Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

NIPPV linked to increased hospital mortality rates in small group of patients

21.10.2011
Although increased use of noninvasive positive-pressure ventilation (NIPPV) nationwide has helped decrease mortality rates among patients hospitalized with chronic obstructive pulmonary disease (COPD), a small group of patients requiring subsequent treatment with invasive mechanical ventilation (IMV) have a significantly higher risk of death than those placed directly on IMV, according to researchers in the United States who studied patterns of NIPPV use.

The findings were published online ahead of the print edition of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Patients hospitalized with COPD frequently require mechanical ventilation – either invasive or noninvasive – to help them breathe. IMV requires insertion of a rigid tube into the airway which allows oxygen to enter and exit the lungs freely. Invasive methods often involve a significant risk of infection which can occur when bacteria gather around the tube and its fittings. As a result, NIPPV methods are used when possible to minimize infection risks. NIPPV relies on the use of a mask to deliver pressurized air through the mouth and nose.

The two common forms of NIPPV are continuous positive airway pressure (CPAP), which provides a continuous pressurized stream of air, and bilevel positive airway pressure (BPAP), which offers different pressures for inhalation and exhalation. "We performed the first examination of the patterns and outcomes of NIPPV treatment for acute exacerbations of COPD in clinical practice nationwide, using data from an estimated 7,511,267 million hospital admissions in the United States during 1998-2008," said Fernando Holguin, MD, MPH, an assistant professor of medicine in the Pulmonary, Allergy and Critical Care Division at the University of Pittsburgh School of Medicine. "The current study, to the best of our knowledge, is the first to report a dramatic shift towards NIPPV use for treating respiratory failure from acute exacerbations in the United States."

The increase is consistent with results reported by investigators in smaller studies, he said.

For this study, researchers from the University of Pittsburgh, Emory University, the University of Illinois at Chicago and the University of Kentucky reviewed clinical patient data gathered by the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database between 1998 and 2008. The researchers examined changes in the frequency of NIPPV and IMV use from 1998 to 2008, and compared patient demographics, income status, payer type, hospital region and hospital type among patients who initially received NIPPV, IMV or no respiratory support after hospital admission. They also examined in-hospital mortality, length-of-stay and total hospitalization charges, and compared those outcomes among patient groups.

At the completion of the study, they found that although the annual number of hospitalizations for acute exacerbations remained relatively constant during the 10-year period, there was a progressive increase in the use of NIPPV and a progressive decrease in use of IMV; during the entire study period, there was a fourfold increase in the use of NIPPV, which had grown to overtake IMV as the most frequently used form of respiratory support for patients hospitalized with acute exacerbations in the United States.

They also found that despite a steady decline in mortality among most patients studied, patients who used NIPPV and were then transitioned to IMV had significantly higher mortality rates than other patients, and that the mortality rate in these transitioned patients increased during the study period while mortality rates of other groups declined. Patients in this group also experienced the greatest increase in hospital charges and longest hospital length-of-stay.

"The concerning finding in our analysis was the high mortality in the group of patients who, despite initial treatment with NIPPV, required subsequent placement on IMV," said Dr. Holguin, who also serves as the assistant director of the University of Pittsburgh Medical Center's Asthma Institute at the University of Pittsburgh School of Medicine. "It is notable that this finding is contrary to that found in the carefully monitored patient environment of clinical trials, where those transitioned from NIPPV to IMV did not have higher mortality than patients placed on IMV from the beginning."

Dr. Holguin added that the overall trend toward greater use of NIPPV was likely due to several factors, including clinical trials linking NIPPV with a decrease in hospital mortality, increased confidence in using NIPPV and the ability to use NIPPV outside of the intensive care unit.

"These results suggest that healthcare providers should continue to be aggressive with the use of noninvasive ventilation for patients with acute exacerbations, but definitely should intensively monitor sick patients, intervene early in the absence of improvement, and carefully examine if transitioning to IMV is in the interest of a patient with a poor prognosis," he said.

Brian Kell | EurekAlert!
Further information:
http://www.thoracic.org

Further reports about: COPD Medicine NIPPV mortality rate oak mortality rates

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Stingless bees have their nests protected by soldiers

24.02.2017 | Life Sciences

New risk factors for anxiety disorders

24.02.2017 | Life Sciences

MWC 2017: 5G Capital Berlin

24.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>