Use and outcomes of noninvasive positive pressure ventilation in acute care hospitals in Massachusetts.
BACKGROUND
This study determined actual utilization rates and outcomes of noninvasive positive pressure ventilation (NIV) at selected hospitals that had participated in a prior survey on NIV use.


METHODS
This observational cohort study, based at eight acute care hospitals in Massachusetts, focused on all adult patients requiring ventilatory support for acute respiratory failure during predetermined time intervals.


RESULTS
Of 548 ventilator starts, 337 (61.5%) were for invasive mechanical ventilation and 211 (38.5%) were for NIV, with an overall NIV success rate of 73.9% (ie, avoidance of intubation or death while on NIV or within 48 h of discontinuation). Causal diagnoses for respiratory failure were classified as (I) acute-on-chronic lung disease (23.5%), (II) acute de novo respiratory failure (17.9%), (III) neurologic disorders (19%), (IV) cardiogenic pulmonary edema (16.8%), (V) cardiopulmonary arrest (12.2%), and (VI) others (10.6%). NIV use and success rates for each of the causal diagnoses were, respectively, (I) 76.7% and 75.8%, (II) 37.8% and 62.2%, (III) 1.9% and 100%, (IV) 68.5% and 79.4%, (V) none, and (VI) 17.2% and 60%. Hospital mortality rate was higher in patients with invasive mechanical ventilation than in patients with NIV (30.3% vs 16.6%, P &lt; .001).


CONCLUSIONS
NIV occupies an important role in the management of acute respiratory failure in acute care hospitals in selected US hospitals and is being used for a large majority of patients with acute-on-chronic respiratory failure and acute cardiogenic pulmonary edema. NIV use appears to have increased substantially in selected US hospitals over the past decade.


BACKGROUND
ClinicalTrials.gov; No.: NCT00458926; URL: www.clinicaltrials.gov.
Department of Pulmonary Disease, Başkent University, Istanbul, Turkey.
Aylin
A
Ozsancak Ugurlu
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA.
Samy S
SS
Sidhom
St. Elizabeth's Medical Center, Steward Health Care, Boston, MA.
Ali
A
Khodabandeh
Boston Medical Center, Boston, MA.
Michael
M
Ieong
Cape Cod Health Systems, Cape Cod Healthcare Inc, Hyannis, MA.
Chester
C
Mohr
Lowell General Hospital, Lowell, MA.
Denis Y
DY
Lin
Saints Medical Center, Lowell, MA.
Irwin
I
Buchwald
Morton Hospital, Steward Health Care, Taunton, MA.
Imad
I
Bahhady
Jordan Hospital, Plymouth, MA.
John
J
Wengryn
Pulmonary Associates, Newark, DE.
Vinay
V
Maheshwari
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA. Electronic address: nhill@tuftsmedicalcenter.org.
Nicholas S
NS
Hill
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome