Non-invasive mechanical ventilation and mortality in immunocompromised patients hospitalized with pneumonia

BackgroundNon-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity.MethodsWe retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals.ResultsIn 42,048 admissions for AECOPD over 6 years, the median risk-standardized initial NIV % was 57.3% (interquartile interval [IQI]=41.9–64.4%). Hospitals in the highest risk-standardized NIV % quartiles cared for more rural patients, used invasive ventilators less frequently, and had longer length of hospital stay, but had no difference in mortality relative to the hospitals in the lowest quartiles. The risk-standardized NIV % was 65.3% (IQI=34.2–84.2%) in rural and 55.1% (IQI=10.8–86.6%) in urban hospitals (p=0.047), but hospital mortality did not differ between the two groups.ConclusionNIV use varied significantly across hospitals, with rural hospitals having higher risk-standardized NIV % rates than urban hospitals. Further research should investigate the exact mechanism of variation in NIV use between rural and urban hospitals.

NATIONAL OUTCOMES OF STATUS ASTHMATICUS AMONG THE ELDERLY

End-of-life care is costly, and decedents often experience overtreatment or low-quality care. Noninvasive ventilation (NIV) may be a palliative approach to avoid invasive mechanical ventilation (IMV) among select patients who are hospitalized at the end of life. To examine the trends in NIV and IMV use among decedents with a hospitalization in the last 30 days of life. This population-based cohort study used a 20% random sample of Medicare fee-for-service beneficiaries who had an acute care hospitalization in the last 30 days of life and died between January 1, 2000, and December 31, 2017. Sociodemographic, diagnosis, and comorbidity data were obtained from Medicare claims data. Data analysis was performed from September 2019 to July 2020. Use of NIV or IMV. Validated International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification procedure codes were reviewed to identify use of NIV, IMV, both NIV and IMV, or none. Four subcohorts of Medicare beneficiaries were identified using primary admitting diagnosis codes (chronic obstructive pulmonary disease [COPD], congested heart failure [CHF], cancer, and dementia). Measures of end-of-life care included in-hospital death (acute care setting), hospice enrollment at death, and hospice enrollment in the last 3 days of life. Random-effects logistic regression examined NIV and IMV use adjusted for sociodemographic characteristics, admitting diagnosis, and comorbidities. A total of 2 470 435 Medicare beneficiaries (1 353 798 women [54.8%]; mean [SD] age, 82.2 [8.2] years) were hospitalized within 30 days of death. Compared with 2000, the adjusted odds ratio (AOR) for the increase in NIV use was 2.63 (95% CI, 2.46-2.82; % receipt: 0.8% vs 2.0%) for 2005 and 11.84 (95% CI, 11.11-12.61; % receipt: 0.8% vs 7.1%) for 2017. Compared with 2000, the AOR for the increase in IMV use was 1.04 (95% CI, 1.02-1.06; % receipt: 15.0% vs 15.2%) for 2005 and 1.63 (95% CI, 1.59-1.66; % receipt: 15.0% vs 18.2%) for 2017. In subanalyses comparing 2017 with 2000, similar trends found increased NIV among patients with CHF (% receipt: 1.4% vs 14.2%; AOR, 14.14 [95% CI, 11.77-16.98]) and COPD (% receipt: 2.7% vs 14.5%; AOR, 8.22 [95% CI, 6.42-10.52]), with reciprocal stabilization in IMV use among patients with CHF (% receipt: 11.1% vs 7.8%; AOR, 1.07 [95% CI, 0.95-1.19]) and COPD (% receipt: 17.4% vs 13.2%; AOR, 1.03 [95% CI, 0.88-1.21]). The AOR for increased NIV use was 10.82 (95% CI, 8.16-14.34; % receipt: 0.4% vs 3.5%) among decedents with cancer and 9.62 (95% CI, 7.61-12.15; % receipt: 0.6% vs 5.2%) among decedents with dementia. The AOR for increased IMV use was 1.40 (95% CI, 1.26-1.55; % receipt: 6.2% vs 7.6%) among decedents with cancer and 1.28 (95% CI, 1.17-1.41; % receipt: 5.7% vs 6.2%) among decedents with dementia. Among decedents with NIV vs IMV use, lower rates of in-hospital death (50.3% [95% CI, 49.3%-51.3%] vs 76.7% [95% CI, 75.9%-77.5%]) and hospice enrollment in the last 3 days of life (57.7% [95% CI, 56.2%-59.3%] vs 63.0% [95% CI, 60.9%-65.1%]) were observed along with higher rates of hospice enrollment (41.3% [95% CI, 40.4%-42.3%] vs 20.0% [95% CI, 19.2%-20.7%]). This study found that the use of NIV rapidly increased from 2000 through 2017 among Medicare beneficiaries at the end of life, especially among persons with cancer and dementia. The findings suggest that trials to evaluate the outcomes of NIV are warranted to inform discussions about the goals of this therapy between clinicians and patients and their health care proxies.

This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novohypoxaemicrespiratory failure. This is a prospective study that includes subjects with de novohypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO₂/FiO₂, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO₂/FiO₂: higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). A value of P < 0.05 was considered significant. A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes (P = 0.04), peak inspired pressure (P < 0.001), PaO₂ (P < 0.001), SaO₂ (P < 0.002), PaO₂/FiO₂ (P < 0.002), RR (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.

In Brief Patients with severe asthma exacerbations, status asthmaticus (SA), or near-fatal asthma, account for almost 2 million emergency department visits annually in the United States, 497,000 hospital admissions, and 5000 deaths. Approximately, 2% to 70% (mean, 30%) of ICU admissions for asthma require mechanical ventilation, and the mortality rate of mechanically ventilated patients can range from 6% to 42% in high-risk populations. Risk stratifying patients presenting with a severe exacerbation is difficult. In this article, the pathophysiology of near-fatal asthma and SA is reviewed. Many patients who died of SA lack the typical risk factors for death. The 2 phenotypes of severe asthma (acute and subacute onset) are similar with respect to presenting signs but their demographics and rate of decline differ after illness onset. The clinical evaluation and risk stratification of patients presenting with severe asthma exacerbations are a vital and challenging component of their care. The rational use of inhaled and systemic therapies is also required to minimize complications and maximize benefits. Strategies for the use of mechanical ventilation that minimize the risk of barotrauma and use of permissive hypercapnia are a key to reduce mortality. The use of extrinsic positive end expiratory pressure is not contraindicated and may benefit a subset of patients. At this time, the use of noninvasive mechanical ventilation in the most severe asthma exacerbations cannot be recommended. The use of sedatives, inhalational anesthetics, and paralytics as adjuncts to mechanical ventilation have potential risks and their use must be individualized. Status asthmaticus and near fatal asthma are life-threatening entities. The care requires an assessment of risk and, often, a critical care environment. This review discusses the intensive care management of patients presenting with severe asthma exacerbations.

This study aimed to characterize which are the early determinants of immediate failure of the use of noninvasive mechanical ventilation (NIMV) outside the ICU. This prospective study included patients who were admitted to the Military Hospital in Guayaquil, Ecuador. Each variable was analyzed independently by using a multiple logistic regression model toward establishing an association with the event. A total of 249 cases of NIMV over a 10 year period of its application outside the ICU was included in the study. Fifty-five (22.10%) patients were transferred to the ICU, A multivariate analysis showed that the determinants of immediate NIMV failure outside the ICU were the following: age (OR: 1.12; P = 0.03); SBP (OR: 1.04; P = 0.001); HR (OR: 1.66; P < 0.0001); pCO₂ (OR: 1.16; P = 0.007); pO2 (OR: 1.35; P = 0.003); levels of IPAP (OR: 1.35; P < 0.0001); and the number of quadrants affected, as shown in a chest X-ray (OR: 1.40; P < 0.0001). The number of affected quadrants in a chest X-ray, tachyarrhythmia and hypoxemia may be useful in the initial decision in the use of NIMV outside the ICU. High values of IPAP, the persistence of elevated pCO₂, arterial hypotension, and age could be useful as a second screening associated with immediate NIMV failure outside the ICU.

Background: Despite several studies having been carried in this organizational context, there is an absence of information about the effectiveness of non-invasive mechanical ventilation (NIV) in Emergency Departments (ED), based on a number of suitable patients with acute respiratory failure (ARF) of different aetiology. In particular, it has not yet been defined as to whether the context of the ED suits the necessary requirement of quality for the correct application of the method and if the obtained results are different from those taken in other studies in general or respiratory intensive care unit. Finally there are few data related to the predictive factors to NIV failure (endotracheal intubation, in-hospital mortality) when applied in the emergency setting. Methods: To answer these questions we have retrospectively studied a population of 210 patients (95 with COPD exsacerbation ; 92 with acute cardiogenic pulmonary oedema; 23 with severe community acquired pneumonia) treated for ARF in the “critical area” of four Italian level II Emergency Departments. For all patients demographic data; some comorbidities (diabetes, dementia, sopraventricular arrhythmias, obesity); the physiological scores (Kelly, SAPS II, Apache II); the need for pharmacological sedation; vital and blood gas parameters (evaluated at entry, after one hour of treatment and before its suspension); the ventilatory modality applied (CPAP or PSV + PEEP) and some parameters of in-hospital stay (duration of the hospitalization in the critical area, duration of ventilation, compliance to the treatment, patient's refusal to continue it, development of skin necrosis, need for endotracheal intubation, in-hospital mortality) were considered. Finally demographic, event of death with Cox regression or to the need for ETI through linear regression analysis. Results: Globally, in-hospital mortality reached 13,3%, the percentage of failure with consequent endotracheal intubation amounted to 10,4% . Considering the single aetiologic groups in the patients with COPD, exsacerbation mortality and ETI percentage were 12,6% and 13,7% respectively; in ACPO patients these data respectively amounted to 3,3% and 4,3%; while for patients with severe CAP they respectively reached 34,7% and 21,7%. The following factors were independently correlated with in-hospital mortality: SAPS II &gt; 35, presence of dementia for COPD patients; SAPS II &gt; 35; presence of dementia, presence of sopraventricular arrhythmias for ACPO patients; SAPS II &gt; 35, presence of sopraventricular arrhythmias, presence of dementia for CAP patients. Considering the whole population of 210 patients, the predictive factors of in-hospital mortality were the following: SAPS II &gt; 35; presence of dementia; presence of sopraventricular arrhythmias; maintenance of a respiratory rate above 24 bpm during tratment. The following were factors independently correlated with the need for endotracheal intubation: male gender, pH &lt; 7,32, respiratory rate &gt; 24 bpm, mean arterial pressure &gt; 96 mmHg, all measured at one hour of treatment, for COPD patients; male gender sex, pH &lt; 7,32 , respiratory rate &gt; 24 bpm, PaCO2&gt; 54,5 mm Hg all measured after one hour treatment for ACPO patients. Given the low number of patients, it was not possible to perform the logistic regression and to calculate the matrix of covariance of the parameter for the CAP group. Considering the whole series of patients, the factors independently correlated to ETI resulting in the following: male gender; diagnosis of COPD; pH &lt; 7,32, respiratory rate &gt; 24 bpm, mean arterial pressure &gt; 96 mm Hg, PaCO2 &gt; 54,5 mm Hg, all measured after one hour treatment. Conclusions: In conclusion, our study shows that NIV is racticable in the ED with safety and clinical results I T A L I A N J O U R N A L O F P U B L I C H E A L T H JPH - Year 6, Volume 5, Number 3, 2008 T H E M E P A P E R S 1 9 9

Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered via a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.

BackgroundA pneumothorax is common in patients admitted to the intensive care unit (ICU) with coronavirus disease (COVID-19) when non-invasive or invasive mechanical ventilation is performed to maintain adequate oxygenation. The aim of the present study was to investigate the effects of elevated inflammatory markers and an elevated systemic immune inflammatory index (SII) on mortality in this patient population.Materials and methodsBetween March 2020 and May 2021, 124 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reacion positviity who were admitted to the ICU in our hospital and diagnosed with and treated for a pneumothorax were evaluated retrospectively. Interleukin-6 (IL-6), C-reactive protein, neutrophil, lymphocyte, platelet and white blood cell levels were measured. These parameters were used to calculate the neutrophil–lymphocyte ratio (NLR) and SII, and the association of these parameters with pneumothorax-related mortality was examined.ResultsThis study included 39 female (31.5%) and 85 male (68.5%) patients. The mean age was 65.3 ± 12.6 years. Non-invasive mechanical ventilation was performed in 13 (10.5%) patients, and 111 (89.5%) patients received invasive mechanical ventilation. Tube thoracostomy was performed in 113 patients (91.1%), and 11 patients (8.9%) were treated with oxygen therapy. The factors affecting mortality in the pneumothorax patients were the Charlson Comorbidity Index (four or higher), IL-6 level and NLR. The IL-6 level was 53.4 in those who died versus 24.6 in those who survived (p = 0.017). The NLR in the patients who died was 16.9 as compared to 12.5 in those who survived (p = 0.011).ConclusionElevated markers of infection were associated with an increased risk of mortality in pneumothorax patients with COVID-19 who received invasive or non-invasive mechanical ventilation in the ICU. In this patient population, high levels of positive end-expiratory pressure should be avoided, and inflammatory marker levels and the SII should be closely monitored.

目的 评估意大利PICU无创通气(non-invasive ventilation，NIV)临床应用进展。设计 全国多中心回顾性观察性队列研究。场所 意大利PICU网的13家内/外科PICU。对象 2011年1月1日至2013年12月31日间入组的7111例0～16岁患儿。干预措施 无。测量方法和主要结果 记录呼吸衰竭病因，NIV模式及时间，界面类型，治疗失败率及预后。2006年11月1日至2007年4月30日的呼吸道病毒感染流行期间曾进行相关研究，对比两组数据。本次共纳入PICU患儿7 111例，NIV使用率8.8%(n＝630)。入PICU时未行MV患儿(n＝3819)中行NIV者585例(15.3%)，且3年内比例显著增长(2006年11.6%，2012年18.2%)。17.2%的气管插管(endotracheally intubated，ETI)患儿于拔管后行NIV支持以避免再次插管，此数值在2006年、2011年、2012年分别为11.9%、15.3%、21.6%。2006年至2012年，NIV失败率由10%升至16.1%。结论 部分意大利PICU首选NIV为呼吸支持手段比例增加并成功应用。现有研究显示NIV用于轻度急性呼吸衰竭治疗可靠且安全。NIV为儿童下呼吸道感染(细支气管炎及肺炎)、急/慢性呼吸衰竭及预防再插管的主要辅助通气手段。 设计 全国多中心回顾性观察性队列研究。 场所 意大利PICU网的13家内/外科PICU。 对象 2011年1月1日至2013年12月31日间入组的7111例0～16岁患儿。 干预措施 无。 测量方法和主要结果 记录呼吸衰竭病因，NIV模式及时间，界面类型，治疗失败率及预后。2006年11月1日至2007年4月30日的呼吸道病毒感染流行期间曾进行相关研究，对比两组数据。本次共纳入PICU患儿7 111例，NIV使用率8.8%(n＝630)。入PICU时未行MV患儿(n＝3819)中行NIV者585例(15.3%)，且3年内比例显著增长(2006年11.6%，2012年18.2%)。17.2%的气管插管(endotracheally intubated，ETI)患儿于拔管后行NIV支持以避免再次插管，此数值在2006年、2011年、2012年分别为11.9%、15.3%、21.6%。2006年至2012年，NIV失败率由10%升至16.1%。 结论 部分意大利PICU首选NIV为呼吸支持手段比例增加并成功应用。现有研究显示NIV用于轻度急性呼吸衰竭治疗可靠且安全。NIV为儿童下呼吸道感染(细支气管炎及肺炎)、急/慢性呼吸衰竭及预防再插管的主要辅助通气手段。

Background: Administration of nebulized medications is a very common practice in the ICU. Although several aerosol generating devices can be selected, most ICUs use the small volume jet nebulizers. Although some recommendations on where to place aerosol generators when administering aerosol treatments to patients undergoing invasive and noninvasive mechanical ventilation or high-flow nasal cannula (HFNC) have been published, there are still many inconsistencies in the clinical setting. Placement of these aerosol generators can be adversely affected by humidification devices and lead to significant changes in pulmonary mechanics. The goal of this study was to determine where respiratory therapists (RTs) place nebulizer when administering a treatment in the ICU. Methods: For this prospective, observational study, pediatric and adult subjects who were placed on invasive mechanical ventilation (IMV), and noninvasive mechanical ventilation (NIV) or high flow nasal cannula (HFNC) with an order to receive a nebulized treatment were included. The study was conducted at a large university-affiliated hospital in Texas and was approved by the IRB. The research team communicated with RTs when it was time to administer an aerosol treatment to subjects in the ICU. Once the subject was identified, the electronic medical record was accessed to collect demographic information and placement of the nebulizer was documented in the data collection form as the treatment was administered. Results: A total of 32 subjects were selected for analysis; 18 from the pediatric ICU and 14 from the adult ICU. The majority of the sample was on IMV (50%), followed by HFNC (28.1%), and NIV (21.9%). The nebulizer was placed on the dry side of the heated humidifier (HH) in every patient on IMV. For all patients on NIV, nebulizers were placed on the inspiratory limb of the circuit between the interface and the exhalation valve. When placed on HFNC, the nebulizer was connected to the dry side of the HH in 3 subjects while 6 subjects had their nebulizers placed on the inspiratory limb of the breathing circuit. Conclusions: The results of this study suggest that while there is variation in regard to where RTs place the aerosol generator when using HFNC, they are consistent in their practice of placing the nebulizer when using IMV or NIV as recommended in published guidelines. Further evaluation of practices while delivering aerosol treatments to patients on HFNC may be required.

BackgroundTo determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted.ResultsThirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay.ConclusionsThe overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0289-y) contains supplementary material, which is available to authorized users.

Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive and invasively ventilated patients are discussed, with a particular emphasis on initiation and ongoing monitoring priorities focused on maintaining patient safety and improving patient outcomes.

The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized. We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002-2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models. A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support (p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74-1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88-3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time. Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.

Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System