Evidence-based Utilization of Noninvasive Ventilation and Patient Outcomes
Evidence-based Utilization of Noninvasive Ventilation and Patient Outcomes
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DOI：
10.1513/annalsats.201703-208oc
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发表时间：
2017-11-01
影响因子：
8.3
通讯作者：
Walkey, Allan J.
中科院分区：
文献类型：
--
作者：
Mehta, Anuj B.;Douglas, Ivor S.;Walkey, Allan J.
基本原理：强有力的证据支持对慢性阻塞性肺疾病和心力衰竭引起的呼吸窘迫患者使用无创通气（NIV）（强有力的证据条件[SEC]）。尽管NIV对其他急性呼吸衰竭原因的益处尚不清楚，但在证据较弱的情况下使用NIV的情况正在增加，尽管有证据表明NIV失败患者的死亡率较高（从NIV到有创机械通气[IMV]的进展）与最初使用IMV治疗的比较。目的：确定医院在循证使用NIV方面的差异与患者结局的相关性。方法：使用2011年加州州住院患者数据库，我们确定了接受NIV的成年患者。如果患者患有慢性阻塞性肺疾病急性加重或心力衰竭，则认为其患有NIV的SEC。我们使用多变量分层逻辑回归来确定医院使用NIV治疗SEC的比率与患者NIV失败风险（NIV后需要IMV）之间的相关性。结果：在22，706例以NIV作为初始治疗策略的住院患者中，6，820例（30.0%）有SEC。SEC患者NIV失败的风险低于证据不足的患者（8.1%对18.2%，P
Rationale: Strong evidence supports use of noninvasive ventilation (NIV) for patients with respiratory distress from chronic obstructive pulmonary disease and heart failure (strong evidence conditions [SECs]). Despite unclear benefits of NIV for other causes of acute respiratory failure, utilization for conditions with weaker evidence is increasing, despite evidence demonstrating higher mortality for patients who suffer NIV failure (progression from NIV to invasive mechanical ventilation [IMV])) compared with being treated initially with IMV.Objectives: To determine the association of hospital variation in evidence-based utilization of NIV with patient outcomes.Methods: Using the California State Inpatient Database 2011, we identified adult patients who received NIV. Patients were considered to have an SEC for NIV if they had an acute exacerbation of chronic obstructive pulmonary disease or heart failure. We used multivariable hierarchical logistic regression to determine the association between hospital rates of NIV use for SECs and patient risk of NIV failure (need for IMV after NIV).Results: Among 22,706 hospitalizations with NIV as the initial ventilatory strategy, 6,820 (30.0%) had SECs. Patients with SECs had lower risk of NIV failure than patients with weak evidence conditions (8.1 vs. 18.2%, P