Hospitals Patterns of Use of Noninvasive Ventilation in Patients with Asthma Exacerbation (Hospitals Use of Ventilation in Asthma)

Background

There is limited data on the use of noninvasive ventilation in patients with asthma exacerbation. The objective of this study was to characterize hospital patterns of noninvasive ventilation use in patients with asthma, and evaluate the association with the use of invasive mechanical ventilation and case-fatality rate.

Methods

Cross-sectional study using an electronic medical record dataset, which includes comprehensive pharmacy and laboratory results from 58 hospitals. Data on 13,558 patients admitted from 2009 to 2012 were analyzed. Initial noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) was defined as the first ventilation method during hospitalization.Hospital-level risk-standardized rates of noninvasive ventilation among all admissions with asthma were calculated using a hierarchical regression model. Hospitals were grouped into quartiles of noninvasive ventilation to compare the outcomes.

Results

Overall, 90.3% of patients with asthma were not ventilated, 4.0% were ventilated with noninvasive and 5.7% with invasive ventilation. Twenty-two (38%) hospitals did not use NIV for any included admissions. Hospital level adjusted NIV rates varied considerably; range: 0.4% to 33.1% (median: 5.2%). Hospitals in the highest quartile of NIV did not have lower IMV use (5.4% vs 5.7%) but did have a small but significantly shorter length of stay. Higher NIV rates were not associated with lower risk adjusted case-fatality rates.

Conclusions

Large variation exists in hospital use of noninvasive ventilation for patients with an acute exacerbation of asthma. Higher hospital rates of NIV use does not appear to be associated with lower invasive ventilation rates. These results indicate a need to understand contextual and organizational factors contributing to this variability.

from #Medicine via ola Kala on Inoreader http://ift.tt/1kwmDKw
via IFTTT