TY - JOUR T1 - Utilization of Mechanical Ventilation for Asthma Exacerbations: Analysis of a National Database JF - Respiratory Care SP - 644 LP - 653 DO - 10.4187/respcare.02505 VL - 59 IS - 5 AU - Rahul Nanchal AU - Gagan Kumar AU - Tillotama Majumdar AU - Amit Taneja AU - Jayshil Patel AU - Gaurav Dagar AU - Elizabeth R Jacobs AU - Jeff Whittle Y1 - 2014/05/01 UR - http://rc.rcjournal.com/content/59/5/644.abstract N2 - 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. ER -