@article {Nanchal644, author = {Rahul Nanchal and Gagan Kumar and Tillotama Majumdar and Amit Taneja and Jayshil Patel and Gaurav Dagar and Elizabeth R Jacobs and Jeff Whittle}, title = {Utilization of Mechanical Ventilation for Asthma Exacerbations: Analysis of a National Database}, volume = {59}, number = {5}, pages = {644--653}, year = {2014}, doi = {10.4187/respcare.02505}, publisher = {Respiratory Care}, abstract = {BACKGROUND: The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown. METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008. RESULTS: The number of AEs increased by 15.8\% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4\% in 2000 to 0.73\% in 2008, whereas NIV use increased from 0.34\% to 1.9\%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged. CONCLUSIONS: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/59/5/644}, eprint = {https://rc.rcjournal.com/content/59/5/644.full.pdf}, journal = {Respiratory Care} }