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Thirty-day hospital readmissions among mechanically ventilated emergency department patients
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    Hospital readmissions among mechanically ventilated in ED. Is it feasibly a preventative strategy?
    • Andrea Purro, emergency and critical care medicine Humanitas Gradenigo Hospital, Turin, Italy
    • Other Contributors:
      • Davide Torti, emergency and critical care medicine
      • Alastair J Glossop, Department of Critical Care and Anaesthesia
      • Antonio Esquinas, Intensive Care Unit

    Dear Editor,

    It is widely recognised that the management of patients with acute respiratory failure in the Emergency Department (ED) is a pivotal point that may influence outcomes at later stages in patient care pathways. In particular, the decision to submit patients to invasive mechanical ventilation (IMV) and the mode of ventilator settings utilised are of relevance in determining patient outcomes. It is also acknowledged that early hospital readmission following an episode of acute critical illness is a major problem not only for patients’ quality of life but also healthcare systems in general. Thus we read with great interest the recent retrospective study by Page DB et al., in which the authors investigated the relationship between ED pathways of care and the risk factors for unplanned 30-day readmissions. We applaud the authors on their efforts, however we also feel that there are several confounding issues that warrant further discussion.

    Firstly, the length of the time for which patients were treated and mechanically ventilated in the ED was relatively short - at 5 hours and 30 mins - compared the total length of stay (LOS) in hospital. We feel that this short period is unlikely to have contributed any meaningful effect on overall patient outcomes. Moreover, it would have been of great interest to discuss any changes in ventilator parameters between ED and ICU, and if the initial choice of ventilator settings could have influenced patient outcomes, i...

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    Conflict of Interest:
    None declared.