de Miguel-Díez Javier, Jiménez-García Rodrigo, Hernández-Barrera Valentín, Puente-Maestu Luis, Ji Zichen, de Miguel-Yanes José M, Méndez-Bailón Manuel, López-de-Andrés Ana
Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Arch Bronconeumol. 2020 Dec;56(12):792-800. doi: 10.1016/j.arbres.2019.12.008. Epub 2020 Jan 25.
We examined fifteen years trends (2001-2015) in the use of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both (NIV+IMV) among patients hospitalized for community acquired pneumonia (CAP). We also analyzed trends overtime and the influence of patient factors in the in-hospital mortality (IHM) after receiving NIV, IMV or NIV+IMV.
Observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database.
Over a total of 1,486,240 hospitalized patients with CAP, we identified 56,158 who had received ventilator support in Spain over the study period. Of them, 54.82% received NIV, 37.04% IMV and 8.14% both procedures. The use of NIV and NIV+IMV increased significantly (p<0.001) over time (from 0.91 to 12.84 per 100.000 inhabitant and from 0.23 to 1.19 per 100.000 inhabitants, respectively), while the IMV utilization decreased (from 3.55 to 2.79 per 100,000 inhabitants; p<0.001). Patients receiving NIV were the oldest and had the highest mean value in the Charlson comorbidity index (CCI) score and readmission rate. Patients who received only IMV had the highest IHM. Factors associated with IHM for all groups analyzed included age, comorbidities and readmission. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV+IMV.
We found an increase in NIV use and a decline in IMV utilization in patients hospitalized for CAP over the study period. Patients receiving NIV were the oldest and had the highest CCI score and readmission rate. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV+IMV.
我们研究了因社区获得性肺炎（CAP）住院患者使用无创通气（NIV）、有创机械通气（IMV）或两者联合使用（NIV + IMV）的15年趋势（2001 - 2015年）。我们还分析了随时间变化的趋势以及患者因素对接受NIV、IMV或NIV + IMV后院内死亡率（IHM）的影响。
观察性回顾性流行病学研究。我们的数据来源是西班牙国家医院出院数据库。
在总共1,486,240例因CAP住院的患者中，我们确定在研究期间西班牙有56,158例接受了机械通气支持。其中，54.82%接受了NIV，37.04%接受了IMV，8.14%接受了两种通气方式。随着时间的推移，NIV和NIV + IMV的使用显著增加（p < 0.001）（分别从每10万居民中的0.91例增加到12.84例，从每10万居民中的0.23例增加到1.19例），而IMV的使用率下降（从每10万居民中的3.55例降至2.79例；p < 0.001）。接受NIV的患者年龄最大，Charlson合并症指数（CCI）得分和再入院率的平均值最高。仅接受IMV的患者院内死亡率最高。所有分析组中与院内死亡率相关的因素包括年龄、合并症和再入院。接受NIV、IMV和NIV + IMV的CAP患者的院内死亡率随时间显著下降。
我们发现在研究期间，因CAP住院的患者中NIV的使用增加，IMV的使用率下降。接受NIV的患者年龄最大，CCI得分最高，再入院率也最高。接受NIV、IMV和NIV + IMV的CAP患者的院内死亡率随时间显著下降。
