title: Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010.
abstract: BACKGROUND
  Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).
  
  
  METHODS
  A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.
  
  
  RESULTS
  We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially.
  
  
  CONCLUSIONS
  The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.
authors.affiliation: Unidad Docente de Medicina Preventiva y Salud Pública de la Región de Murcia, España. bienvenida.carpe@carm.es
authors.forename: Bienvenida
authors.initials: B
authors.lastname: Carpe-Carpe
authors.forename: Lauro
authors.initials: L
authors.lastname: Hernando-Arizaleta
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Ibáñez-Pérez
authors.forename: Joaquín A
authors.initials: JA
authors.lastname: Palomar-Rodríguez
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Esquinas-Rodríguez
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data / Q000639:trends*; D010351:Patient Discharge / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D017678:Sex Distribution; D013030:Spain; D055815:Young Adult
keywords: Biomedical technology assessment; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Evaluación de tecnología biomédica; Positive pressure respiration; Respiración con presión positiva