Impact of initial ventilation strategies on in-hospital mortality in sepsis patients: insights from the MIMIC-IV database

Abstract

Background: This study evaluates the impact of different initial ventilation strategies on in-hospital mortality among sepsis patients. Methods: We included hospitalized sepsis patients who underwent mechanical ventilation from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized them into groups based on their initial ventilation strategy: non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV). The main endpoint analyzed was in-hospital mortality. A propensity score matching model was employed to address confounding factors, and Cox survival analysis was performed in the matched cohort. Subgroup analyses were conducted to evaluate population heterogeneity. Results: Among 19,796 patients who received mechanical ventilation, 10,073 (50.8%) initially received NIV. The analysis included 2935 matched pairs. Patients initially receiving NIV exhibited a higher survival rate (P = 0.009) and a 24% lower risk of in-hospital mortality compared to those initially receiving IMV (P < 0.001). Subgroup analysis indicated significant survival benefits with initial NIV for patients without malignant tumor (MT), or lower Sequential Organ Failure Assessment (SOFA) scores and higher PO2/FiO2. Conclusion: Among sepsis patients, initial NIV is linked to increased in-hospital survival rates and reduced mortality risk, particularly in patients without concurrent MT, lower SOFA scores, and higher PO2/FiO2.