Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study.
Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study.
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DOI：
10.1513/annalsats.201206-034oc
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发表时间：
2013-02-01
影响因子：
8.3
通讯作者：
Wiener, Renda Soylemez
中科院分区：
文献类型：
--
作者：
Walkey, Allan J;Wiener, Renda Soylemez
基本原理：虽然支持在慢性阻塞性肺疾病（COPD）急性加重期使用无创通气（NIV）的证据是强有力的，但其他原因导致的急性呼吸衰竭的证据差异很大。我们确认了11659人，从2000年至2009年的全国住院患者样本中收集了668例急性呼吸衰竭病例，并比较了诊断为或不诊断为急性呼吸衰竭的病例的NIV使用趋势和失败率。COPD：测量和主要结果：接受NIV的COPD患者比例从2000年的3.5%增加到2009年的12.3%（增加250%），接受NIV的非COPD患者比例从2000年的1.2%增加到2009年的6.0%（增加400%）。非COPD患者使用NIV的增加率（18.1%年变化）显著高于COPD患者（14.3%年变化; P = 0.02）。无COPD的患者更可能出现需要气管插管的NIV失败（校正比值比，1.19; 95%置信区间，1.15-1.22; P < 0.0001）。NIV失败的患者比接受机械通气但未进行NIV试验的患者有更高的住院死亡率（校正比值比，1.14; 95%置信区间，1.11-1.17; P < 0.0001）。结论：无论支持证据如何，急性呼吸衰竭期间NIV的使用率在所有诊断中均以相似的速度增加。然而，NIV在没有COPD的患者中更容易失败，并且NIV失败与死亡率增加相关。
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.