Chest
Original ResearchUse and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in Massachusetts
Section snippets
Study Centers
Eight of 76 medical centers from our prior survey11 were selected based on their willingness to participate, distance < 90 miles from Boston, and ability to provide a mix of teaching and nonteaching hospitals. The institutional review boards of participating institutions approved the study (Tufts ID #7642) and waived the need for patient consent because it was observational only. Characteristics of the eight acute care hospitals are presented in Table 1. Participating hospitals were estimated
Overall NIV Utilization
Figure 1 shows that of 1,153 episodes of mechanical ventilation screened, 605 were excluded and 548 episodes in 540 patients met entry criteria. The utilization rate of NIV as a first-line ventilator modality was 38.5% among all ventilator starts. NIV was discontinued early (prior to meeting weaning criteria) in 75 NIV starts (35.5%). Twenty, discontinued after a median of 3.6 hours of NIV (interquartile range, 0.4-20.3), required no further ventilatory assistance, survived, and were considered
Discussion
Our study demonstrates that use of NIV is quite common in selected acute care hospitals in the United States, even among low utilizers in a previous survey.11 As anticipated, use of NIV depends heavily on etiology of ARF and is most commonly applied in patients with COPD exacerbations and CPE, diagnoses for which it is recommended as a first-line therapy by current guidelines.1, 7, 8
In an early survey of NIV application in 15 acute care teaching hospitals in Ontario, Canada, 63% of respondents
Acknowledgments
Author contributions: Drs Ozsancak Ugurlu, Sidhom, and Hill are guarantors of the entire manuscript.
Dr Ozsancak Ugurlu: contributed to study design, data acquisition, and analysis and preparation of the manuscript.
Dr Sidhom: contributed to study design, data acquisition, and analysis and preparation of the manuscript.
Dr Khodabandeh: contributed to study design, data acquisition, and analysis and preparation of the manuscript.
Dr Ieong: contributed to data acquisition and preparation of the
References (25)
- et al.
Noninvasive ventilation for critical care
Chest
(2007) - et al.
Non-invasive ventilation in acute respiratory failure
Lancet
(2009) - et al.
Utilization of noninvasive ventilation in acute care hospitals: a regional survey
Chest
(2006) International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure
Am J Respir Crit Care Med
(2001)- et al.
Noninvasive ventilation in acute respiratory failure
Crit Care Med
(2007) - et al.
Noninvasive positive pressure ventilation in the acute care setting: where are we?
Eur Respir J
(2008) - et al.
Non-invasive ventilation
Minerva Anestesiol
(2009) - et al.
Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting
CMAJ
(2011) Non-invasive ventilation in acute respiratory failure
Thorax
(2002)- et al.
Increased use of noninvasive ventilation in French intensive care units
Intensive Care Med
(2006)
Evolution of mechanical ventilation in response to clinical research
Am J Respir Crit Care Med
Bilevel noninvasive positive pressure ventilation for acute respiratory failure: survey of Ontario practice
Crit Care Med
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An observational study on the practice of noninvasive ventilation at a tertiary level Australian intensive care unit
2020, Australian Critical CareCitation Excerpt :On the other hand, immediate failure after secondary NIV application, which occurred in one episode, may have been the result of premature extubation. ICU mortality was 1.7%, while hospital mortality was 5%, which appears to be at the lower end of the range (5–22%) noted in recent observational studies.12,19,20 Recent literature has raised concerns about increased mortality among patients who fail NIV and need invasive mechanical ventilation compared with those who are managed with invasive ventilation from time zero.2,22,23
Noninvasive ventilation failure in pneumonia patients ≥ 65 years old: The role of cough strength
2018, Journal of Critical CareThe effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis
2018, American Journal of Emergency Medicine
Funding/Support: Dr Hill received support from the Eli Lilly Distinguished Scholar Award of The CHEST Foundation of the American College of Chest Physicians. The study also received support from a generous gift from Respironics, Inc/Koninklijke Philips N.V. Dr Ozsancak Ugurlu received a research grant from The Scientific and Technological Research Council of Turkey (TUBITAK).
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