Tøttenborg Sandra Søgaard, Johnsen Søren Paaske, Thomsen Reimar Wernich, Nielsen Henrik, Hansen Ejvind Frausing, Lange Peter
Department of Public Health, Section of Social Medicine, University of Copenhagen, 1014 Copenhagen, Denmark.
Dan Med J. 2013 Aug;60(8):A4686.
A nationwide chronic obstructive pulmonary disease (COPD) quality improvement programme--DrCOPD--was initiated in Denmark in 2008. We examined subsequent national and regional trends in the use of non-invasive ventilation (NIV) and trends in mortality following NIV and invasive mechanical ventilation among patients acutely admitted with a COPD exacerbation.
We did a nationwide, population-based prospective study using DrCOPD to identify all incident hospitalizations with COPD from 2008 through 2011 (n = 24,982) and to record the use of NIV during hospitalization. Date of death was retrieved from the Danish Civil Registration System.
During follow-up, the use of NIV treatment in patients with first-time COPD hospitalization increased statistically significantly in all five Danish regions. At the national level, the use of NIV increased from 5.8% to 7.0% (adjusted for age, sex and co-morbidity, relative risk (RR): 1.21, 95% confidence interval (CI): 1.05-1.38). Concurrently, a statistically significant increase from 1.3% to 1.8% (RR: 1.36; 95% CI: 1.03-1.80) in NIV given together with invasive mechanical ventilation was observed. During the four years of follow-up, mortality remained stable with some regional variation. In-hospital mortality following NIV was also stable over time, while mortality decreased slightly in patients treated with both NIV and invasive mechanical ventilation.
Use of NIV in Denmark increased after the launch of a national COPD quality programme in 2008. However, regional variation remains and no substantial improvements in mortality have been observed. Continued efforts are warranted to ensure appropriate implementation of NIV.
The study was supported financially by University of Copenhagen and the Danish Lung Association.
The study was approved by the Danish Data Protection Agency (record no. 2012-41-0438), the Danish National Indicator Project, Danish Regions and the Danish Ministry of Health.
2008年丹麦启动了一项全国性慢性阻塞性肺疾病（COPD）质量改进计划——DrCOPD。我们研究了随后全国和各地区无创通气（NIV）的使用趋势，以及急性加重期COPD患者接受NIV和有创机械通气后的死亡率趋势。
我们利用DrCOPD开展了一项基于全国人群的前瞻性研究，以确定2008年至2011年期间所有因COPD而住院的患者（n = 24,982），并记录住院期间NIV的使用情况。死亡日期从丹麦民事登记系统中获取。
在随访期间，丹麦所有五个地区首次因COPD住院患者的NIV治疗使用率均有显著统计学意义的增加。在全国范围内，NIV的使用率从5.8%增至7.0%（经年龄、性别和合并症校正后，相对风险（RR）：1.21，95%置信区间（CI）：1.05 - 1.38）。同时，观察到与有创机械通气联合使用的NIV使用率从1.3%显著增至1.8%（RR：1.36；95% CI：1.03 - 1.80）。在四年的随访期间，死亡率保持稳定，但存在一些地区差异。NIV治疗后的院内死亡率也随时间保持稳定，而接受NIV和有创机械通气联合治疗的患者死亡率略有下降。
2008年丹麦启动全国COPD质量计划后，NIV的使用有所增加。然而，地区差异仍然存在，且未观察到死亡率有实质性改善。有必要继续努力确保NIV的合理应用。
该研究由哥本哈根大学和丹麦肺脏协会提供资金支持。
该研究获得丹麦数据保护局（记录编号：2012 - 41 - 0438）、丹麦国家指标项目、丹麦各地区以及丹麦卫生部的批准。
