title: An international survey on noninvasive ventilation use for acute respiratory failure in general non-monitored wards.
abstract: BACKGROUND
  Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF.
  
  
  METHODS
  A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The multiple-choice anonymous questionnaire to be filled out online was distributed worldwide by mail, LinkedIn, and Facebook professional groups.
  
  
  RESULTS
  One-hundred fifty-seven questionnaires were filled out and analyzed. Respondents were from 51 countries from all 5 continents. NIV application in general wards was reported by 66% of respondents. Treatments were reported as increasing in 57% of cases. Limited training and human resources were the most common reasons for not using NIV in general wards. Overall, most respondents perceived that NIV avoids tracheal intubation in most cases; worsening of ARF, intolerance, and inability to manage secretions were the most commonly reported causes of NIV failure.
  
  
  CONCLUSIONS
  Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting.
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.affiliation: Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esquinas
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy. pasin.laura@hsr.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Nardelli
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Frati
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Pintaudi
authors.affiliation: Pneumology Department, Coimbra Hospital and University, Coimbra, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Matos
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: acute respiratory failure; general wards; noninvasive ventilation; survey