Use and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in Massachusetts

Uğurlu, Aylin Özsancak; Sidhom, Samy; Khodabandeh, Ali; Ieong, Michael H.; Mohr, Chester; Lin, Denis; Buchwald, Irwin; Bahhady, Imad; Wengryn, John; Maheshwari, Vinay; Hill, Nicholas S.

doi:10.1378/chest.13-1707

Cited by 62 publications

(20 citation statements)

References 17 publications

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“…Clinical practice guidelines recommend NIV as the treatment of choice in patients with respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema, where it reduces mortality and complications associated with invasive mechanical ventilation (IMV) (6–9). However, many clinicians use NIV in patients with respiratory failure outside of these indications, a practice that has also increased (1, 5, 10, 11). For example, the use of NIV for pneumonia increased by 50% from 2000 to 2009 (5).…”

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confidence: 99%

“…For example, patients with pneumonia who received NIV were 56% and more likely to require intubation than patients with COPD who received NIV (5). NIV failure (going from NIV to IMV) has been implicated with increased complications and mortality compared to IMV alone (1, 2, 10, 18–23). NIV use for pneumonia may also lead to greater mortality than other modes of noninvasive oxygen supplementation such as high-flow nasal cannula (24).…”

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confidence: 99%

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Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia

Valley

Walkey

Lindenauer

et al. 2017

Critical Care Medicine

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Objective Despite increasing use, evidence is mixed as to the appropriate use of noninvasive ventilation in patients with pneumonia. We aimed to determine the relationship between receipt of noninvasive ventilation and outcomes for patients with pneumonia in a real-world setting. Design, Setting, Patients We performed a retrospective cohort study of Medicare beneficiaries (aged > 64 yr) admitted to 2,757 acute-care hospitals in the United States with pneumonia, who received mechanical ventilation from 2010 to 2011. Exposures Noninvasive ventilation versus invasive mechanical ventilation. Measurement and Main Results The primary outcome was 30-day mortality with Medicare reimbursement as a secondary outcome. To account for unmeasured confounding associated with noninvasive ventilation use, an instrumental variable was used—the differential distance to a high noninvasive ventilation use hospital. All models were adjusted for patient and hospital characteristics to account for measured differences between groups. Among 65,747 Medicare beneficiaries with pneumonia who required mechanical ventilation, 12,480 (19%) received noninvasive ventilation. Patients receiving noninvasive ventilation were more likely to be older, male, white, rural-dwelling, have fewer comorbidities, and were less likely to be acutely ill as measured by organ failures. Results of the instrumental variable analysis suggested that, among marginal patients, receipt of noninvasive ventilation was not significantly associated with differences in 30-day mortality when compared with invasive mechanical ventilation (54% vs 55%; p = 0.92; 95% CI of absolute difference, –13.8 to 12.4) but was associated with significantly lower Medicare spending ($18,433 vs $27,051; p = 0.02). Conclusions Among Medicare beneficiaries hospitalized with pneumonia who received mechanical ventilation, noninvasive ventilation use was not associated with a real-world mortality benefit. Given the wide CIs, however, substantial harm associated with noninvasive ventilation could not be excluded. The use of noninvasive ventilation for patients with pneumonia should be cautioned, but targeted enrollment of marginal patients with pneumonia could enrich future randomized trials.

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confidence: 99%

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Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia

Valley

Walkey

Lindenauer

et al. 2017

Critical Care Medicine

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“…Когда терапия с помощью низкопоточных устройств недостаточна для поддержания адекватного газообмена, используется неинвазивная масочная вентиляция легких (НИМВЛ) [8,9]. Благодаря созданию положительного давлению в дыхательных путях она способствует раскрытию коллабированных альвеол, уменьшению функционального мертвого пространства и увеличению вентиляционной поверхности легких, а также позволяет поддерживать альвеолы в открытом состоянии в фазу выдоха за счет ПДКВ.…”

Section: Introductionunclassified

“…When therapy utilizing low-flow devices are not enough to maintain adequate gas exchange, noninvasive mask ventilation (NIPPV) is used [8,9]. Due to creation of positive pressure in airways, it assists opening of collapsed alveoli, reduction of functional dead space, and increase of the ventilation surface of lungs; it also allows keeping alveoli opened during the expiration phase due to positive end-expiratory pressure.…”

Section: Introductionmentioning

confidence: 99%

Influence of Noninvasive Respiratory Support Techniques on Gas Exchange in Cardiac Surgical Patients Suffering from Post-Operative Respiratory Failure

Еременко¹,

Полякова²,

Vyzhigina³

2019

Obŝaâ reanimatologiâ

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Respiratory failure (RF) after tracheal extubation occurs in 5–25% of cardiac surgical patients. Various noninvasive respiratory support techniques are available for RF treatment.The purpose of the study is a comparative assessment of the effect on gas exchange of oxygen inhalation through a mask with noninvasive airway positive pressure mask ventilation, and high-flow lung ventilation during post-extubation respiratory failure in cardiac surgical patients.Materials and methods. 52 cardiac surgical patients with post-extubation respiratory failure (mean age 61 (55–67) years) were included in the study. Respiratory failure critera were as follows: PaO2/FiO2 _ 300 mm Hg or SpO2 _ 88% during room air breathing. Exclusion criteria included presentation of pleural effusion in patients, pneumothorax, diaphragm paresis. Every patient was subjected consecutively to arterial blood gases test during room air breathing, low-flow oxygen therapy using a mask with a pre-volume bag, high-flow ventilation (HFNC), and noninvasive positive pressure mask ventilation (NIPPV). Each method was applied during 1 hour prior to the test. Respiratory rate (RR) and capillary blood saturation (SpO2) were monitored throughout the whole study.Results. PaO2/FiO2 during low-flow oxygen therapy was equal to 171 (137–243) mm Hg. At the background of HFNC, this index increased to 235 (183–305) mm Hg (P=0.00004), and upon transfer to NIPPV — to 228 (180–288) mm Hg (P=0.000028). SpO2 during HFNC and NIPPV increased from 95 (93–98)% to 98 (96–99)% (P=0.000006) and 97 (95–98)%, respectively (P=0.000006 and P=0.000069). PaCO2 was higher during oxygen mask breathing compared to air breathing: 41 (37–44) mm Hg and 38 (34–42) mm Hg, correspondingly, P=0.0017. Upon transfer to HFNC, PaCO2 lowered on average by 10% (37 (33–39) mm Hg, P=0.0000001), to NIPPV — by 7% (38 (36–42) mm Hg, P=0,0015). Differences were also significant when compred RR during oxygen mask breathing (20 (16–24) respirations/minute) vs. HFNC (16 (12–20) respirations/minute, P=0.0) and vs. NIPPV (18 (16–20) respirations/minute, P=0.018). Comparison of HFNC vs. NIPPV revealed reliable difference in RR (16 (12–20) respirations/minute against 18 (16-20) respirations/minute, P=0.016), PaCO2 (37 (33–39) mm Hg against 38 (36–42) mm Hg, P=0.0034), and SpO2 (98 (96–99)% against 97 (95–98)%, P=0.022).Conclusion. HFNC and NIPPV exert a similar positive effect on the oxygenating function of lungs and gas exchange in cardiac surgical patients with post-extubation respiratory failure. Compared to NIPPV, high-flow ventilation renders most significant positive effect on elimination of CO2, RR and SpO2, and is better tolerated by patients.

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“…The final concentration of oxygen truly delivered to the patient can be lower than the set fraction of inspired oxygen (FiO 2 SET) and depends on the ventilatory demands of the patient [6]. When oxygen therapy is insufficient to correct hypoxemia, Non Invasive ventilation (NIV) is often used to avoid reintubation and improve Outcomes [7]. Several studies have been conducted to show the outcomes of NIV in Acute Hypoxemic Respiratory Failure in many groups of patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Rizk¹,

Essawy²,

Ali³

et al. 2018

OJAnes

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Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO 2 , SpO 2 and PaO 2-to-FiO 2 ratio). Results: Mean PO 2 and SO 2 have increased after using of both venture and Cpap, increase in both PCO 2 and HCO 3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen How to cite this paper:

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Use and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in Massachusetts

Cited by 62 publications

References 17 publications

Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia

Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia

Influence of Noninvasive Respiratory Support Techniques on Gas Exchange in Cardiac Surgical Patients Suffering from Post-Operative Respiratory Failure

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

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