title: Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study.
abstract: BACKGROUND
  Although evidence supporting use of noninvasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD) is strong, evidence varies widely for other causes of acute respiratory failure.
  
  
  OBJECTIVE
  To compare utilization trends and outcomes associated with NIV in patients with and without COPD.
  
  
  METHODS
  We identified 11,659,668 cases of acute respiratory failure from the Nationwide Inpatient Sample during years 2000 to 2009 and compared NIV utilization trends and failure rates for cases with or without a diagnosis of COPD.
  
  
  RESULTS
  The proportion of patients with COPD who received NIV increased from 3.5% in 2000 to 12.3% in 2009 (250% increase), and the proportion of patients without COPD who received NIV increased from 1.2% in 2000 to 6.0% in 2009 (400% increase). The rate of increase in the use of NIV was significantly greater for patients without COPD (18.1% annual change) than for patients with COPD (14.3% annual change; P = 0.02). Patients without COPD were more likely to have failure of NIV requiring endotracheal intubation (adjusted odds ratio, 1.19; 95% confidence interval, 1.15-1.22; P < 0.0001). Patients in whom NIV failed had higher hospital mortality than patients receiving mechanical ventilation without a preceding trial of NIV (adjusted odds ratio, 1.14; 95% confidence interval, 1.11-1.17; P < 0.0001).
  
  
  CONCLUSIONS
  The use of NIV during acute respiratory failure has increased at a similar rate for all diagnoses, regardless of supporting evidence. However, NIV is more likely to fail in patients without COPD, and NIV failure is associated with increased mortality.
authors.affiliation: Boston University School of Medicine, The Pulmonary Center, R-304, 715 Albany Street, Boston, MA 02118, USA. alwalkey@bu.edu
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D017063:Outcome Assessment, Health Care; D011175:Positive-Pressure Respiration / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014600:Utilization Review