospital stay. Prolonged mechanical ventilation (PMV) was defined as mechanical ventilation lasting 21 days or longer in accordance with the Centers for Medicare and Medicaid Services (CMS) definition. Univariate analysis was performed to compare characteristics and outcomes across racial identities. Multivariate logistic regression was completed regarding PMV allowing adjustment for confounding variables and assessment of the independent predictive value of racial identity. The analysis was deemed exempt from IRB review, and was performed using R in R-Studio, p-value ≤0.05 was considered significant. RESULTS: The compiled dataset resulted in 8917 mechanical ventilation cases. Of the 8917 cases, 338 patients experienced prolonged mechanical ventilation. The overall rate of PMV was 4%. There were 176/5987 (2.9%) White patients and 162/2930 (5.5%) Non-white patients that had prolonged mechanical ventilation (p<.001). Specifically for Black patients, logistic regression utilized all significant univariate variables confirmed the independent predictive value multivariate OR of 1.62. Additionally, Non-White patients with PMV had on average longer ICU length of stay and were less likely to be discharged to Hospice. CONCLUSIONS: There has been considerable research in identifying marginalized heath care of Non-white patients throughout the hospital. In the ICU, we looked to identify prolonged mechanical ventilation as it’s associated with numerous deleterious outcomes such as sepsis and delirium. A multihospital single system evaluation identified 338 cases of prolonged mechanical ventilation. Following data analysis, Non-White patients were nearly twice the risk of experiencing PMV as compared to White patients. Further investigation into the specific factors is still needed to reduce racial disparities in mechanical ventilation. CLINICAL IMPLICATIONS Identification of racial disparities, rates of prolonged mechanical ventilation, and length of stay in the ICU. DISCLOSURES No relevant relationships by David Barbat No relevant relationships by Camden Gardner