ICU Utilization for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Noninvasive Ventilation

Abstract

Objectives: We investigated whether patients with chronic obstructive pulmonary disease could safely receive noninvasive ventilation outside of the ICU. Design: Retrospective cohort study. Setting: Twelve states with ICU utilization flag from the State Inpatient Database from 2014. Patients: Patients greater than or equal to 18 years old with primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease and secondary diagnosis of respiratory failure who received noninvasive ventilation. Interventions: None. Measurements and Main Results: Multilevel logistic regression models were used to obtain hospital-level ICU utilization rates. We risk-adjusted using both patient/hospital characteristics. The primary outcome was in-hospital mortality; secondary outcomes were invasive monitoring (arterial/central catheters), hospital length of stay, and cost. We examined 5,081 hospitalizations from 424 hospitals with ICU utilization ranging from 0.05 to 0.98. The overall median in-hospital mortality was 2.62% (interquartile range, 1.72-3.88%). ICU utilization was not significantly associated with in-hospital mortality (β = 0.01; p = 0.05) or length of stay (β = 0.18; p = 0.41), which was confirmed by Spearman correlation (ρ = 0.06; p = 0.20 and ρ = 0.02; p = 0.64, respectively). However, lower ICU utilization was associated with lower rates of invasive monitor placement by linear regression (β = 0.05; p < 0.001) and Spearman correlation (ρ = 0.28; p < 0.001). Lower ICU utilization was also associated with significantly lower cost by linear regression (β = 14.91; p = 0.02) but not by Spearman correlation (ρ = 0.09; p = 0.07).

Goldilocks, the Three Bears and Intensive Care Unit Utilization: Delivering Enough Intensive Care But Not Too Much. A Narrative Review

“…These results indicate wide variation in admission patterns for patients with low likelihood of death among Veterans Administration hospitals. Similarly wide variation is reported in studies using other data sources [10][11][12][13][14][15][16]. Figure 1 depicts the theoretical relationship between likelihood of intensive care unit admission and patient severity of.…”

“…Several of the studies also examined secondary outcomes, such as the likelihood of patients receiving invasive procedures. For example, Myers et al showed that patients admitted to the The only study showing a difference in clinical outcome by treatment location is highlighted in bold ICU intensive care unit intensive care unit with chronic obstructive pulmonary disease requiring noninvasive ventilation had higher rates of central venous lines and arterial lines [10]. Admon et al showed that patients admitted to the intensive care unit with pulmonary embolus had higher rates of mechanical ventilation, noninvasive ventilation, central venous catheterization and thrombolysis [13].…”

Low-Cost Pulmonary Ventilator for Patient Monitoring for Covid-19 Disease

“…Blocks erected for the purpose of support were also moved further beneath the Ambu. A potentiometer was also linked to the LCD, which could be used to raise the intensity of the display depending on the surroundings (shadow or sunlight) [9].…”

A scoring system derived from electronic health records to identify patients at high risk for noninvasive ventilation failure

“…In this study we found that when NIV was started for unusual diagnoses such as drug overdose or seizure, the risk of NIV failure was high; for this group, the decision to intubate has to be seriously considered. Fourth, the prognostic model can be used as an aid in making decisions about placement of patients in ICU or intermediate care, thereby matching the intensity of monitoring with the needs of the patient [36,37]. Of note, in a step-down unit, patients are generally monitored with the same technology as in an ICU but frequency of monitoring and the intensity of care provided by the nurses and respiratory therapists is lower [38,39].…”