Utilization of mechanical ventilation for asthma exacerbations: analysis of a national database. Respir Care 2014 May;59(5):644-53
Date
10/10/2013Pubmed ID
24106317Pubmed Central ID
PMC4580276DOI
10.4187/respcare.02505Scopus ID
2-s2.0-84899740023 (requires institutional sign-in at Scopus site) 37 CitationsAbstract
BACKGROUND: The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown.
METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate 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 AEs increased by 15.8% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008, whereas NIV use increased from 0.34% to 1.9%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged.
CONCLUSIONS: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.
Author List
Nanchal R, Kumar G, Majumdar T, Taneja A, Patel J, Dagar G, Jacobs ER, Whittle JAuthors
Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of WisconsinJayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin
Amit Taneja MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Asthma
Databases, Factual
Disease Progression
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Noninvasive Ventilation
United States
Young Adult
