Utilization Of Non-Invasive Ventilation In Patients With Acute Respiratory Failure From 2000-2009: A Population-Based Study

The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Annals of the American Thoracic Society 02/2013; 10(1):10-17. DOI: 10.1513/AnnalsATS.201206-034OC
Source: PubMed


Rationale: Although evidence supporting use of noninvasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD) is strong, evidence varies widely for other causes of acute respiratory failure. Objectives: To compare utilization trends and outcomes associated with NIV in patients with and without COPD. Methods: We identified 11,659,668 cases of acute respiratory failure from the Nationwide Inpatient Sample during years 2000 to 2009 and compared NIV utilization trends and failure rates for cases with or without a diagnosis of COPD. Measurements and Main Results: The proportion of patients with COPD who received NIV increased from 3.5% in 2000 to 12.3% in 2009 (250% increase), and the proportion of patients without COPD who received NIV increased from 1.2% in 2000 to 6.0% in 2009 (400% increase). The rate of increase in the use of NIV was significantly greater for patients without COPD (18.1% annual change) than for patients with COPD (14.3% annual change; P = 0.02). Patients without COPD were more likely to have failure of NIV requiring endotracheal intubation (adjusted odds ratio, 1.19; 95% confidence interval, 1.15-1.22; P < 0.0001). Patients in whom NIV failed had higher hospital mortality than patients receiving mechanical ventilation without a preceding trial of NIV (adjusted odds ratio, 1.14; 95% confidence interval, 1.11-1.17; P < 0.0001). Conclusion: The use of NIV during acute respiratory failure has increased at a similar rate for all diagnoses, regardless of supporting evidence. However, NIV is more likely to fail in patients without COPD, and NIV failure is associated with increased mortality.

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    ABSTRACT: Recent studies suggest that noninvasive positive pressure ventilation (NPPV) administered by nasal or oronasal mask avoids the need for endotracheal intubation, rapidly improves vital signs, gas exchange, and sense of dyspnea, and may reduce mortality in selected patients with acute respiratory failure, but few controlled trials have been done. The present study used a randomized prospective design to evaluate the possible benefits of NPPV plus standard therapy versus standard therapy alone in patients with acute respiratory failure. Patients to receive NPPV were comfortably fitted with a standard nasal mask connected to a BiPAP ventilatory assist device (Respironics, Inc., Murrysville, PA) in the patient flow-triggered/time-triggered (S/T) mode, and standard therapy consisted of all other treatments deemed necessary by the primary physician, including endotracheal intubation. The need for intubation was reduced from 73% in the standard therapy group (11 of 15 patients) to 31% in the NPPV group (5 of 16 patients, p < 0.05). Among chronic obstructive pulmonary disease (COPD) patients, the reduction was even more striking, with 8 of 12 (67%) control patients requiring intubation compared with 1 of 11 (9%) NPPV patients (p < 0.05). Heart and respiratory rates were significantly lower in the NPPV group than in control patients within 1 h, and PaO2 was significantly improved in the NPPV group for the first 6 h. Dyspnea scores and maximal inspiratory pressures were better in the NPPV than in control patients at 6 h, and nurses and therapists spent similar amounts of time at the bedside for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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