title: Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) had proven benefits in clinical trials that included selected patients admitted to highly skilled centers. Whether these benefits apply to every patient and in everyday practice deserves appraisal. The aim of the study was to assess the use and outcomes of NIV over the last 15 years.
  
  
  METHODS
  Multicenter database study of critically ill patients who required ventilatory support for acute respiratory failure between 1997 and 2011. The impact of first-line NIV on 60-day mortality was evaluated using a marginal structural model. Follow-up was censored on day 60.
  
  
  RESULTS
  Of 3,163 patients, 1,232 (39 %) received NIV. Over the study period, first-line NIV increased from 29 to 42 %, and NIV success rates increased from 69 to 84 %. NIV decreased 60-day mortality [adjusted hazard ratio (aHR), 0.75; 95 % confidence interval (95 % CI), 0.68-0.83; P < 0.0001]. This protective effect was observed in patients with acute-on-chronic respiratory failure (aHR, 0.71; 95 % CI, 0.57-0.90; P = 0.004), but not in patients with cardiogenic pulmonary edema (aHR, 0.85; 95 % CI, 0.70-1.03; P = 0.10) or in patients with hypoxemic ARF, either immunocompetent (aHR, 1.18; 95 % CI, 0.87-1.59; P = 0.30) or immunocompromised (aHR, 0.89; 95 % CI, 0.70-1.13; P = 0.35). NIV failure was an independent time-dependent risk factor for mortality (aHR, 4.2; 95 % CI, 2.8-6.2; P < 0.0001).
  
  
  CONCLUSIONS
  The use of NIV increased steadily over the study period. First-line NIV was associated with better 60-day survival and fewer ICU-acquired infections compared to first-line intubation. Survival benefits from NIV occurred only in patients with acute-on-chronic respiratory failure and immunocompromised patients.
authors: Réanimation médicale, Medical ICU, Hôpital Saint-Louis, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France, david.schnell1@gmail.com.
authors: David
authors: D
authors: Schnell
authors: Jean-François
authors: JF
authors: Timsit
authors: Michael
authors: M
authors: Darmon
authors: Aurélien
authors: A
authors: Vesin
authors: Dany
authors: D
authors: Goldgran-Toledano
authors: Anne-Sylvie
authors: AS
authors: Dumenil
authors: Maite
authors: M
authors: Garrouste-Orgeas
authors: Christophe
authors: C
authors: Adrie
authors: Lila
authors: L
authors: Bouadma
authors: Benjamin
authors: B
authors: Planquette
authors: Yves
authors: Y
authors: Cohen
authors: Carole
authors: C
authors: Schwebel
authors: Lila
authors: L
authors: Soufir
authors: Samir
authors: S
authors: Jamali
authors: Bertrand
authors: B
authors: Souweine
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D000208:Acute Disease; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods* / Q000639:trends*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome