Use of Noninvasive vs Invasive Ventilation for Patients Hospitalized With Acute Exacerbation of COPD, 2010 to 2019

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) contribute to morbidity and mortality. Noninvasive ventilation (NIV), a resource-intensive intervention, decreases mortality and the need for invasive mechanical ventilation.

To study NIV and mechanical ventilation use, NIV failure, and hospital NIV case volumes for inpatients with AECOPD from 2010 to 2019.

This retrospective cohort study used the Nationwide Readmissions Database (2010-2019) for adults (≥40 years old) hospitalized for AECOPD. Rates of NIV and mechanical ventilation use and NIV failure were compared per year. Multivariable hierarchical regression models were used. Hospital case volumes of NIV use (overall and for patients with AECOPD) were compared across years.

Patients with AECOPD accounted for 3.35% of admissions in 2010 and 3.20% in 2019. Risk-adjusted rate (95% CI) of mechanical ventilation use decreased from 6.0% (5.6%-6.4%) to 4.5% (4.2%-4.8%); NIV use increased from 6.2% (5.6%-6.9%) to 10.9% (9.9%-12.0%). Noninvasive ventilation failure rate (95% CI) decreased from 7.8% (6.9%-8.7%) to 5.6% (5.0%-6.2%). Mean (SD) hospital case volume for NIV increased overall from 207.3 (237.0) in 2010 to 360.4 (447.4) in 2019 (P < .001); for patients with AECOPD, from 39.5 (37.8) to 79.0 (78.7) (P < .001).

From 2010 to 2019, mechanical ventilation use and NIV failure decreased; NIV use and hospital NIV case volumes increased. These results indicate greater need for monitored beds, equipment, and trained staff.