Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study

Ann Am Thorac Soc. 2013 Feb;10(1):10-7. doi: 10.1513/AnnalsATS.201206-034OC.


Rationale: Although evidence supporting use of noninvasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD) is strong, evidence varies widely for other causes of acute respiratory failure.

Objectives: To compare utilization trends and outcomes associated with NIV in patients with and without COPD.

Methods: We identified 11,659,668 cases of acute respiratory failure from the Nationwide Inpatient Sample during years 2000 to 2009 and compared NIV utilization trends and failure rates for cases with or without a diagnosis of COPD.

Measurements and main results: The proportion of patients with COPD who received NIV increased from 3.5% in 2000 to 12.3% in 2009 (250% increase), and the proportion of patients without COPD who received NIV increased from 1.2% in 2000 to 6.0% in 2009 (400% increase). The rate of increase in the use of NIV was significantly greater for patients without COPD (18.1% annual change) than for patients with COPD (14.3% annual change; P = 0.02). Patients without COPD were more likely to have failure of NIV requiring endotracheal intubation (adjusted odds ratio, 1.19; 95% confidence interval, 1.15-1.22; P < 0.0001). Patients in whom NIV failed had higher hospital mortality than patients receiving mechanical ventilation without a preceding trial of NIV (adjusted odds ratio, 1.14; 95% confidence interval, 1.11-1.17; P < 0.0001).

Conclusion: The use of NIV during acute respiratory failure has increased at a similar rate for all diagnoses, regardless of supporting evidence. However, NIV is more likely to fail in patients without COPD, and NIV failure is associated with increased mortality.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Disease Progression
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Noninvasive Ventilation* / methods
  • Noninvasive Ventilation* / statistics & numerical data
  • Noninvasive Ventilation* / trends
  • Outcome Assessment, Health Care
  • Positive-Pressure Respiration / methods
  • Practice Patterns, Physicians' / trends
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / mortality
  • Respiratory Insufficiency* / therapy
  • Treatment Outcome
  • United States / epidemiology
  • Utilization Review