TY - JOUR T1 - Acute exacerbations of COPD (AECOPD) in intensive care unit (ICU): Are non-invasive ventilation (NIV) use and mortality different in high volume ICUs? JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p5007 AU - Martin Dres AU - Thi-Chien Tran AU - Philippe Aegerter AU - Antoine Rabbat AU - Bertrand Guidet AU - Gerard Huchon AU - Nicolas Roche Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p5007.abstract N2 - Introduction: NIV for the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) increased last decades. ICU teams caring for a high number of AECOPD could gain more experience and therefore use NIV in a higher proportion of patients. The case-volume could also be associated with ICU mortality.Material and methods: The French CUB-REA database includes 32 ICUs. AECOPD cases were extracted according to ICD-10 coding. To assess the effect of case volume on NIV use, invasive ventilation (IV) use and mortality, multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors.Results: Between 1998 and 2008, 6,434 AECOPD were identified. SAPS II and ICU mortality gradually increased (35 to 41 and 11 to 16%, respectively). The proportion of patients receiving any mechanical ventilation increased (66% to 85%), with a marked increase in the use of NIV (from 19% to 43%) and a decrease in the use of IV (35 to 23%). Case volume tertiles were: low volume (10 admissions per year), intermediate (10-26) and high volume (more than 26). There was a significant association between case volume, NIV use and ICU mortality: OR for the highest versus lowest and intermediate tertiles were: 5.61 [95% CI: 4.87 - 6.46] and 0.83 [95% CI: 0.73 - 0.94], respectively.Conclusion: During this period, the severity and mortality rate of AECOPD admitted in CUB-REA ICUs increased. There was a growing use of NIV and a decreased use of IV. NIV use and ICU mortality were related to case volume, suggesting that increasing experience favours the use of NIV without impairing patients' outcomes. ER -