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Comparative Effectiveness of Noninvasive Ventilation vs Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Patients With Acute Respiratory Failure
Author(s) -
Tsai ChuLin,
Lee WenYa,
Delclos George L.,
Hanania Nicola A.,
Camargo Carlos A.
Publication year - 2013
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2014
Subject(s) - medicine , emergency department , mechanical ventilation , acute exacerbation of chronic obstructive pulmonary disease , emergency medicine , exacerbation , confidence interval , retrospective cohort study , copd , respiratory failure , pneumothorax , hospital medicine , intensive care medicine , surgery , psychiatry
BACKGROUND Limited evidence exists on the comparative effectiveness of noninvasive ventilation ( NIV ) vs invasive mechanical ventilation ( IMV ) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) patients with respiratory failure. OBJECTIVES To characterize the use of NIV and IMV , and to compare the effectiveness of NIV vs IMV in AECOPD . DESIGN AND PATIENTS Retrospective cohort study using data from the 2006–2008 Nationwide Emergency Department Sample. Emergency department visits for AECOPD with acute respiratory failure were identified with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. MEASURES The outcome measures were inpatient mortality, hospital length of stay, hospital charges, and complications. RESULTS There were an estimated 101,000 visits annually for AECOPD with acute respiratory failure; 96% were admitted to the hospital. Of these, NIV use increased from 14% in 2006 to 16% in 2008 ( P =0.049). Use of NIV, however, varied widely between hospitals, ranging from 0% to 100% with a median of 11%. Noninvasive ventilation was more often used in higher–case volume, Northeastern hospitals. In a propensity score analysis, NIV use, compared with IMV, was associated with lower inpatient mortality (risk ratio: 0.54, 95% confidence interval [CI]: 0.50‐0.59), shortened hospital length of stay (−3.2 days; 95% CI: −3.4 to −2.9 days), lower hospital charges (−$35,012; 95% CI: −$36,848 to −$33,176), and lower risk of iatrogenic pneumothorax (0.05% vs 0.5%, P <0.001). CONCLUSIONS Although NIV use is increasing in US hospitals, its adoption remains low and varies widely between hospitals. Our observational study suggests NIV appears to be more effective and safer than IMV for AECOPD in the real‐world setting. Journal of Hospital Medicine 2013;8:165–172. © 2013 Society of Hospital Medicine