Bilevel noninvasive positive pressure ventilation for acute respiratory failure: survey of Ontario practice.
OBJECTIVE
To determine physicians' stated practices regarding the use of bilevel noninvasive ventilation (NIV) for acute respiratory failure and the predictors of practice variation.


METHODS
Cross-sectional postal survey.


METHODS
Province of Ontario, Canada.


METHODS
Attending physicians and residents in four specialties at 15 teaching hospitals.


METHODS
We used literature searches and focus groups to design questions related to NIV utilization with respect to frequency, location of and indications for use, awareness of supporting literature, and perceived efficacy. We assessed the survey's clinical sensibility and reliability. We used regression analyses to evaluate practice variation among hospitals and specialties and to determine predictors of more frequent NIV use, initiation of and continued use in nonmonitored settings, and use for specific indications.


RESULTS
Three hundred eighty-five (48%) of 808 physicians responded; 242 used NIV. The two most common indications for NIV use were chronic obstructive pulmonary disease and congestive heart failure. NIV guidelines, protocols, or policies were available in 12 of 15 hospitals. We found variation in NIV utilization among specialties but not hospitals. Specialty (critical care and respirology versus internal and emergency medicine), fewer years of postgraduate experience, and a greater number of noninvasive ventilators were predictors of more frequent NIV use (all p < or = .001). Only 6% of respondents reported initiation of use and continued use most frequently in nonmonitored settings, which increased with the number of noninvasive ventilators (p = .02). Physician characteristics such as awareness of the literature were predictive of NIV use for exacerbations of chronic obstructive pulmonary disease, whereas perceived NIV efficacy was predictive of use for many indications, including congestive heart failure.


CONCLUSIONS
Self-reported practice variation for bilevel NIV exists among specialties but not hospitals and differs with respect to frequency, location of use, and use for specific indications. Some factors associated with variation in NIV use may be suitable targets for utilization improvement interventions.
Division of Critical Care Medicine, University of Western Ontario, London, Ontario, Canada.
Karen E A
KE
Burns
Tasnim
T
Sinuff
Neill K J
NK
Adhikari
Maureen O
MO
Meade
Diane
D
Heels-Ansdell
Claudio M
CM
Martin
Deborah J
DJ
Cook
D000208:Acute Disease; D003430:Cross-Sectional Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008511:Medicine / Q000706:statistics & numerical data; D009864:Ontario; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000628:therapy*; D013038:Specialization