title: NIPPV: prevalence, approach and barriers to use at Canadian ALS centres.
abstract: OBJECTIVE
  The purpose of this study was to evaluate Canadian amyotrophic lateral sclerosis (ALS) centres with respect to: 1) the prevalence of Non-invasive positive pressure ventilation (NIPPV) and invasive mechanical ventilation via tracheostomy (TV) utilization, 2) the approach to NIPPV use, focusing upon the currently employed initiation criteria and 3) the barriers influencing NIPPV administration.
  
  
  METHODS
  A descriptive survey research design aimed to obtain quantitative data and open-ended responses from an active physician at each of the 15 multidisciplinary Canadian ALS centres.
  
  
  RESULTS
  The principal findings of this study were: 1) NIPPV and TV are used in 18.3% and 1.5% of patients at Canadian ALS centres, respectively, 2) symptoms of respiratory insufficiency, namely orthopnea (clinical significance rated at 9.00/10 +/- 1.48), dyspnea (8.27 +/- 1.95) and morning headache (7.55 +/- 1.21) are the most significant indicators for NIPPV initiation, 3) the primary barriers to NIPPV utilization are patient intolerance (70% of centres) and inaccessibility of respirologists and ventilation technologists (50% of centres).
  
  
  CONCLUSIONS
  Variability in NIPPV use has an impact upon the management of Canadian ALS patients. The establishment of more definitive NIPPV initiation criteria, emphasizing respiratory symptoms, and the attenuation of barriers to NIPPV use should be targeted so as to ensure optimal care for all ALS patients.
authors.affiliation: Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Ritsma
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Berger
authors.forename: David A
authors.initials: DA
authors.lastname: Charland
authors.forename: Michael A
authors.initials: MA
authors.lastname: Khoury
authors.forename: Joel T
authors.initials: JT
authors.lastname: Phillips
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strong
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Schulz
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015337:Multicenter Studies as Topic; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011787:Quality of Health Care; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000379:methods