Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study

Abstract

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.

Figure 1.

Population incidence of mechanical ventilation and noninvasive ventilation utilization among patients with an acute respiratory failure diagnosis in the United States, 2000 to 2009. COPD = chronic obstructive pulmonary disease.

Figure 2.

(A) United States trends in ventilator practice patterns during acute respiratory failure hospitalizations among patients with chronic obstructive pulmonary disease, 2000 to 2009. (B) United States trends in ventilator practice patterns during acute respiratory failure hospitalizations among patients without a diagnosis of chronic obstructive pulmonary disease, 2000 to 2009.

Figure 3.

Changing etiologies of acute respiratory failure among patients receiving noninvasive ventilation, 2000 versus 2009.