Comparative Effectiveness of Noninvasive Ventilation vs Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Patients With Acute Respiratory Failure

Abstract

BACKGROUNDLimited evidence exists on the comparative effectiveness of noninvasive ventilation (NIV) vs invasive mechanical ventilation (IMV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure.OBJECTIVESTo characterize the use of NIV and IMV, and to compare the effectiveness of NIV vs IMV in AECOPD.DESIGN AND PATIENTSRetrospective cohort study using data from the 2006–2008 Nationwide Emergency Department Sample. Emergency department visits for AECOPD with acute respiratory failure were identified with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.MEASURESThe outcome measures were inpatient mortality, hospital length of stay, hospital charges, and complications.RESULTSThere were an estimated 101,000 visits annually for AECOPD with acute respiratory failure; 96% were admitted to the hospital. Of these, NIV use increased from 14% in 2006 to 16% in 2008 (P=0.049). Use of NIV, however, varied widely between hospitals, ranging from 0% to 100% with a median of 11%. Noninvasive ventilation was more often used in higher–case volume, Northeastern hospitals. In a propensity score analysis, NIV use, compared with IMV, was associated with lower inpatient mortality (risk ratio: 0.54, 95% confidence interval [CI]: 0.50‐0.59), shortened hospital length of stay (−3.2 days; 95% CI: −3.4 to −2.9 days), lower hospital charges (−$35,012; 95% CI: −$36,848 to −$33,176), and lower risk of iatrogenic pneumothorax (0.05% vs 0.5%, P