Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe Asthma Exacerbation: A Cohort Study.

Abstract

The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality. Retrospective, propensity-score-matched cohort study. Administrative data from Healthcare Cost and Utilization Project's State Inpatient Databases for New York and Florida, 2006-2019. Patients 5-80 years old hospitalized with an asthma exacerbation. Receipt of NPPV. Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6-6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5-7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensity-score matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40-0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21-0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95% CI, 0.29-0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15-1.11). NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.