Utilization of mechanical ventilation for asthma exacerbations: Analysis of a national database

Rahul Nanchal, Gagan Kumar, Tillotama Majumdar, Amit Taneja, Jayshil Patel, Gaurav Dagar, Elizabeth R. Jacobs, Jeff Whittle

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

BACKGROUND: The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown. METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008. RESULTS: The number of AEs increased by 15.8% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008, whereas NIV use increased from 0.34% to 1.9%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged. CONCLUSIONS: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.

Original languageEnglish (US)
Pages (from-to)644-653
Number of pages10
JournalRespiratory Care
Volume59
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • Asthma
  • Intensive care unit
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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