Mechanical Ventilation Outcomes in Patients With Pulmonary Hypertension in the United States: A National Retrospective Cohort Analysis.
OBJECTIVE
The outcome of patients with pulmonary arterial hypertension (PAH) who undergo mechanical ventilation is not well known.


METHODS
The Nationwide Inpatient Sample for 2006 to 2012 was used to isolate patients with a diagnosis of PAH who also underwent invasive (MV) and noninvasive (NIMV) mechanical ventilation. The primary outcome was in-hospital mortality.


RESULTS
The hospital records of 55 208 382 patients were studied, and there were 21 070 patients with PAH, of whom 1646 (7.8%) received MV and 834 (4.0%) received NIMV. Those receiving MV had higher mortality (39.1% vs 12.6%, P < .001) and longer hospital stays (11.9 days, interquartile range [IQR] 6.1-22.2 vs 6.7 days, IQR 3.4-11.9, P < .001) than those undergoing NIMV. Of the patients treated with MV, 4.4% also used home oxygen therapy and had similar overall mortality to those who did not use home oxygen (35.3% vs 39.1%, P = .46). Similarly, there was no relationship between home oxygen use and mortality in patients treated with NIMV (10.6% vs 12.6%, P = .48). Notably, more patients treated with NIMV used home oxygen than those treated with MV (14.4% vs 4.4%, P < .001).


CONCLUSIONS
Patients with PAH who undergo invasive mechanical ventilation have an in-hospital mortality of 39.1%. Future work may help identify the types of patients who benefit most from advanced respiratory support in a critical care setting.
1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.|2 Harvard T.H. Chan School of Public Health, Harvard University, MA, USA.
Barret
B
Rush
3 Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Bradly J
BJ
Biagioni
1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.|4 Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Landon
L
Berger
1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.|5 Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Robert
R
McDermid
D000368:Aged; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000401:mortality; D063868:Patient Outcome Assessment; D012121:Respiration, Artificial / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
ICU outcomes; United States; mechanical ventilation; pulmonary hypertension