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2015 ; 147
(4
): 959-968
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Trends in mechanical ventilation among patients hospitalized with acute
exacerbations of COPD in the United States, 2001 to 2011
#MMPMID25375230
Stefan MS
; Shieh MS
; Pekow PS
; Hill N
; Rothberg MB
; Lindenauer PK
Chest
2015[Apr]; 147
(4
): 959-968
PMID25375230
show ga
BACKGROUND: The use of noninvasive ventilation (NIV) in acute exacerbation of
COPD has increased over time. However, little is known about patient factors
influencing its use in routine clinical practice. METHODS: This was a
retrospective cohort study of 723,560 hospitalizations for exacerbation of COPD
at 475 hospitals between 2001 and 2011. The primary study outcome was the initial
form of ventilation (NIV or invasive mechanical ventilation [IMV]). Hierarchical
generalized linear models were used to examine the trends in ventilation and
patient characteristics associated with receipt of NIV. RESULTS: After adjusting
for patient and hospital characteristics, initial NIV increased by 15.1% yearly
(from 5.9% to 14.8%), and initial IMV declined by 3.2% yearly (from 8.7% to
5.9%); annual exposure to any form of mechanical ventilation increased by 4.4%
(from 14.1% to 20.3%). Among case subjects treated with ventilation, those aged ?
85 years had a 22% higher odds of receiving NIV compared with those aged < 65
years, while blacks (OR, 0.86) and Hispanics (OR, 0.91) were less likely to be
treated with NIV than were whites. Cases with a high burden of comorbidities and
those with concomitant pneumonia had high rates of NIV failure and were more
likely to receive initial IMV. Use of NIV increased at a faster rate among the
admissions of the oldest patients relative to the youngest. CONCLUSIONS: The use
of NIV for COPD exacerbations has increased steadily, whereas IMV use has
declined. Several patient factors, including age, race, and comorbidities,
influenced the receipt of NIV. Further research is needed to identify the factors
driving these patterns.