Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe Asthma Exacerbation: A Cohort Study

Objectives: The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality. Design: Retrospective, propensity-score–matched cohort study. Setting: Administrative data from Healthcare Cost and Utilization Project’s State Inpatient Databases for New York and Florida, 2006–2019. Patients: Patients 5–80 years old hospitalized with an asthma exacerbation. Interventions: Receipt of NPPV. Measurements and Main Results: Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6–6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5–7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensity-score matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40–0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21–0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95% CI, 0.29–0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15–1.11). Conclusions: NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.