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Adjuvants to Mechanical Ventilation for Acute Respiratory Failure. Adoption, De-adoption, and Factors Associated with Selection.
- Source :
- Annals of the American Thoracic Society; Jan2017, Vol. 14 Issue 1, p94-102, 9p
- Publication Year :
- 2017
-
Abstract
- <bold>Rationale: </bold>Adoption and de-adoption of adjuvant strategies to mechanical ventilation for acute respiratory failure (ARF), and factors associated with their selection, have not been extensively evaluated.<bold>Objectives: </bold>To evaluate change in use of adjuvants to mechanical ventilation for ARF (2008-2013), the impact of landmark publications on adoption and de-adoption, and factors associated with use.<bold>Methods: </bold>Changes in use of four adjuvants for ARF from 2008 to 2013, the impact of landmark publications on use, and factors associated with use were evaluated with the Premier Database. Extracorporeal membrane oxygenation (ECMO), inhaled nitric oxide, inhaled epoprostenol, and continuous neuromuscular blockading agents (cNMBAs) in adult mechanically ventilated patients were identified on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes and billing data.<bold>Measurements and Main Results: </bold>Among 514,913 patients with ARF, 11,567 (2.3%) were treated with at least one adjuvant. cNMBAs were the most frequently used adjuvants (n = 10,073, 2.1% in capable hospitals), followed by inhaled pulmonary vasodilators (n = 1,878, 1.0% in capable hospitals; 58% nitric oxide), and ECMO (n = 195, 0.2% in capable hospitals). There was an increase in ECMO and inhaled epoprostenol over time but no change in nitric oxide or cNMBAs. Segmented regression analysis was used to evaluate whether clinical practice was in accordance with emerging evidence from landmark studies. Using the relevant landmark publication dates, these analyses did not reveal any change in use over time after publication with the exception of inhaled epoprostenol-for which rates of growth decreased over time, possibly in response to the evidence. There was a significant amount of variability in patient and hospital factors associated with use with between adjuvants.<bold>Conclusions: </bold>Between 2008 and 2013, there was an increase in use of ECMO and inhaled epoprostenol, and no change in use of inhaled nitric oxide or continuous intravenous infusion of a neuromuscular blocking agent. There was considerable variability in patient and hospital factors associated with use across different adjuvants. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTIHYPERTENSIVE agents
THERAPEUTIC use of nitric oxide
ADULT respiratory distress syndrome treatment
RESPIRATORY insufficiency treatment
BRONCHODILATOR agents
PROSTACYCLIN
ARTIFICIAL respiration
EXTRACORPOREAL membrane oxygenation
LONGITUDINAL method
NEUROMUSCULAR blocking agents
RETROSPECTIVE studies
ACUTE diseases
INHALATION administration
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 23296933
- Volume :
- 14
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Annals of the American Thoracic Society
- Publication Type :
- Academic Journal
- Accession number :
- 122226348
- Full Text :
- https://doi.org/10.1513/AnnalsATS.201606-438OC