Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011.
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.
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA. Electronic address: Mihaela.Stefan@bhs.org.
Mihaela S
MS
Stefan
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA.
Meng-Shiou
MS
Shieh
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Department of Biostatistics, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA.
Penelope S
PS
Pekow
Division of Pulmonary and Critical Care Medicine, Boston, MA.
Nicholas
N
Hill
Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH.
Michael B
MB
Rothberg
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA.
Peter K
PK
Lindenauer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012121:Respiration, Artificial / Q000639:trends*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology