Noninvasive Ventilation Use in Critically Ill Patients with Acute Asthma Exacerbations

被引:38
|
作者
Althoff, Meghan D. [1 ]
Holguin, Fernando [1 ]
Yang, Fan [2 ]
Grunwald, Gary K. [2 ]
Moss, Marc [1 ]
Vandivier, R. William [1 ]
Ho, P. Michael [3 ,4 ]
Kiser, Tyree H. [5 ]
Burnham, Ellen L. [1 ]
机构
[1] Univ Colorado, Div Pulm Sci & Crit Care Med, Aurora, CO 80045 USA
[2] Colorado Sch Publ Hlth, Dept Biostat & Informat, Aurora, CO USA
[3] Univ Colorado, Div Cardiol, Sch Med, Aurora, CO 80045 USA
[4] VA Eastern Colorado Hlth Care Syst, Div Cardiol, Aurora, CO USA
[5] Univ Colorado, Dept Clin Pharm, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO 80045 USA
关键词
continuous positive airway pressure; critical care outcomes; respiratory insufficiency; retrospective studies; mechanical ventilators; OBSTRUCTIVE PULMONARY-DISEASE; CLASSIFICATION-OF-DISEASES; ACUTE RESPIRATORY-FAILURE; POSITIVE AIRWAY PRESSURE; UNITED-STATES; MECHANICAL VENTILATION; CONTROLLED-TRIAL; OUTCOMES; EPIDEMIOLOGY; CODES;
D O I
10.1164/rccm.201910-2021OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Noninvasive ventilation decreases the need for invasive mechanical ventilation and mortality among patients with chronic obstructive pulmonary disease but has not been well studied in asthma. Objectives: To assess the association between noninvasive ventilation and subsequent need for invasive mechanical ventilation and in-hospital mortality among patients admitted with asthma exacerbation to the ICU. Methods: We performed a retrospective cohort study using administrative data collected during 2010-2017 from 682 hospitals in the United States. Outcomes included receipt of invasive mechanical ventilation and in-hospital mortality. Generalized estimating equations, propensity-matched models, and marginal structural models were used to assess the association between noninvasive ventilation and outcomes. Measurements and Main Results: The study population included 53,654 participants with asthma exacerbation. During the study period, 13,540 patients received noninvasive ventilation (25.2%; 95% confidence interval [CI], 24.9-25.6%), 14,498 underwent invasive mechanical ventilation (27.0%; 95% CI, 26.7-27.4%), and 1,291 died (2.4%; 95% CI, 2.3-2.5%). Among those receiving noninvasive ventilation, 3,013 patients (22.3%; 95% CI, 21.6-23.0%) required invasive mechanical ventilation after first receiving noninvasive ventilation, 136 of whom died (4.5%; 95% CI, 3.8-5.3%). Across all models, the use of noninvasive ventilation was associated with a lower odds of receiving invasive mechanical ventilation (adjusted generalized estimating equation odds ratio, 0.36; 95% CI, 0.32-0.40) and in-hospital mortality (odds ratio, 0.48; 95% CI 0.40-0.58). Those who received noninvasive ventilation before invasive mechanical ventilation were more likely to have comorbid pneumonia and severe sepsis. Conclusions: Noninvasive ventilation use during asthma exacerbation was associated with improved outcomes but should be used cautiously with acute comorbid conditions.
引用
收藏
页码:1520 / 1530
页数:11
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