Prevalence, risk factors and consequences of early clinical deterioration under non-invasive ventilation in emergency department patients: a prospective, multicentre, observational study of the French IRU Network

Marjanovic, N; Lestienne, J; Balen, F; Coisy, F; Gerlier, C; Guenezan, J; Mimoz, O; SFMU-IRU network

doi:10.1186/s13054-025-05430-7

Respiratory failure & ventilation

Prevalence, risk factors and consequences of early clinical deterioration under non-invasive ventilation in emergency department patients: a prospective, multicentre, observational study of the French Initiative Recherche Urgences (IRU) Network

Crit CarePublished 3 Jun 2025Prospective observational study

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Authors' conclusion

Early clinical deterioration under NIV is common in EDs, affecting nearly one out of two patients, and is associated with higher 7-day mortality.

Study context

Population: Adults (≥ 18 years) requiring non-invasive ventilation (NIV) in emergency settings (ED or EMS), 68 French EDs and EMS of the IRU network; excluding known do-not-resuscitate order or low autonomyincluded over 5 days
Participants: 198 adults

Exposure: Early Clinical Deterioration vs No Early Clinical Deterioration
Outcome: Early clinical deterioration under NIV (need for tracheal intubation or presumptive criteria for intubation)
Follow-up: 1 h

Methodological detailsmulticentre, 68 French EDs and EMS in the IRU network

Multicentre
68 French EDs and EMS in the IRU network

Main finding

As reported in the abstract

Early clinical deterioration under NIV (prevalence)

Patients with early clinical deterioration at 1 h

41%

Observational data: associations, not effects.

Secondary outcomes

Baseline factors associated with early clinical deterioration

	← Lower odds ←→ Higher odds →	aOR (95% CI)
GCS < 14	0.050.21520	5.5 (1.8–19.4)
Signs of increased work of breathing	0.050.21520	2.8 (1.2–7.1)
	0.050.21520Adjusted odds ratio (log scale)

Outcome	← Lower odds ←→ Higher odds →	aOR (95% CI)
Baseline factors associated with early clinical deteriorationHeart rate > 115 beats per minute	0.20.5125	2.5 (1.3–5.2)
	0.20.5125Adjusted odds ratio (log scale)

Intubation within 7 days among survivors not intubated at 1 h

P < 0.001

Early Clinical Deterioration12%

No Early Clinical Deterioration3%

7-day mortality · 7 days — Early Clinical Deterioration vs No Early Clinical Deterioration

P = 0.001

Early Clinical Deterioration28%

No Early Clinical Deterioration10%

7-day mortality

	← Lower risk ←→ Higher risk →	aHR (95% CI)
NIV failure	0.10.31310	4.1 (1.8–9.1)
	0.10.31310Adjusted hazard ratio (log scale)

Original publication

Prevalence, risk factors and consequences of early clinical deterioration under non-invasive ventilation in emergency department patients: a prospective, multicentre, observational study of the French IRU Network. Crit Care. Published 3 June 2025. doi:10.1186/s13054-025-05430-7

Read the original article ↗

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