title: A Comparative Effectiveness Study of Rescue Strategies in 1,000 Subjects With Severe Hypoxemic Respiratory Failure.
abstract: BACKGROUND
  Subjects with severe hypoxemic respiratory failure have shown a high mortality in previous studies.
  
  
  METHODS
  All adult ICU patients requiring mechanical ventilation from 2005 to 2010 at Mayo Clinic were screened for severe hypoxemia (Murray lung injury score of ≥ 3). Extracorporeal membrane oxygenation, prone positioning, high-frequency oscillatory ventilation (HFOV), and inhaled vasodilators were considered as rescue strategies. A propensity-based scoring was created for the indication or predilection to use each strategy. A model was created to evaluate the association of each rescue strategy with hospital mortality.
  
  
  RESULTS
  Among 1,032 subjects with severe hypoxemia, 239 subjects received some form of rescue strategy (59 received a combination of therapies, and 180 received individual therapies). Inhaled vasodilators were the most common, followed by HFOV. Rescue strategies were used in younger subjects with severe oxygenation deficits. Subjects receiving rescue strategies had higher mortality and longer ICU stays. None of the strategies individually or in combination showed a significant association with hospital mortality after adjusting covariates by propensity scoring. Adjusted Odds ratios and respective 95% CI were as follows: HFOV 0.67 (0.35-1.27), extracorporeal membrane oxygenation 0.63 (0.18-1.92), prone position 1.07 (0.49-2.28), and inhaled vasodilators 1.17 (0.78-1.77).
  
  
  CONCLUSIONS
  In this retrospective comparative effectiveness study, there was no association of rescue strategies with hospital mortality in subjects with severe hypoxemia.
authors.affiliation: Departments of Transplant and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida METRIC (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Emergency and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota morenofranco.pablo@mayo.edu.
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno Franco
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
authors.affiliation: Respiratory Care, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilson
authors.affiliation: METRIC (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Emergency and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota Division of Pulmonary Care & Critical Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: METRIC (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Emergency and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota Division of Pulmonary Care & Critical Medicine, Mayo Clinic, Rochester, Minnesota Division of Pulmonary Care & Critical Medicine, Ohio State University, Wexner Medical Center, Columbus, Ohio.
authors.forename: Sonal R
authors.initials: SR
authors.lastname: Pannu
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D003131:Combined Modality Therapy; D057186:Comparative Effectiveness Research; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D006612:High-Frequency Ventilation / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016684:Prone Position; D057216:Propensity Score; D012131:Respiratory Insufficiency / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents
keywords: propensity modeling; rescue strategies; severe hypoxemic respiratory failure