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Original Research: Critical Care Medicine |

Trends in Mechanical Ventilation Among Patients Hospitalized With Acute Exacerbations of COPD in the United States, 2001 to 2011Mechanical Ventilation in COPD

Mihaela S. Stefan, MD; Meng-Shiou Shieh, PhD; Penelope S. Pekow, PhD; Nicholas Hill, MD, FCCP; Michael B. Rothberg, MD, MPH; Peter K. Lindenauer, MD
Author and Funding Information

From the Center for Quality of Care Research (Drs Stefan, Shieh, Pekow, and Lindenauer) and the Division of General Internal Medicine (Drs Stefan and Lindenauer), Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute (Drs Stefan and Lindenauer) and the Division of Pulmonary and Critical Care Medicine (Dr Hill), Tufts University School of Medicine (Drs Stefan and Lindenauer), Boston, MA; the Department of Biostatistics (Dr Pekow), University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA; and the Department of Medicine (Dr Rothberg), Medicine Institute, Cleveland Clinic, Cleveland, OH.

CORRESPONDENCE TO: Mihaela S. Stefan, MD, Department of Medicine, Baystate Medical Center, 756 Chestnut St, 2nd Fl, Springfield, MA 01199; e-mail: Mihaela.Stefan@bhs.org


FUNDING/SUPPORT: This research was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) [Grant 1R18HL108810-01]. Dr Stefan is supported by the NHLBI of the NIH [Grant 1K01HL114631-01A1].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(4):959-968. doi:10.1378/chest.14-1216
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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.

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