Noninvasive ventilation: A survey of practice patterns of its use in India

Abstract

Background and Aims:To understand the practice patterns of noninvasive ventilation (NIV) use by Indian physicians.Subjects and Methods:Around three thousand physicians from all over India were mailed a questionnaire that could capture the practice patterns of NIV use.Results:Completed responses were received from 648 physicians (21.6%). Majority (n = 469, 72.4%, age 40 ± 9 years, M:F 409:60) use NIV in their clinical practice. NIV was most exclusively being used in the ICU setting (68.4%) and the commonest indication for its use was chronic obstructive pulmonary disease (COPD) (71.4%). A significant number did not report use of a conventional ventilator for NIV support (62%). Oronasal mask was the overwhelming favorite among the sampled physicians (68.2%). In most of the cases, the treating physician initiated NIV (60.8%) and a baseline blood gas analysis was performed in only 71.1% of the cases (315/443). Nasal bridge pressure sores was the commonest complication (64.2%).Conclusions:NIV is being widely used in clinical practice in India for various indications. COPD is the most common indication for its deployment. There seems to be a marked variability in the patterns relating to actual deployment of NIV, including the site of initiation, protocols for initiation followed, and monitoring of patients.

Approach of pulmonologists in turkey to noninvasive mechanical ventilation use in acute respiratory failure

“…COPD was shown to be the most frequent indication in most of the previous surveys, and NIV utilization rate for ACLD is shown to be mid-70s in real-life studies (7,8,12,(16)(17)(18)(19). Our findings were consistent with these, as ACLD were the most common indications for NIV use.…”

“…OHS, which for NIV was shown to be equally effective with better outcomes than COPD by Carrillo et al, was the second most common indication after COPD (30). We found the rate of physicians using NIV for CPE to be similar or quite lower than rates in prior surveys, which could be due to the application of NIV by cardiologists without consulting pulmonologists in their units (14,(16)(17)(18). Probably based on the growing evidence on the use of NIV during weaning or for post-extubation ARF, more than 60% of our responders noted quite frequent NIV use in these conditions (28).…”

“…The pulmonologists not using NIV in practice were older specialists, generally from non-teaching hospitals of different regions of Turkey, with a higher patient load and longer experience in the pulmonary field but lower experience in NIV use and ICU. The rate and the associations were reported similarly in Ontario and India surveys (16,18). However, it is important to underline that half of our NIV non-users had NIV training during fellowship, with a median of 3.5 years of experience, and some of them cited a lack of adequate equipment, trained medical staff and appropriate facilities for follow-up of NIV patients rather than poor previous experience in NIV use (oral communication).…”

“…Predictors of NIV success can be listed as the cause and type of ARF, the severity of the underlying disease, the experience and skills of the NIV-applying team, the equipment used or the location of the application (10,11). Surveys done in Europe, America and India reflected the physicians and respiratory therapists' variable attitudes to NIV use (12)(13)(14)(15)(16)(17)(18)(19).…”

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

“…In Europe and India, nearly 70% of physicians use oronasal masks. 25,26 In the United States, 76% of emergency physicians reported using oronasal masks in Ͼ50% of cases, and in 17% of centers, only oronasal masks were used. 27 Thus, our study reflects most cases of NIV intolerance.…”