Literature Update: Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation
Sanjay Kalra MD
Jeffrey L. Roitman EdD

$3.95 		Journal of Cardiopulmonary Rehabilitation & Prevention
April 2012 
Volume 32  Number 2
Pages 113 - 116
 
  PDF Version Available!

ABSTRACT
Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, Mannino D, Sciurba FC, Holguin FAm J Respir Crit Care Med. 2012;185:152-159. Published online first October 20, 2011, doi:10.1164/rccm.201106-1094OC.Rationale: The patterns and outcomes of non-invasive positive-pressure ventilation (NIPPV) use in patients hospitalized for acute exacerbations of COPD nationwide are unknown.Methods: We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, to assess the pattern and outcomes of NIPPV use for acute exacerbations of COPD during 1998-2008.Results: An estimated 7,511,267 admissions for acute exacerbations occurred from 1998-2008. There was a 462% increase in NIPPV use (from 1.0% to 4.5% of all admissions), and a 42% decline in invasive mechanical ventilation (IMV) use (from 6.0% to 3.5% of all admissions) during these years. This was accompanied by an increase in the size of a small cohort of patients requiring transition from NIPPV to IMV. In-hospital mortality in this group appeared to be worsening over time. By 2008, these patients had a high mortality rate (29.3%) which represented 61% higher odds of death compared to patients directly placed on IMV (95% CI 24-109%), and 677% greater odds of death compared to patients treated with NIPPV alone (95% CI 475-948%). With the exception of patients transitioned from NIPPV to IMV, in-hospital outcomes were favorable and improved steadily year by year.Conclusions: The use of NIPPV has increased significantly over time among patients hospitalized for acute exacerbations of COPD, while the need for intubation and in-hospital mortality has declined. However, the rising mortality rate in a small but expanding group of patients requiring invasive mechanical ventilation after treatment with non-invasive ventilation needs further investigation.Editor's Comment: The use of noninvasive positive-pressure ventilation (NIPPV) in the treatment of acute exacerbations of chronic obstructive

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