Utilization of Mechanical Ventilation for Asthma Exacerbations -- Analysis of a National Database.
Respir Care. 2013 Oct 8;
Authors: Nanchal R, Kumar G, Majumdar T, Taneja A, Patel J, Dagar G, Jacobs ER, Whittle J, From the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators
BACKGROUND:: The current frequency of non-invasive (NIV) and invasive mechanical ventilation use in acute asthma exacerbations (AAE) and their relationship to outcomes is unknown.
METHODS:: We used the Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AAE. For each discharge we determined whether NIV or invasive mechanical ventilation was initiated during the first two hospital days. Using multivariable logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008.
RESULTS:: The number of AAE increased by 15.8% from 2000 to 2008. The proportion of admissions where invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008 while NIV increased from 0.34% to 1.9%. The adjusted mortality in AAE requiring NIV or invasive mechanical ventilation was unchanged through 2000 to 2008. LOS was also unchanged.
CONCLUSION:: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we cannot determine the clinical reasons for this increase, LOS and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AAE, before widespread adoption makes it impossible to conduct such a trial.
PMID: 24106317 [PubMed - as supplied by publisher]