Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation

Fortis, Spyridon; Gao, Yubo; O'Shea, Amy; Beck, Brice; Kaboli, Peter J.; Vaughan-Sarrazin, Mary

doi:10.2147/copd.s321053

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…Primary diagnosis of COPD consistent with (ICD-9-CM codes: 490.x, 491.xx, 492.xx and 496.xx); secondary AECOPD diagnosis (ICD-9-CM codes: 491.21,491.22); primary diagnosis of acute respiratory failure (ICD-9-CM codes: 518.81, 518.82, 518.84 or 799.1). 8 The diagnosis of other diseases is shown in Table S1 . The ACEI/ARB use was defined as a record of using ACEI or ARB in “Medications on admission” in MIMIC-III.…”

Section: Methodsmentioning

confidence: 99%

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The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Ruan¹,

Li²,

Hu³

et al. 2022

COPD

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Background Acute respiratory failure (ARF) is a common cause of admission to the intensive care unit (ICU) for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There is still a lack of effective interventions and treatments. ACE inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) were effective in COPD patients. We aimed to study the effect of ACEI/ARB use on AECOPD combined with ARF and evaluate the effect of in-hospital continuation of medication. Methods We included patients with AECOPD and ARF from the Medical Information Bank for Intensive Care (MIMIC-III) database. MIMIC III is a large cohort database from Boston, USA. Patients were divided into two groups according to the use of ACEI/ARB before admission. Propensity score matching (PSM) was used to reduce potential bias between the two groups. Cox regression and Kaplan-Meier curves compared 30-day mortality in ACEI/ARB users and non-users. We also defined and analyzed the use of in-hospital ACEI/ARB. Multiple models were used to ensure the robustness of the findings. Subgroup analysis was used to analyze the variability between groups. Results A total of 544 patients were included in the original study. After PSM, 256 patients were included in the matched cohort. Multivariate Cox regression showed 30-day mortality was significantly lower in ACEI/ARB users compared with controls (HR = 0.50, 95% CI: 0.29–0.86, p = 0.013). In PSM and inverse probability-weighted models, the results are stable Continued in-hospital use of ACEI/ARB remains effective (HR 0.40, 95% CI 0.22–0.74, p = 0.003). Kaplan-Meier showed a significant difference in survival between the two groups. Conclusion This study found that pre-hospital ACEI/ARB use was associated with reduced mortality in patients with AECOPD and ARF.

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Section: Methodsmentioning

confidence: 99%

“…Patients with missing vital information, comorbid asthma, or admission time less than 24 hours were excluded from our cohort. 8 The diagnosis of other diseases is shown in Table S1. The ACEI/ARB use was defined as a record of using ACEI or ARB in "Medications on admission" in MIMIC-III.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Ruan¹,

Li²,

Hu³

et al. 2022

COPD

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“…This is work is a part of a larger mixed-methods study described in a previous publication. (14,15) The methods carried out in this study may have overlap without our previous work. ( 14) All methods were carried out in accordance with relevant guidelines and regulations.…”

Section: Methodsmentioning

confidence: 99%

Association of Rural Living with COPD-related Hospitalizations and Deaths in US Veterans

Fortis

Gao

Baldomero

et al. 2022

Preprint

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It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality. We retrospectively analyzed Veterans Affairs (VA) and Medicare data of a nationwide cohort of veterans with COPD aged ≥ 65 years with a COPD encounter between 2011 and 2014 that had a follow-up until 2017. Patients were categorized based on residential location into urban, rural, and isolated rural. We used generalized linear and Cox proportional hazards models to assess the association of residential location with AECOPD-related hospitalizations and mortality. Age, sex, race, travel time to the nearest VA hospital, and comorbidity were included as covariates in the models. Of 165,996 patients with COPD, 45,045 (27.1%) experienced at least one AECOPD-related hospitalization over the study period. Rural (relative risk-RR) = 0.93; 95%CI:0.92 to 0.94;p < 0.001) and isolated rural residence (RR = 0.85;95%CI:0.82 to 0.87;p < 0.001) were associated with fewer AECOPD-related hospitalizations relative to urban residence. Travel time to the closet VA hospital was inversely associated with AECOPD-related hospitalizations. Among patients who were alive after discharge for their second AECOPD-related hospitalization, rural residence was associated with increased mortality risk (hazard ratio = 1.06; 95%CI = 1.01 to 1.10;p = 0.011).Rural living is not associated with AECOPD-related hospitalizations, but it is associated with 6% increased risk for death among patients who were alive after discharge following a second AECOPD-related hospitalization.

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“…Marieke Duiverman (Groningen, the Netherlands) presented NIV as the first-line intervention to relieve work of breathing in patients with COPD presenting with acute hypercapnic respiratory failure. NIV clinical practice varies widely across hospitals [ 80 ]. Evidence-based use improves exacerbation outcomes, including mortality, endotracheal intubation, hospitalisation duration, gas exchange and complications [ 81 , 82 ], whereas delayed NIV implementation increases mortality [ 83 ].…”

Section: Treatment Of Acute Respiratory Failure In Copd Patientsmentioning

confidence: 99%

ERS International Congress 2022: highlights from the Respiratory Intensive Care Assembly

et al. 2023

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Early Career Members of Assembly 2 (Respiratory Intensive Care) attended the 2022 European Respiratory Society Annual Congress in Barcelona. The conference covered acute and chronic respiratory failure. Sessions of interest to our Assembly members and to those interested in respiratory critical care included the state-of-the-art session on respiratory critical care, the journal session (ERS/Lancet) on acute respiratory distress syndrome (ARDS) phenotyping into precision medicine, specificity of COVID-19 ARDS and its post critical care. A symposium on treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and innovations in mechanical ventilation either in intensive care unit or at home were also reported. These sessions are summarized in this article.

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Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation

Cited by 8 publications

References 39 publications

The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Association of Rural Living with COPD-related Hospitalizations and Deaths in US Veterans

ERS International Congress 2022: highlights from the Respiratory Intensive Care Assembly

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