title: Non-invasive ventilation outside of the Intensive Care Unit: an Italian survey.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) is increasingly utilized for patients with acute respiratory failure (ARF). The shortage of Intensive Care Unit (ICU) beds, a growing confidence with the technique, and the opportunity to treat ARF in a more responsive phase lead to the application of NIV outside of the ICU. The Study Group on Emergency of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) promoted a national survey to collect data on NIV use outside of the ICU.
  
  
  METHODS
  An anonymous questionnaire was developed, focusing on the location and modalities of NIV treatments, organizational and technical aspects, monitoring, estimated outcomes, the presence of protocols, and complications. The questionnaire was mailed to all members of the Scientific Society.
  
  
  RESULTS
  Forty-six respondents were from 46 hospitals. Thirty-seven (80%) respondents applied NIV in the Emergency Department and/or General Wards. In the majority of hospitals (72%), training preceded NIV introduction. NIV could be applied in all ordinary wards in 28% of the hospitals. Patients remained in their ward in 89% of the hospitals, and a protocol was present in 70% of the hospitals. Monitoring was usually limited to continuous pulse-oxymetry and EKG; 18% of respondents did not have a monitoring standard. Reported complications and practical problems were potentially severe. Few hospitals (15%) collected data on NIV treatments. The efficacy of NIV was perceived as low, as 73% of respondents estimated that NIV avoided tracheal intubation in less than half of the treated patients.
  
  
  CONCLUSIONS
  In Italy, NIV is extensively applied in non-intensive wards, and its use is not free from criticalities and contradictions. Further prospective studies and possibly guidelines are needed.
authors: Department of Anesthesia and Intensive Care, Vita-Salute University and San Raffaele Hospital, Milan, Italy. cabrini.luca@hsr.it
authors: L
authors: L
authors: Cabrini
authors: M
authors: M
authors: Antonelli
authors: G
authors: G
authors: Savoia
authors: M
authors: M
authors: Landriscina
mesh_terms: D000075202:Contraindications; D003422:Critical Care; D004562:Electrocardiography; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008991:Monitoring, Physiologic; D010092:Oximetry; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires