PulmonaryThe comparative effectiveness of noninvasive and invasive ventilation in patients with pneumonia☆
Section snippets
Background
Each year in the United States, nearly one million patients with acute respiratory failure (ARF) are treated with invasive mechanical ventilation (IMV) [1]. Up to 40% of mechanically ventilated patients die in the hospital [2], [3], and some of these deaths are directly attributable to complications of the ventilator [4]. In selected groups of patients with ARF, noninvasive mechanical ventilation (NIV) reduces the need for endotracheal intubation leading to better outcomes. While most of the
Design and setting
We conducted a retrospective cohort study of patients hospitalized between January 1, 2009 and December 31, 2012 using Cerner HealthFacts (Cerner Corporation, Kansas City). Data in HealthFacts is extracted directly from the EMR from hospitals in which Cerner has a data use agreement. Encounters may include pharmacy, clinical and microbiology laboratory, admission and billing information. All admissions, medication orders and dispensing, laboratory orders and specimens are date and time stamped,
Results
A total of 3971 patients from 81 hospitals were included in the analysis. 1109 (27.9%) patients were initially managed with NIV and 2862 (72.1%) received IMV. (Fig. 1) Patients' mean (SD) age was 61.7 (13.6) years, 51.7% were male, 72.5% were white and mean (SD) comorbidity score was 3.6 (2.6). Mean (SD) LAPS was 70.7 (28.7), 39.2% were admitted to the ICU and 45.2% had community acquired pneumonia. In-hospital mortality was 25.9%, mean (SD) length of stay was 10.4 days (8.5) and 30-day
Discussion
In this retrospective study of nearly 4000 patients hospitalized with pneumonia who required ventilation, we found that more than one fourth of the patients received NIV as the initial ventilation method. Patients treated with NIV tended to have lower severity of illness at admission as evidenced by lower LAPS scores and were more likely to have comorbid COPD, and heart failure. In the propensity-matched cohort, NIV therapy was associated with a 29% relative reduction of in-hospital mortality
Author contributions
Drs. Stefan, Lindenauer, Pekow, Steingrub, Lagu and Hill conceived and designed the study. Dr. Stefan acquired the data used in the analysis. Drs. Stefan, Priya, Nathanson, Lindenauer, Lagu, Steingrub, and Hill were involved in the analysis and interpretation of the data. Dr. Stefan drafted the manuscript and Drs. Lindenauer, Priya, Pekow, Lagu, Steingrub, Nathanson, Pekow and Hill reviewed and contributed to revisions prior to submission.
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Cited by (0)
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This work was supported by grant 1K01HL114631-011 from the National Heart, Lung and Blood Institute of the National Institutes of Health. Dr Lindenauer was supported by grant K24HL132008 from the National Heart Lung and Blood Institute. Dr. Lagu was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K01HL114745. The funders had no role in data collection, management, analysis; study design, conduct, or interpretation of study findings; or the preparation, review, or approval of the manuscript for submitted for publication.
Dr. Hill has served as a consultant for Phillips Respironics, Actelion, Gilead, Pfizer, and Bayer and has received grants/research support from Fisher Paykel, Actelion, Gilead, and United Therapeutics; the article submitted is not related in any way to these relationships. The other authors have indicated no financial conflicts of interest.