title: Trends in Prevalence and Prognosis in Subjects With Acute Chronic Respiratory Failure Treated With Noninvasive and/or Invasive Ventilation.
abstract: BACKGROUND
  The pattern and outcome of noninvasive ventilation (NIV) use in patients with acute or chronic respiratory disease other than COPD is not well known. The aims of this study were to investigate trends over time in underlying respiratory diseases, use of NIV, and outcomes in COPD and non-COPD patients with acute respiratory failure.
  
  
  METHODS
  We made a retrospective analysis of data recorded prospectively from 1,113 subjects admitted between 1998 and 2012.
  
  
  RESULTS
  Subject diagnoses were distributed as follows: COPD, n=568 (51%); bilateral bronchiectasis, n=113 (10%); obesity, n=166 (15%); chronic diffuse interstitial lung disease, n=131 (12%); restrictive pulmonary disease, n=113 (10%); and asthma, n=22 (2%). The proportion of subjects with bilateral bronchiectasis significantly decreased (OR 0.91, 95% CI 0.865-0.951, P<.001), whereas the proportion of subjects with obesity increased (OR 1.03, 95% CI 1.001-1.063, P=.049) over time. The use of NIV (OR 1.05, 95% CI 1.010-1.090, P=.01) and the proportion of subjects initially treated with NIV (OR 1.05, 95% CI 1.013-1.094, P=.009) increased significantly in COPD subjects only. Time trend of mortality was not significant (OR 0.98, 95% CI 0.95-1.01, P=.23), whereas the severity of illness in subjects significantly increased. Transition from NIV to invasive mechanical ventilation (IMV) (OR 2.05, 95% CI 1.36-3.11, P=<.001), IMV (OR 10.49, 95% CI 4.88-10.56, P<.001) and diffuse interstitial lung disease (OR 10.63, 95% CI 5.43-20.83, P<.001) were independently associated with death in the ICU.
  
  
  CONCLUSIONS
  Over time, respiratory diseases have changed in non-COPD subjects and trends in the use and efficacy of NIV differ between COPD and non-COPD subjects. Mortality remained stable while the severity of illness in subjects increased. In COPD and non-COPD subjects, transition from NIV to IMV was associated with a poorer prognosis.
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit Institut National de la Santé et de la Recherche Médicale CIC-0203, Faculté de Médecine, Université Rennes I, Institut Formation Recherche 40 arnaud.gacouin@chu-rennes.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.affiliation: Centre Hospitalier Universitaire Rennes, Service de Pneumologie Institut de Recherche en Santé, Environnement et Travail 1085, Faculté de Pharmacie, Rennes, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Jouneau
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit.
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.affiliation: Université Rennes I, Faculté de Médecine, Biosit Centre Hospitalier Universitaire Rennes, Service de Pneumologie.
authors.forename: Mallory
authors.initials: M
authors.lastname: Kerjouan
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouju
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fillatre
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit Institut National de la Santé et de la Recherche Médicale CIC-0203, Faculté de Médecine, Université Rennes I, Institut Formation Recherche 40.
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.affiliation: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit Institut National de la Santé et de la Recherche Médicale CIC-0203, Faculté de Médecine, Université Rennes I, Institut Formation Recherche 40.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Tadié
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D001987:Bronchiectasis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data / Q000639:trends*; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data / Q000639:trends*; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: acute respiratory failure; bronchiectasis; chronic obstructive pulmonary disease; epidemiology; interstitial lung disease; mechanical ventilation; mortality; noninvasive ventilation