Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically III Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

被引：69

作者：

Stefan, Mihaela S. ^{[1
,2
,3
,4
]}

Nathanson, Brian H. ^{[5
]}

Higgins, Thomas L. ^{[2
,6
]}

Steingrub, Jay S. ^{[2
,6
]}

Lagu, Tara ^{[1
,2
]}

Rothberg, Michael B. ^{[7
]}

Lindenauer, Peter K. ^{[1
,2
,3
,4
]}

机构：

[1] Baystate Med Ctr, Ctr Qual Care Res, Springfield, MA 01199 USA

[2] Baystate Med Ctr, Dept Gen Internal Med, Springfield, MA USA

[3] Tufts Clin & Translat Sci Inst, Boston, MA USA

[4] Tufts Univ, Sch Med, Boston, MA 02111 USA

[5] OptiStatim LLC, Longmeadow, MA USA

[6] Baystate Med Ctr, Div Pulm & Crit Care Med, Springfield, MA USA

[7] Cleveland Clin, Inst Med, Ctr Value Based Care Res, Cleveland, OH 44106 USA

来源：

CRITICAL CARE MEDICINE | 2015年 / 43卷 / 07期

基金：

美国国家卫生研究院;

关键词：

acute respiratory failure; chronic obstructive pulmonary disease; intensive care unit; invasive mechanical ventilation; noninvasive ventilation; Simplified Acute Physiology Score II; POSITIVE-PRESSURE VENTILATION; CONVENTIONAL MECHANICAL VENTILATION; RESPIRATORY-FAILURE; MORTALITY; TRIAL;

D O I：

10.1097/CCM.0000000000000945

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives:To compare the characteristics and hospital outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease treated in the ICU with initial noninvasive ventilation or invasive mechanical ventilation. Design:Retrospective, multicenter cohort study of prospectively collected data. We used propensity matching to compare the outcomes of patients treated with noninvasive ventilation to those treated with invasive mechanical ventilation. We also assessed predictors for noninvasive ventilation failure. Setting:Thirty-eight hospitals participating in the Acute Physiology and Chronic Health Evaluation database from 2008 through 2012. Subjects:A total of 3,520 patients with a diagnosis of chronic obstructive pulmonary disease exacerbation including 27.7% who received noninvasive ventilation and 45.5% who received invasive mechanical ventilation. Interventions:None. Measurements and Main Results: Noninvasive ventilation failure was recorded in 13.7% from patients ventilated noninvasively. Hospital mortality was 7.4% for patients treated with noninvasive ventilation; 16.1% for those treated with invasive mechanical ventilation; and 22.5% for those who failed noninvasive ventilation. In the propensity-matched analysis, patients initially treated with noninvasive ventilation had a 41% lower risk of death compared with those treated with invasive mechanical ventilation (relative risk, 0.59; 95% CI, 0.36-0.97). Factors that were independently associated with noninvasive ventilation failure were Simplified Acute Physiology Score II (relative risk = 1.04 per point increase; 95% CI, 1.03-1.04) and the presence of cancer (2.29; 95% CI, 0.96-5.45). Conclusions: Among critically ill adults with chronic obstructive pulmonary disease exacerbation, the receipt of noninvasive ventilation was associated with a lower risk of in-hospital mortality compared with that of invasive mechanical ventilation; noninvasive ventilation failure was associated with the worst outcomes. These results support the use of noninvasive ventilation as a first-line therapy in appropriately selected critically ill patients with chronic obstructive pulmonary disease while also highlighting the risks associated with noninvasive ventilation failure and the need to be cautious in the face of severe disease.

引用

页码：1386 / 1394

页数：9

共 26 条

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