Abstract
(1) Background: We examine trends (2001–2015) in the use of non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) among patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). (2) Methods: Observational retrospective epidemiological study, using the Spanish National Hospital Discharge Database. (3) Results: We included 1,431,935 hospitalizations (aged ≥40 years) with an AE-COPD. NIV use increased significantly, from 1.82% in 2001–2003 to 8.52% in 2013–2015, while IMV utilization decreased significantly, from 1.39% in 2001–2003 to 0.67% in 2013–2015. The use of NIV + invasive mechanical ventilation (IMV) rose significantly over time (from 0.17% to 0.42%). Despite the worsening of clinical profile of patients, length of stay decreased significantly over time in all types of ventilation. Patients who received only IMV had the highest in-hospital mortality (IHM) (32.63%). IHM decreased significantly in patients with NIV + IMV, but it remained stable in those receiving isolated NIV and isolated IMV. Factors associated with use of any type of ventilatory support included female sex, lower age, and higher comorbidity. (4) Conclusions: We found an increase in NIV use and a decline in IMV utilization to treat AE-COPD among hospitalized patients. The IHM decreased significantly over time in patients who received NIV + IMV, but it remained stable in patients who received NIV or IMV in isolation.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation that is not completely reversible and is often progressive [1]
(4) Conclusions: We found an increase in non-invasive ventilation (NIV) use and a decline in invasive mechanical ventilation (IMV) utilization to treat acute exacerbation of COPD (AE-COPD) among hospitalized patients
Our study provides important information about trends in mechanical ventilation use for AE-COPD and associated outcomes
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation that is not completely reversible and is often progressive [1]. The natural course of COPD is characterized by the occurrence of exacerbations (usually two to three per year), which are acute events characterized by a worsening of COPD symptoms, often leading to additional treatments, emergency room visits, or hospitalizations [4]. They result in a substantial burden on patients and healthcare systems [5], being a major contributor to the economic costs of COPD [6]. The main characteristic of NIV, in comparison with IMV, is that the pressure is applied through a mask, avoiding endotracheal intubation [8]
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