Utilization of Mechanical Ventilation for Asthma Exacerbations: Analysis of a National Database

作者：Nanchal Rahul^*; Kumar Gagan; Majumdar Tillotama; Taneja Amit; Patel Jayshil; Dagar Gaurav; Jacobs Elizabeth R; Whittle Jeff

来源：Respiratory Care, 2014, 59(5): 644-653.

DOI：10.4187/respcare.02505

• asthma
• mechanical ventilation
• intensive care unit

BACKGROUND: The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown. %26lt;br%26gt;METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008. %26lt;br%26gt;RESULTS: The number of AEs increased by 15.8% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008, whereas NW use increased from 0.34% to 1.9%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged. %26lt;br%26gt;CONCLUSIONS: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NW can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.

• 出版日期2014-5