title: Comparative effectiveness of noninvasive ventilation vs invasive mechanical ventilation in chronic obstructive pulmonary disease patients with acute respiratory failure.
abstract: BACKGROUND
  Limited evidence exists on the comparative effectiveness of noninvasive ventilation (NIV) vs invasive mechanical ventilation (IMV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure.
  
  
  OBJECTIVE
  To characterize the use of NIV and IMV, and to compare the effectiveness of NIV vs IMV in AECOPD.
  
  
  METHODS
  Retrospective cohort study using data from the 2006-2008 Nationwide Emergency Department Sample. Emergency department visits for AECOPD with acute respiratory failure were identified with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.
  
  
  METHODS
  The outcome measures were inpatient mortality, hospital length of stay, hospital charges, and complications.
  
  
  RESULTS
  There were an estimated 101,000 visits annually for AECOPD with acute respiratory failure; 96% were admitted to the hospital. Of these, NIV use increased from 14% in 2006 to 16% in 2008 (P=0.049). Use of NIV, however, varied widely between hospitals, ranging from 0% to 100% with a median of 11%. Noninvasive ventilation was more often used in higher-case volume, Northeastern hospitals. In a propensity score analysis, NIV use, compared with IMV, was associated with lower inpatient mortality (risk ratio: 0.54, 95% confidence interval [CI]: 0.50-0.59), shortened hospital length of stay (-3.2 days; 95% CI: -3.4 to -2.9 days), lower hospital charges (-$35,012; 95% CI: -$36,848 to -$33,176), and lower risk of iatrogenic pneumothorax (0.05% vs 0.5%, P<0.001).
  
  
  CONCLUSIONS
  Although NIV use is increasing in US hospitals, its adoption remains low and varies widely between hospitals. Our observational study suggests NIV appears to be more effective and safer than IMV for AECOPD in the real-world setting.
authors: Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA. cltsai@post.harvard.edu
authors: Chu-Lin
authors: CL
authors: Tsai
authors: Wen-Ya
authors: WY
authors: Lee
authors: George L
authors: GL
authors: Delclos
authors: Nicola A
authors: NA
authors: Hanania
authors: Carlos A
authors: CA
authors: Camargo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods / Q000639:trends; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome