Table 3. Secondary Outcomes of Patients Receiving On-Demand Nebulization vs Routine Nebulization.
| Outcome | On-Demand Nebulization (n = 455) | Routine Nebulization (n = 467) | Absolute Difference (95% CI) | P Valuea |
|---|---|---|---|---|
| Mortality, No. of events/total No. (%) | ||||
| 28-d | 141/455 (31.0) | 149/467 (31.9) | –0.9 (–6.9 to 5.1) | .78 |
| ICU | 135/455 (29.7) | 137/467 (29.3) | 0.3 (–5.6 to 6.2) | .94 |
| 90-db | 160/415 (38.5) | 156/425 (36.7) | 1.8 (–4.7 to 8.4) | .62 |
| Hospitalb | 161/416 (38.7) | 165/438 (37.7) | 1.0 (–5.5 to 7.5) | .78 |
| Duration of invasive ventilation, median (IQR) | 4 (2-8) | 4 (2-10) | –0.5 (–1.3 to 0.2) | .28 |
| Length of stay, median (IQR), d | ||||
| ICU | 5 (2-10) | 5 (2-13) | –0.8 (–1.8 to 0.2) | .49 |
| Hospital | 15 (7-27) | 14 (6-27) | –0.9 (–3.0 to 1.2) | .57 |
| Pulmonary complications, No. (%)c | 204 (44.8) | 228 (48.8) | –4.0 (–10.4 to 2.4) | .24 |
| Moderate or severe ARDSd | 23 (5.1) | 30 (6.4) | –1.4 (–4.4 to 1.6) | .40 |
| VAPe | 14 (3.1) | 10 (2.1) | 0.9 (–1.1 to 3.0) | .41 |
| Severe atelectasisf | 175 (38.5) | 200 (42.8) | –4.4 (–10.7 to 2.0) | .18 |
| Pneumothoraxg | 25 (5.5) | 22 (4.7) | 0.8 (–2.1 to 3.6) | .65 |
| Tube occlusionh | 1 (0.2) | 2 (0.4) | -0.2 (–0.9 to 0.5) | .99 |
| Adverse events, No. (%)i | 63 (13.8) | 137 (29.3) | –15.5 (–20.7 to –10.3) | <.001 |
| Tachyarrhythmia | 57 (12.5) | 121 (25.9) | –13.4 (–18.4 to –8.4) | <.001 |
| Agitation | 1 (0.2) | 20 (4.3) | –4.1 (–5.9 to –2.2) | <.001 |
| Hypoxemia | 9 (2.0) | 20 (4.3) | –2.3 (–4.5 to –0.1) | .06 |
| Dyspnea | 1 (0.2) | 5 (1.1) | –0.9 (–1.9 to 0.2) | .22 |
| Bronchospasm | 1 (0.2) | 4 (0.9) | –0.6 (–1.6 to 0.3) | .37 |
| Apnea | 0 | 3 (0.6) | –0.6 (–1.4 to 0.1) | .25 |
| Self-extubation | 0 | 4 (0.9) | –0.9 (–1.7 to 0.0) | .06 |
| Vomiting | 1 (0.2) | 6 (1.3) | –1.1 (–2.2 to 0.0) | .12 |
Abbreviations: ARDS, acute respiratory distress syndrome; ICU, intensive care unit; IQR, interquartile range; VAP, ventilator-associated pneumonia.
a
Not corrected for multiple comparisons.
b
Follow-up was not complete for 90-day and hospital mortality.
c
Severe pulmonary complications that were not present at start of the study.
d
Moderate or severe ARDS according to the Berlin criteria.
e
New infiltrate on chest radiograph after more than 48 hours of invasive ventilation, for which antibiotics were started.
f
Atelectasis in more than 1 lobe.
g
Pneumothorax with or without the need for a pleural drain.
h
Tube occlusion requiring tube replacement.
i
Adverse events during and within the first hour after start of nebulization.