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- Title
Noninvasive Ventilation Use in Critically Ill Patients with Acute Asthma Exacerbations.
- Authors
Althoff, Meghan D.; Holguin, Fernando; Fan Yang; Grunwald, Gary K.; Moss, Marc; Vandivier, R. William; Ho, P. Michael; Kiser, Tyree H.; Burnham, Ellen L.; Yang, Fan
- Abstract
Rationale: Noninvasive ventilation decreases the need for invasive mechanical ventilation and mortality among patients with chronic obstructive pulmonary disease but has not been well studied in asthma.Objectives: To assess the association between noninvasive ventilation and subsequent need for invasive mechanical ventilation and in-hospital mortality among patients admitted with asthma exacerbation to the ICU.Methods: We performed a retrospective cohort study using administrative data collected during 2010-2017 from 682 hospitals in the United States. Outcomes included receipt of invasive mechanical ventilation and in-hospital mortality. Generalized estimating equations, propensity-matched models, and marginal structural models were used to assess the association between noninvasive ventilation and outcomes.Measurements and Main Results: The study population included 53,654 participants with asthma exacerbation. During the study period, 13,540 patients received noninvasive ventilation (25.2%; 95% confidence interval [CI], 24.9-25.6%), 14,498 underwent invasive mechanical ventilation (27.0%; 95% CI, 26.7-27.4%), and 1,291 died (2.4%; 95% CI, 2.3-2.5%). Among those receiving noninvasive ventilation, 3,013 patients (22.3%; 95% CI, 21.6-23.0%) required invasive mechanical ventilation after first receiving noninvasive ventilation, 136 of whom died (4.5%; 95% CI, 3.8-5.3%). Across all models, the use of noninvasive ventilation was associated with a lower odds of receiving invasive mechanical ventilation (adjusted generalized estimating equation odds ratio, 0.36; 95% CI, 0.32-0.40) and in-hospital mortality (odds ratio, 0.48; 95% CI 0.40-0.58). Those who received noninvasive ventilation before invasive mechanical ventilation were more likely to have comorbid pneumonia and severe sepsis.Conclusions: Noninvasive ventilation use during asthma exacerbation was associated with improved outcomes but should be used cautiously with acute comorbid conditions.
- Subjects
NONINVASIVE ventilation; CRITICALLY ill; ASTHMA; DISEASE exacerbation; OBSTRUCTIVE lung diseases; ASTHMA treatment; DISEASE progression; PNEUMONIA; RESPIRATORY insufficiency; RETROSPECTIVE studies; ARTIFICIAL respiration; HOSPITAL mortality; SEPSIS; CATASTROPHIC illness; CRITICAL care medicine; RESEARCH funding; TRACHEA intubation; LONGITUDINAL method; COMORBIDITY
- Publication
American Journal of Respiratory & Critical Care Medicine, 2020, Vol 202, Issue 11, p1520
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201910-2021OC