Outcomes of Non-invasive Ventilation for Acute Exacerbations of COPD in the United States, 1998-2008.
Am J Respir Crit Care Med. 2011 Oct 20;
Authors: Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, Mannino D, Sciurba FC, Holguin F
RATIONALE: The patterns and outcomes of non-invasive positive-pressure ventilation (NIPPV) use in patients hospitalized for acute exacerbations of COPD nationwide are unknown. METHODS: We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, to assess the pattern and outcomes of NIPPV use for acute exacerbations of COPD during 1998-2008. RESULTS: An estimated 7,511,267 admissions for acute exacerbations occurred from 1998-2008. There was a 462% increase in NIPPV use (from 1.0% to 4.5% of all admissions), and a 42% decline in invasive mechanical ventilation (IMV) use (from 6.0% to 3.5% of all admissions) during these years. This was accompanied by an increase in the size of a small cohort of patients requiring transition from NIPPV to IMV. In-hospital mortality in this group appeared to be worsening over time. By 2008, these patients had a high mortality rate (29.3%) which represented 61% higher odds of death compared to patients directly placed on IMV (95% CI 24-109%), and 677% greater odds of death compared to patients treated with NIPPV alone (95% CI 475-948%). With the exception of patients transitioned from NIPPV to IMV, in-hospital outcomes were favorable and improved steadily year by year. CONCLUSIONS: The use of NIPPV has increased significantly over time among patients hospitalized for acute exacerbations of COPD, while the need for intubation and in-hospital mortality has declined. However, the rising mortality rate in a small but expanding group of patients requiring invasive mechanical ventilation after treatment with non-invasive ventilation needs further investigation.
PMID: 22016446 [PubMed - as supplied by publisher]