Trends and Variations in Tracheal Intubation for Acute Respiratory Failure in the US

BACKGROUND: Acute respiratory failure (ARF) is a critical medical emergency with increasing mortality rates and hospitalizations in the United States (US). Tracheal intubation (TI) is often required to provide mechanical ventilation in these patients. However, recent evidence shows that TI in critically ill patients is associated with substantial morbidity and mortality, and hence, understanding trends and variations in the practice of TI in critically ill patients with ARF is crucial for improving patient outcomes and healthcare practices. HYPOTHESIS: The study aims to evaluate the frequency of TIs in ARF patients and to assess trends and variations in TI use across US hospitals. We hypothesize a declining trend in TIs among ARF patients and significant variability in TI utilization across US hospitals. METHODS: In our retrospective cohort study, we utilized the National Inpatient Sample (NIS) database from the HCUP. Patient selection relied on ICD 10th Revision codes to identify critically ill adults aged 18 and above who underwent TI and were diagnosed with ARF (2016-2020). We also extracted patient demographic and hospitalization details from the database. RESULTS: From 2016-2020, 2,531,420 patients were admitted to US hospitals with ARF, and of these, 522,746 underwent TI (26.02%). The mean age was 62 years, 44.4% were women, and the in-hospital mortality was 32.8% (95% CI, 32.6%-33.0%). The mortality among patients receiving TI increased significantly from 30.6% (95% CI, 30.1%-31.1%) in 2016 to 37.8% (95% CI, 37.3%-38.3%) in 2020 (p<.0001). However, the percentage of ARF-related hospitalizations receiving TI decreased from 23.9% (95% CI, 23.4% - 24.4%) in 2016 to 18.9% (95% CI, 18.5% - 19.3%) in 2020 (p<.0001). CONCLUSION: We found a decline in TI use for patients with ARF across hospitals in the United States. This could be due to the increased use of alternative techniques to manage ARF, such as non-invasive ventilation and high-flow nasal cannula.