Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010 |
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Authors: | Bienvenida Carpe-Carpe Lauro Hernando-Arizaleta M Carmen Ibáñez-Pérez Joaquín A Palomar-Rodríguez Antonio M Esquinas-Rodríguez |
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Institution: | 1. Unidad Docente de Medicina Preventiva y Salud Pública de la Región de Murcia, Murcia, España;2. Servicio de Planificación y Financiación Sanitaria, D.G.P.O.S.F.I. Consejería de Sanidad y Política Social de la Región de Murcia, Murcia, España;3. Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, España |
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Abstract: | IntroductionNoninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).Subjects and methodsA retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.ResultsWe identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.ConclusionsThe introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. |
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Keywords: | Enfermedad pulmonar obstructiva cró nica Respiració n con presió n positiva Evaluació n de tecnologí a biomé dica |
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