title: Where is Noninvasive Ventilation Actually Delivered for Acute Respiratory Failure?
abstract: OBJECTIVE
  Few studies have examined locations of noninvasive ventilation (NIV) application for acute respiratory failure (ARF). We aimed to track actual locations of NIV delivery and related outcomes.
  
  
  METHODS
  Observational cohort study based at 8 acute care hospitals in Massachusetts on adult patients admitted for ARF requiring ventilatory support during pre-determined time intervals.
  
  
  RESULTS
  Of 1225 ventilator starts, 499 were NIV; 209 (42%) in intensive care units (ICU), 185 (37%) in emergency departments (ED), 91 (18%) on general wards, and 14 (3%) in other units. Utilization (% of all ventilator starts) (1), success (2) and in-hospital mortality (3) rates for patients initiated on NIV in ICU, ED, and general and other wards were (1) 38, 36, 73, and 52%, (2) 60, 77, 68, and 93% and (3) 25, 12, 17, and 0%, respectively (p < 0.05 for all). Patients with acute-on-chronic lung disease (ACLD) and acute pulmonary edema (APE) were begun on NIV most often in EDs and patients with 'de novo' ARF and neurologic disorders most often in ICU's. Approximately 2/3 of patients begun on NIV outside of ICUs were transferred within 72 h to ICUs, wards or other units.
  
  
  CONCLUSIONS
  Most NIV starts occurred in ICUs and EDs but utilization rate was highest (>50%) on general wards where a fifth of NIV starts took place. Actual location depended on etiology of ARF as patients with ACLD and APE were started more often in EDs and "de novo" ARF in ICU. NIV failure and mortality rates were higher in ICUs related to the greater proportion of patients with "de novo" ARF.
authors.affiliation: Department of Pulmonary Disease, Baskent University, Oymaci sok. No: 2, 34662, Altunizade/Istanbul, Turkey. aozsancak@hotmail.com.
authors.forename: Aylin
authors.initials: A
authors.lastname: Ozsancak Ugurlu
authors.affiliation: Pulmonary Department, Newton-Wellesley Hospital, Newton, MA, USA.
authors.forename: Samy S
authors.initials: SS
authors.lastname: Sidhom
authors.affiliation: Mass Lung and Allergy PC, Leominster, MA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Khodabandeh
authors.affiliation: Boston Medical Center, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ieong
authors.affiliation: Cape Cod Health Systems, Hyannis, MA, USA.
authors.forename: Chester
authors.initials: C
authors.lastname: Mohr
authors.affiliation: Lowell General Hospital, Lowell, MA, USA.
authors.forename: Denis Y
authors.initials: DY
authors.lastname: Lin
authors.affiliation: Saints Medical Center, Lowell, MA, USA.
authors.forename: Irwin
authors.initials: I
authors.lastname: Buchwald
authors.affiliation: Morton Hospital, Taunton, MA, USA.
authors.forename: Imad
authors.initials: I
authors.lastname: Bahhady
authors.affiliation: Jordan Hospital, Plymouth, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Wengryn
authors.affiliation: Pulmonary Associates, Newark, DE, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Maheshwari
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D011654:Pulmonary Edema / Q000150:complications / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Acute respiratory failure; Emergency care; General wards; Intensive care units; Noninvasive ventilation