Primary diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) globally, while primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype that may lead to central airway obstruction by compressing or invading the airways. Prompt management of airway obstruction is crucial, as severe cases can be life-threatening if left untreated.  This study reports the case of a 27-year-old man with chronic cough, weight loss, and computed tomography (CT) of the chest revealing a large anterior mediastinal tumor with an extension into the neck and left lung causing airway compression and complete left lung collapse who was found to have PMBCL. The aim of this case report is to show that, in some cases of malignant central airway obstruction, the treatment approach should be based primarily on treating the underlying cause instead of procedural intervention, depending on clinical presentation and history of response to therapy. We highlight the treatment strategy of primary therapy for DLBCL to address central airway obstruction rather than surgical or bronchoscopic intervention.

Background/Objectives: Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prevent peri-intubation hypotension has been raised. This systematic review and meta-analysis aims to review the safety and efficacy of this practice. Methods: The study was fully registered with PROSPERO on 13 October 2022, and screening for eligibility was initiated on 20 September 2024. Randomized controlled trials, along with retrospective or prospective cohort studies, were included in the search. The terms "peri-intubation hypotension", "vasopressors", "intubation", and "anesthesia induced hypotension" were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases. An assessment of bias for each study was conducted using the Newcastle-Ottawa Quality Assessment Scale. The primary outcome was the rate of hypotension peri-intubation. Any complications secondary to hypotension or vasopressors were the secondary outcome. Results: We identified 13 studies, which were all randomized controlled studies, to include in the final analysis. The risk ratio for preventing peri-intubation hypotension was 1.6 (95% CI, 1.2-2.14) with the use of prophylactic phenylephrine while giving propofol versus no prophylactic vasopressors and 1.28 (95% CI 1.03-1.60) with the use of ephedrine. Conclusions: These findings suggest that in patients undergoing intubation in the operating room with propofol, prophylactic vasopressors given with induction for intubation decrease the odds of hypotension.

The benefit of Inhaled nitric oxide (iNO) therapy in the setting of COVID-19-related ARDS is obscure. We performed a multicenter retrospective study to evaluate the impact of iNO on patients with COVID-19 who require respiratory support. This retrospective multicenter study included COVID-19 patients enrolled in the SCCM VIRUS COVID-19 registry who were admitted to different Mayo Clinic sites between March 2020 and June 2022 and required high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation (IMV). Patients were included in the ‘spontaneously breathing’ group if they remained non-intubated or were initiated on an HFNC (± NIV) before intubation. Patients who got intubated without prior use of an HFNC (± NIV) were included in the ‘intubated group.’ They were further divided into categories based on their iNO usage. Propensity score matching (PSM) and inverse propensity of treatment weighting (IPTW) were performed to examine outcomes. Among 2767 patients included in our analysis, 1879 belonged to spontaneously breathing (153 received iNO), and 888 belonged to the intubated group (193 received iNO). There was a consistent improvement in FiO2 requirement, P/F ratio, and respiratory rate within 48 h of iNO use among both spontaneously breathing and intubated groups. However, there was no significant difference in intubation risk with iNO use among spontaneously breathing patients (PSM OR 1.08, CI 0.71–1.65; IPTW OR 1.10, CI 0.90–1.33). In a time-to-event analysis using Cox proportional hazard model, spontaneously breathing patients initiated on iNO had a lower hazard ratio of in-hospital mortality (PSM HR 0.49, CI 0.32–0.75, IPTW HR 0.40, 95

Diabetic ketoacidosis (DKA), hypertriglyceridemia, and acute pancreatitis are a rare and potentially fatal triad. This article presents a fatal case of acute pancreatitis, DKA, and hypertriglyceridemia in a patient with undiagnosed diabetes mellitus struggling with alcoholism. The patient was unresponsive to standard pancreatitis and DKA treatment protocol and progressed to develop multi-organ failure. Despite best efforts, the patient expired on day five of admission.

Bilothorax, an exudative pleural effusion due to the accumulation of bile. It is also called cholethorax or thoracobilia and was initially reported in 1971. Here, we report a rare case of an elderly male presenting with bilateral bilothorax due to esophageal rupture. A 78-year-old man with multiple medical ailments presented to the emergency room (ER) with a severe episode of vomiting accompanied by a popping sound, respiratory distress, and right sided chest pain. The patient had tachycardia, BP of 101/89 mm Hg, and tachypnea. Computed tomography scan of the chest and abdomen revealed air adjacent to the esophagus, suggesting perforation, atelectasis of right lung, and bilateral pleural effusion (R > L). However, an esophagram did not reveal any perforation. Right-sided chest tube drained dark green bilious fluid. The day after admission, he experienced hemodynamic compromise and hypoxemia requiring intubation, along with fluids and inotropes support. Diagnosis of bilateral bilothorax complicated by hypoxemic respiratory failure with septic shock was made. Cultures were drawn, and empiric antibiotics were started. Nuclear hepatobiliary scan (HIDA) was performed to rule out a hepatobiliary fistula. Results showed reflux activity in the stomach, and distal esophageal leak was identified. Gastrojejunal stenting was performed. However, after prolonged intubation, the family decided on terminal extubation, and he died while receiving hospice care. This case highlights the rarity of bilateral bilothorax, where the HIDA scan played a crucial role in identifying an esophageal leak as the underlying cause, despite normal esophagram results. This condition necessitates prompt diagnosis and aggressive therapeutic interventions.

REPORTreceived high dose melphalan conditioning followed by autologous HSCT.His initial posttransplant course was complicated by persistent tachycardia, diarrhea due to Clostridium difficile infection, pancytopenia, and fever with negative cultures.A chest CT scan on HSCT day 7 showed subpleural nodular consolidation within the periphery of the lower lobes and diffuse ground glass opacities with centrilobular components throughout the lungs, suggestive of an underlying infectious or inflammatory process.On HSCT day 11, he started developing increasing respiratory distress and desaturation despite noninvasive ventilation.His absolute neutrophil count had increased to 0.28 x 10 9 /L, which was indicative of engraftment.However, due to the concern for engraftment syndrome, filgrastim had to be discontinued. IntroductIonPulmonary complications following hematopoietic stem cell transplant (HSCT) are common, and the prognosis of patients who develop acute respiratory distress syndrome (ARDS) following HSCT is poor. 1 The use of venovenous extracorporeal membrane oxygenation (VV-ECMO) has been growing worldwide, with more centers being capable of providing this supportive treatment modality, and the indications have been expanding beyond the conventional use in ARDS in otherwise uncomplicated patients.Despite technological advances in the field of ECMO, its use as a salvage therapy for life-threatening cardiopulmonary complications related to HSCT remains controversial, mainly due to dismal survival rates, with adult patients having worse outcomes than children. 2 However, significant advancements in HSCT and immune effector cell therapy have led to increased survival leading to recommendations regarding ECMO candidacy in children with complications due to HSCT. 3 Yet, there have been few published case reports 4,5 regarding the use of ECMO in this population, and the decision to use ECMO in such situations continues to be challenging.Proceeding with ECMO as a rescue maneuver should be made on a case-by-case basis keeping in mind its risks and potential benefits.We present the case of an adult patient who required ECMO during the peri-engraftment period for severe hypoxic respiratory failure following an autologous stem cell transplant. case descrIptIonA 49-year-old male patient with a diagnosis of International Staging System III, high-risk (t4; 14) immunoglobulin A κ-myeloma after receiving four cycles of chemotherapy with daratumumabbortezomib-lenalidomide-dexamethasone + denosumab, 1-

PURPOSE: Laryngotracheal complications have been reported in prolonged laryngotracheal intubation, and the outcomes include failed extubation, stridor, or dysphonia after extubation.Initiation of an early tracheostomy can avoid such risks to some extent, although the evidence of such benefit in the COVID-19 population is inadequately described in the existing literature. METHODS:We performed a retrospective multi-center study on COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022 and underwent tracheostomy during the hospital stay.Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry and retrospective chart review.We used a cutoff of 7 days from the day of intubation to identify early tracheostomy.Information regarding post-intubation complications was collected from hospital discharge notes and ENT notes (consult notes and follow-up visit notes) and included but was not limited to subglottic stenosis, vocal cord edema, upper airway injury, and vocal paresis with dysphonia.The chi-square and independent sample t-test were used to compare the categorical and continuous variables. RESULTS:Our study cohort consisted of 226 patients, of which the majority were male (66.37%),Caucasian (67.25%), and non-Hispanic (79.64%).The cohort's median age was 57 years, and the median BMI was 31.4 kg/m2.Among 226 patients, 61 underwent early tracheostomy, and 165 underwent late tracheostomy.The median length of invasive mechanical ventilation via endotracheal tube before tracheostomy was 3 (1,6) days in the early-tracheostomy group and 15 (12,20) days in the latetracheostomy group.The median number of intubation events before tracheostomy was similar across the two groups (1 day in both groups).The overall incidence of post-intubation complication in our cohort was 3.09% (7 out of 226 patients), with an incidence of 3.63% (6/165) in the late tracheostomy group and 1.63% (1/61) in the early tracheostomy group.However, the difference was not statistically significant between the two groups (p¼0.44).The most common type of complication was subglottic stenosis (4/7; 57.12%).Other complications were vocal cord edema, upper airway (oropharyngeal) injury, and vocal paresis with dysphonia.CONCLUSIONS: Our study found no statistically significant difference in post-intubation complications between hospitalized COVID-19 patients who underwent early or late tracheostomy.However, due to the low incidence, further large-scale studies are warranted to confirm these findings.CLINICAL IMPLICATIONS: Identifying post-intubation laryngotracheal complications is of great importance during the patient's hospital stay and after discharge.Reduction of such risk through an early tracheostomy, if supported by evidence, will positively influence patient outcomes and healthcare burden.

SESSION TITLE: Critical Care Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: COVID-19-related acute respiratory distress syndrome (ARDS) is associated with profound hypoxia and changes in pulmonary hemodynamics. Inhaled nitric oxide (iNO) is a pulmonary vasodilator and has shown a beneficial role in improving oxygenation. Our study aimed to explore the effects of iNO on oxygenation quantitatively among intubated and non-intubated COVID-19 patients. METHODS: We performed a retrospective multi-center study on COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022. Patients were included for analysis if they were intubated during nitric oxide therapy initiation (post-intubation group) or remained non-intubated during the entire hospitalization (non-intubated group). Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry and retrospective chart review. Statistical analyses were performed using BlueSky statistics v10.2.1. RESULTS: Our study cohort included 281 patients, of which 197 were in the post-intubation group, and 84 were in the non-intubated cohort. The median age (IQR) of the cohort was 61 (47 - 68) years and median BMI was 31.2 (27.7 – 37.4) kg/m2, with the majority being males (67.9%) and Caucasians (75.08%). In the post-intubation cohort, the median starting dose of iNO was 21 ppm, and the median duration of iNO therapy was 4 days. Post 24hrs of iNO therapy, there was a 46.8% increase in PaO2/FiO2 (P/F) ratio (80 vs. 117.5, p<0.001), 35% decrease in FiO2 requirement (100% vs. 65%, p<0.001), and 9% decrease in respiratory rate (24 vs. 22, p=0.003). After 48 hrs of iNO therapy, there was a 59.3% increase in P/F ratio (80 vs. 127.5, p<0.001), 50% decrease in FiO2 requirement, and 16.7% decrease in respiratory rate (24 vs. 20, p<0.001). There was no change in PEEP requirements during this period. In the non-intubated patient cohort, the median starting dose of iNO was 20 ppm, and the median duration of therapy was four days. There was a 21.1% increase in ratio of oxygen saturation (ROX) (4.45 vs. 5.39, p<0.001) and a 20% decrease in FiO2 requirement (100% vs. 80%, p<0.001) after 24 hours of iNO therapy, but no statistically significant change in respiratory rate and P/F ratio. Similarly, after 48 hours of iNO therapy, there was a 26.9% increase in ROX (4.45 vs. 5.65, p<0.001), a 30% decrease in FiO2 requirement (100% vs. 70%, p<0.001), and an 8.4% decrease in respiratory rate (22 vs. 20/min, p=0.001), without any statistically significant change in P/F ratio. CONCLUSIONS: Our study showed significant improvement in oxygenation indices with inhaled nitric oxide therapy in hospitalized COVID-19 patients in both intubated and non-intubated patients. CLINICAL IMPLICATIONS: Considering its ability to improve oxygenation indices, reduce fractional oxygen requirements and decrease work of breathing by lowering the respiratory rate in hypoxic COVID-19 patients, inhaled nitric oxide therapy should be considered in eligible intubated and non-intubated patients. DISCLOSURES: No relevant relationships by Prasanth Balasubramanian No relevant relationships by Arvind Balavenkataraman No relevant relationships by Vikas Bansal No relevant relationships by Anirban Bhattacharyya No relevant relationships by Sanjay Chaudhary No relevant relationships by Ricardo Diaz Milian No relevant relationships by Pramod Guru No relevant relationships by Abby Hanson No relevant relationships by Shahin Isha No relevant relationships by Anna Jenkins No relevant relationships by Sadhana Jonna No relevant relationships by Rahul Kashyap No relevant relationships by Subekshya Khadka No relevant relationships by Syed Khan No relevant relationships by Sean Kiley No relevant relationships by Pablo Moreno Franco No relevant relationships by Neal Patel No relevant relationships by Quintin Quinones No relevant relationships by Devang Sanghavi No relevant relationships by PARTHKUMAR SATASHIA No relevant relationships by Anna Shapiro No relevant relationships by Jorge Sinclair De Frías No relevant relationships by Aysun Tekin No relevant relationships by Ananya Vasudhar

PURPOSE: Current evidence has suggested that early mobilization helps improve physical, cognitive, and functional outcomes.While it is challenging to ensure mobility in intubated and mechanically ventilated patients on sedation, the use of tracheostomy often facilitates mobilization at an earlier stage.We aim to explore the effects of early tracheostomy on sedative-analgesic use and mobility scores in mechanically ventilated COVID-19 patients. METHODS:We performed a retrospective multi-center study on COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022.Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry, automated data pull by Mayo Data Explorer and retrospective chart review.We used a cutoff of 7 days from the day of intubation to identify early tracheostomy.We selected the BMS value closest to the tracheostomy date as pretracheostomy BMS, the latest BMS value within 14 days as immediate post-tracheostomy BMS, and the highest BMS before discharge as maximum post-tracheostomy BMS.Statistical analysis was performed on BlueSky 10.2.1.The chi-square test and Wilcoxon tests (independent sample and paired sample) were used to compare the categorical and continuous variables, respectively. RESULTS:Our study cohort consisted of 226 patients, of which the majority were male (66.37%),Caucasian (67.25%), and non-Hispanic (79.64%).The cohort's median age was 57 years, and the median BMI was 31.4 kg/m 2 .Out of 226 patients, 61 patients underwent early tracheostomy (#7 days of intubation), and 165 underwent late tracheostomy (>7 days).Our analysis showed that the maximum post-tracheostomy BMS before discharge was higher among the early tracheostomy group (median 38.32 vs. 28.13,p¼0.005), with no difference in pre-tracheostomy BMS and immediate post-tracheostomy BMS (within 14 days) between the groups.The median day when pre-tracheostomy BMS (3 vs 4 days prior, p¼1.00) and maximum post-tracheostomy BMS (23 vs. 20 days, p¼0.41) were collected were similar across the two groups.It was also noted that the early tracheostomy group had a shorter median duration of treatment with propofol (10 vs. 15 days, p¼0.01) and fentanyl (9 vs. 15 days, p<0.001) over the entire hospitalization.The total duration of treatment with ketamine, midazolam, and hydromorphone did not vary between the two groups.CONCLUSIONS: Our findings suggest that early tracheostomy in mechanically ventilated COVID-19 patients is associated with lower sedative analgesic use and better mobilization during hospitalization.CLINICAL IMPLICATIONS: While COVID-19 has posed certain challenges from resource perspective, our findings indicate that adopting an early tracheostomy strategy can confer positive changes in patient mobility and disposition.A reduced sedative medication dosing can also help in cognitive and mental improvement, thus promoting positive hospitalization outcomes.

PURPOSE:Acute hypercapnic respiratory failure is a life-threatening complication of diseases such as chronic obstructive pulmonary disease, obesity hypoventilation, and neuromuscular disease.It is characterized by an elevated carbon dioxide level in arterial blood (PaCO2) with an associated decrease in blood pH.The use of non-invasive ventilation is an effective treatment method which improves mortality and decreases the need for intubation.Bilevel positive airway pressure ventilation (BiPAP) was first used in this situation, where the controlled variable is inspiratory and expiratory pressure.An alternative method is average volume assured pressure support (AVAPS), where the controlled variable is tidal volume.This meta-analysis aimed to compare the efficacy of these methods in treating acute hypercapnic respiratory failure.METHODS: Randomized controlled trials, along with retrospective or prospective cohort studies were included in the search.The terms "acute hypercapnic respiratory failure", "BiPAP", and "AVAPS" were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases.The primary outcome was change in PaCO2 at 3 hours or less.Two investigators independently reviewed the final literature search and extracted data. RESULTS:Five studies were identified as eligible to be included in the final analysis with a total of 434 patients, 211 and 223 who received BiPAP and AVAPS respectively.In patients receiving BiPAP the mean PaCO2 reduction was 6.17 mmHg and 8.09 mmHg in patients receiving AVAPS.Compared to BiPAP, the use of AVAPS demonstrated a significantly larger decrease in PaCO2 at 3 hours, standard difference -0.26 (95% CI; -0.50 to -0.02, p¼0.038).There was no difference in risk of intubation (p¼0.18).CONCLUSIONS: These findings suggest that AVAPS is more efficient than BiPAP in reducing PaCO2 in the setting of acute hypercapnic respiratory failure.CLINICAL IMPLICATIONS: Further analysis will need to be performed to assess whether this effect has an impact on hospital length of stay and mortality.

PURPOSE:Outcomes associated with early tracheostomy in critically ill patients have been discussed in existing literature, although the findings are often conflicting, with a dearth of literature based on a large sample size in COVID-19 patient population.Our study aims at evaluating the hospitalization outcomes associated with early tracheostomy in mechanically ventilated COVID-19 patients. METHODS:We performed a retrospective multi-center study on COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022.Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry by automated data pull and retrospective chart review.We used a cutoff of 7 days from the day of intubation to identify early tracheostomy.Statistical analysis was performed on BlueSky v10.2.1.The chi-square test and independent sample Wilcoxon tests were used to compare the categorical and continuous variables, respectively.RESULTS: Our overall cohort included 226 COVID-19 patients who underwent tracheostomy during the hospital stay, with 61 of them in the early tracheostomy group and 165 in the late tracheostomy group.The Median age of the cohort was 57 years (IQR 47-66) and median BMI was 31.4 kg/m2 (IQR 27.6 -38.1).The majority were males (66.37%),Caucasian (67.25%) and non-Hispanic (79.64%).There was no difference in the distribution of age, gender, BMI, ethnicity, comorbidities (diabetes, hypertensions, CAD, CKD, chronic lung or liver disease, hyperlipidemia) between the early and late tracheostomy group.However, the late tracheostomy group were more likely to be Caucasians (70.30% vs 59.01%, p¼0.03) and less likely to be south Asians (0.60% vs 8.1%, p¼0.03).The median length of ventilation prior to tracheostomy placement were 3 days and 15 days, respectively, in the two groups.Our analysis showed that the median length of invasive mechanical ventilation was shorter with early tracheostomy (22.9 days vs 28 days, p¼0.03).However, there was no difference in mortality rates, ICU length of stay, hospital length of stay, and ECMO duration between the early and late tracheostomy groups.The incidence of positive respiratory culture (39.65% vs 49.04%, p¼0.22) and positive blood culture (20.0% vs 27.7%, p¼0.26) during the hospitalization did not vary between the two groups as well.CONCLUSIONS: Our study showed hospitalized COVID-19 patients had patients who underwent early tracheostomy had a shorter length of invasive mechanical ventilation.However, there was no difference in other hospital outcomes.CLINICAL IMPLICATIONS: Decrease in ventilator days with early tracheostomy may not only leave have a positive impact by reducing prolonged ventilation-associated complications, but also represent improve resource utilization an important improvement given the limited resources during the pandemic.

Introduction: To translate the EORTC QLQ STO-22 for assessment of quality of life of gastric cancer patients in Nepalese language and conduct pilot study of this translation for adapting it to use in Nepalese speaking population. Methods: In the process of translation, we followed the forward-backward translation process according to guidelines recommended by EORTC. Draft version was then pilot tested in a sample of 10 gastric cancer patients. Results: All steps of the EORTC translation guideline were followed successfully. Ten gastric cancer patients were included in the pilot study. Structured interview was conducted with each patient to get feedback on each translated question. Final translated version was created after the pilot study and was approved by EORTC. Conclusion: The Nepalese version of EORTC QLQ STO-22 is a result of a successfully conducted translation procedure. It shows good reliability and is acceptable to Nepalese patients. Further uses in clinical trials and practice will allow for confirmation of its psychometric property.

PURPOSE: Inhaled nitric oxide (iNO), a pulmonary vasodilator, has demonstrated beneficial effects in improving oxygenation among the ARDS population.However, the data regarding the extent to which the drug impacts hospital outcomes is conflicting.Our study explores nitric oxide therapy's effects based upon its initiation time. METHODS:We performed a retrospective multi-center study analyzing COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022 who received iNO and were intubated during the same stay.Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry by automated data pull and retrospective chart review.Patients who received nitric oxide prior to intubation were included in the pre-intubation group and those who were initiated on nitric oxide while intubated, were included in the post-intubation group. RESULTS:Our study cohort consisted of 266 COVID-19 patients, of whom 69 were in the pre-intubation group, and 197 belonged to the post-intubation group.The median age of the cohort was 61 years (47.2, 68.0) with the majority being male (64.2%),Caucasian (71.8%) and non-Hispanic (83.08%).iNO was initiated at a median of 4 days prior to intubation in the preintubation group and on intubation day 1 in the post-intubation groups.The two groups did not differ in the distribution of race, ethnicity, BMI, COVID-19 vaccination, coronary artery disease, or chronic kidney disease.Patients in the pre-intubation group were older (65 vs. 59 years, p<0.001) and had a longer duration of iNO therapy (12 vs. 4 days, p<0.001).They also had a higher prevalence of hypertension (50.72% vs. 33.50%,p¼0.01), diabetes mellitus (31.88% vs. 18.27%, p¼0.01), and hyperlipidemia (37.68% vs. 19.28%,p¼0.002).There was no difference in the ratio of oxygen saturation (ROX) index at admission between the two groups.However, the ROX index was lower in the pre-intubation group prior to, 24 hours after, and 48 hours after iNO initiation (all p<0.01).Pre-intubation group had a shorter length of mechanical ventilation (11.5 vs. 15.9 days, p¼0.007).However, the two groups had no difference in in-hospital mortality rate, hospital LOS, ICU LOS, ECMO, and CRRT requirement.CONCLUSIONS: Initiation of inhaled nitric oxide therapy before intubation was associated with a shorter length of invasive mechanical ventilation.CLINICAL IMPLICATIONS: Pre-intubation inhaled nitric oxide therapy appears to be a safe option for hypoxic COVID-19 patients, with outcomes comparable to post-intubation use.While our study showed its potential role in reducing the length of ventilation with pre-intubation use, further large-scale prospective trials are the need of the hour.

Ventilator-associated pneumonia (VAP) has significant effects on patient outcomes, including prolonging the duration of both mechanical ventilation and stay in the intensive care unit (ICU). The aim of this study was to assess the association between non-invasive ventilation/oxygenation (NIVO) prior to intubation and the rate of subsequent VAP. This was a multicenter retrospective cohort study of adult patients who were admitted to the medical ICU from three tertiary care academic centers in three distinct regions. NIVO was defined as continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or high-flow nasal cannula (HFNC) for any duration during the hospitalization prior to intubation. The primary outcome variable was VAP association with NIVO. A total of 17,302 patients were included. VAP developed in 2.6% of the patients (444/17,302), 2.3% (285/12,518) of patients among those who did not have NIVO, 1.6% (30/1879) of patients who had CPAP, 2.5% (17/690) of patients who had HFNC, 8.1% (16/197) of patients who had BiPAP, and 4.8% (96/2018) of patients who had a combination of NIVO types. Compared to those who did not have NIVO, VAP was more likely to develop among those who had BiPAP (adj OR 3.11, 95% CI 1.80–5.37, p < 0.001) or a combination of NIVO types (adj OR 1.91, 95% CI 1.49–2.44, p < 0.001) after adjusting for patient demographics and comorbidities. The use of BiPAP or a combination of NIVO types significantly increases the odds of developing VAP once receiving IMV.