An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

Abstract

BACKGROUND: Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. METHODS: A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The multiple-choice anonymous questionnaire to be filled out online was distributed worldwide by mail, LinkedIn, and Facebook professional groups. RESULTS: One-hundred fifty-seven questionnaires were filled out and analyzed. Respondents were from 51 countries from all 5 continents. NIV application in general wards was reported by 66% of respondents. Treatments were reported as increasing in 57% of cases. Limited training and human resources were the most common reasons for not using NIV in general wards. Overall, most respondents perceived that NIV avoids tracheal intubation in most cases; worsening of ARF, intolerance, and inability to manage secretions were the most commonly reported causes of NIV failure. CONCLUSIONS: Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting.

Challenges to and opportunities for the implementation of non‐invasive positive pressure ventilation in the Asia‐Pacific region

“…In developed countries, NPPV is used by up to 70% of emergency departments, contrasting to data from mainland China and Lebanon suggesting that only around 48% of emergency departments use NPPV …”

“…In most developed countries, NPPV is used widely in general wards as well as in intensive care unit (ICU). In European and international surveys, the utilization rates of NPPV in general wards have been reported to be 66–75% . The utilization rate of NPPV in general wards in the underdeveloped countries of the Asia‐Pacific region is lower.…”

“…Surveys of international practice suggest that NPPV is used in over 90% of ICU However, in underdeveloped countries of the Asia‐Pacific region, this rate is considerably lower. Data from India reported that only 68.4% of ICU used NPPV .…”

“…Second, greater attention should be paid to staff training. As previously discussed, there is a lack of staff trained in the application of NPPV treatment . It is vital to have well‐trained and experienced staff for the success and tolerance of NPPV treatment.…”

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

“…An international survey of NIV use determined that approximately 42% of patients had failed NIV due to poor patient compliance with the interface and related complications 22. Development of facial pressure injuries related to the NIV interface is widely reported in the literature; however, limited data are available on the risk factors and prevention methods that reduce such complications.…”