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*Dr. Nahidh Mohammed Jabur Al. Mamori, Dr. Ghaida Nadhem Abdul-Jabbar, Dr. Safwan Naser Azeez Hadid


Little is known about the effectiveness of noninvasive ventilation for patients hospitalized with asthma exacerbation. Objectives: To assess clinical outcomes of noninvasive (NIV) and examine predictors for NIV use in patients hospitalized with asthma. Methods: This was a retrospective cohort study at hospitals using an electronic medical record database. We developed a hierarchical regression model to identify factors associated with the choice of initial ventilation and used the Laboratory Acute Physiological Score to adjust for differences in the severity of illness. Weassessed the outcomes of patients treated with initial NIV in a propensity-matched cohort. Results: Sixty-two subjects received NIV for asthma, with 20 (mean age 42 ± 12 years, 62% male) meeting the inclusion criteria. Intubation was avoided in all 20 subjects, including nine (45%) with prior history of intubation due to asthma, eight (40%) who were obtunded, and three (15%) who were unresponsive upon arrival. Results are described as medians (ranges). Initial blood gas (80% venous) results were: pH 7.16 (6.89–7.27), PCO2 77 (65–144) mmHg, and HCO3 _ 27 (20–32) mmol/L. Repeat blood gases (45% venous) performed a median of 117 minutes later were: pH 7.31 (7.22–7.45), PCO2 48 (31–63) mmHg, and HCO3 23 (19–31). Vomiting occurred in one patient; no other adverse events were noted. Conclusions: Among patients hospitalized with asthma exacerbation and requiring ventilatory support (NIV or IMV), more than 40% received NIV. Although patients successfully treated with NIV appear to have better outcomes than those treated with IMV, the low rate of NIV failure suggests that NIV was being used selectively in a lower risk group. The increased risk of mortality for patients who fail NIV highlights the need for careful monitoring to avoid possible delay in intubation.

Keywords: Respiratory insufficiency; outcomes research; mortality; length of stay; electronic medical records.

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