PURPOSE: The role of non invasive ventilation (NIMV) in acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to prevent intubations and use of invasive mechanical ventilation (IMV). We studied the trends of NIMV and IMV in patients admitted with COPD exacerbation.
METHODS: NIS database from 2000 to 2008 was used to examine the trends of IMV (96.7) and NIMV (93.90) in COPD exacerbation related hospitalizations in adults aged 18 and above. ICD-9-CM code 491.21 and 491.22 were used to identify COPD exacerbations. We excluded patients with asthma and interstitial lung disease. Survey commands in STATA were used to estimate frequency of the IMV and NIMV. Chi-square test was used to compare frequency and mortality in the two groups. α was set at 0.05.
RESULTS: A total of 8,337,876 hospital admissions were identified with COPD exacerbation in adults over 18 years of age in United States during 2000 to 2008 period. A total of 6.9% of patients underwent IMV in 2000 which was similar to the proportion undergoing IMV is 2008 (6.4%). However, the use of NIMV increased more than 3 times, from 1.3% in 2000 to 5.0% in 2008. All cause in hospital mortality for COPD exacerbation not requiring mechanical ventilation decreased from 3.1% in 2000 to 2.0% in 2008 (p<0.001). Similarly mortality for those requiring NIMV decreased from 11.6% in 2000 to 8.2% in 2008 (p<0.001). However, mortality in COPD exacerbations undergoing IMV was unchanged through the time period of our study and averaged about 22%.
CONCLUSIONS: We conclude that while the rates of non-invasive mechanical ventilation use in COPD exacerbation is increasing, the rates of invasive mechanical ventilation has not changed significantly. The mortality has remained similar for patients undergoing IMV but has proportionally decreased for NIMV.
CLINICAL IMPLICATIONS: There has been an increasing trend towards use of NIMV in COPD exacerbations.
DISCLOSURE: The following authors have nothing to disclose: Gagan Kumar, Gaurav Dagar, Nilay Kumar, Amit Taneja, Rahul Nanchal
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