Mihaela S Stefan1, Aruna Priya2, Penelope S Pekow3, Tara Lagu4, Jay S Steingrub5, Nicholas S Hill6, Brian H Nathanson7, Peter K Lindenauer4. 1. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA; Division of General Medicine, Baystate Medical Center, Springfield, MA, USA; Tufts University School of Medicine, Boston, MA, USA. Electronic address: Mihaela.Stefan@baystatehealth.org. 2. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA. 3. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA; School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, USA. 4. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA; Division of General Medicine, Baystate Medical Center, Springfield, MA, USA; Tufts University School of Medicine, Boston, MA, USA. 5. Division of Pulmonary and Critical Care, Baystate Medical Center, Springfield, MA, USA. 6. Division of Pulmonary and Critical Care Medicine, Tufts University School of Medicine, Boston, MA, USA. 7. OptiStatim LLC, Longmeadow, MA, USA.
Abstract
PURPOSE: To compare the outcomes of patients hospitalized with pneumonia treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV). MATERIALS AND METHODS: Using the HealthFacts multihospital electronic medical record database, we included patients hospitalized with a diagnosis of pneumonia and treated with NIV or IMV. We developed a propensity model for receipt of initial NIV and assessed the outcomes in a propensity-matched cohort, and in a covariate adjusted and propensity score weighted models. RESULTS: Among 3971 ventilated patients, 1109 (27.9%) were initially treated with NIV. Patients treated with NIV were older, had lower acuity of illness score, and were more likely to have congestive heart failure and chronic pulmonary disease. Mortality was 15.8%, 29.8% and 25.9.0% among patients treated with initial NIV, initial IMV and among those with NIV failure. In the propensity matched analysis, the risk of death was lower in patients treated with NIV (relative risk: 0.71, 95% CI: 0.59-0.85). Subgroup analysis showed that NIV was beneficial among patients with cardiopulmonary comorbidities (relative risk 0.59, 95% CI: 0.47-0.75) but not in those without (relative risk 0.96, 95% CI: 0.74-0.1.25)NIV failure was significantly (p=0.002) more common in patients without cardiopulmonary conditions (21.3%) compared to those with these conditions (13.8%). CONCLUSIONS: Initial NIV was associated with better survival among the subgroup of patients hospitalized with pneumonia who had COPD or heart failure. Patients who failed NIV had high in-hospital mortality, emphasizing the importance of careful patient selection monitoring when managing severe pneumonia with NIV.
PURPOSE: To compare the outcomes of patients hospitalized with pneumonia treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV). MATERIALS AND METHODS: Using the HealthFacts multihospital electronic medical record database, we included patients hospitalized with a diagnosis of pneumonia and treated with NIV or IMV. We developed a propensity model for receipt of initial NIV and assessed the outcomes in a propensity-matched cohort, and in a covariate adjusted and propensity score weighted models. RESULTS: Among 3971 ventilated patients, 1109 (27.9%) were initially treated with NIV. Patients treated with NIV were older, had lower acuity of illness score, and were more likely to have congestive heart failure and chronic pulmonary disease. Mortality was 15.8%, 29.8% and 25.9.0% among patients treated with initial NIV, initial IMV and among those with NIV failure. In the propensity matched analysis, the risk of death was lower in patients treated with NIV (relative risk: 0.71, 95% CI: 0.59-0.85). Subgroup analysis showed that NIV was beneficial among patients with cardiopulmonary comorbidities (relative risk 0.59, 95% CI: 0.47-0.75) but not in those without (relative risk 0.96, 95% CI: 0.74-0.1.25)NIV failure was significantly (p=0.002) more common in patients without cardiopulmonary conditions (21.3%) compared to those with these conditions (13.8%). CONCLUSIONS: Initial NIV was associated with better survival among the subgroup of patients hospitalized with pneumonia who had COPD or heart failure. Patients who failed NIV had high in-hospital mortality, emphasizing the importance of careful patient selection monitoring when managing severe pneumonia with NIV.
Authors: Thomas S Valley; Allan J Walkey; Peter K Lindenauer; Renda Soylemez Wiener; Colin R Cooke Journal: Crit Care Med Date: 2017-03 Impact factor: 7.598
Authors: E Girou; F Schortgen; C Delclaux; C Brun-Buisson; F Blot; Y Lefort; F Lemaire; L Brochard Journal: JAMA Date: 2000-11-08 Impact factor: 56.272
Authors: Gabriel J Escobar; John D Greene; Peter Scheirer; Marla N Gardner; David Draper; Patricia Kipnis Journal: Med Care Date: 2008-03 Impact factor: 2.983
Authors: Mikhail Kosiborod; Silvio E Inzucchi; Harlan M Krumholz; Frederick A Masoudi; Abhinav Goyal; Lan Xiao; Philip G Jones; Suzanne Fiske; John A Spertus Journal: Arch Intern Med Date: 2009-03-09
Authors: Mihaela S Stefan; Brian H Nathanson; Tara Lagu; Aruna Priya; Penelope S Pekow; Jay S Steingrub; Nicholas S Hill; Robert J Goldberg; David M Kent; Peter K Lindenauer Journal: Ann Am Thorac Soc Date: 2016-07
Authors: Reiko Asano; Stephen C Mathai; Peter S Macdonald; Phillip J Newton; David C Currow; Jane Phillips; Wing-Fai Yeung; Patricia M Davidson Journal: Heart Fail Rev Date: 2020-03 Impact factor: 4.214
Authors: Joan M Teno; Laura M Keohane; Susan L Mitchell; David J Meyers; Jennifer N Bunker; Emmanuelle Belanger; Pedro L Gozalo; Amal N Trivedi Journal: J Am Geriatr Soc Date: 2021-05-14 Impact factor: 7.538
Authors: Mihaela S Stefan; Aruna Priya; Penelope S Pekow; Jay S Steingrub; Nicholas S Hill; Tara Lagu; Karthik Raghunathan; Anusha G Bhat; Peter K Lindenauer Journal: BMC Pulm Med Date: 2021-02-05 Impact factor: 3.317