title: Noninvasive ventilation practice patterns for acute respiratory failure in Canadian tertiary care centres: A descriptive analysis.
abstract: BACKGROUND
  The extent of noninvasive ventilation (NIV) use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.
  
  
  OBJECTIVE
  To describe NIV practice variation in the acute setting.
  
  
  METHODS
  A prospective observational study involving 11 Canadian tertiary care centres was performed. Data regarding NIV indication, mode and outcomes were collected for all adults (>16 years of age) treated with NIV for acute respiratory failure during a four-week period (between February and August 2011). Logistic regression with site as a random effect was used to examine the association between preselected predictors and mortality or intubation.
  
  
  RESULTS
  A total of 330 patients (mean [± SD] 30±12 per centre) were included. The most common indications for NIV initiation were pulmonary edema (104 [31.5%]) and chronic obstructive pulmonary disease (99 [30.0%]). Significant differences in indications for NIV use across sites, specialty of ordering physician and location of NIV initiation were noted. Although intubation rates were not statistically different among sites (range 10.3% to 45.4%), mortality varied significantly (range 6.7% to 54.5%; P=0.006). In multivariate analysis, the most significant independent predictor of avoiding intubation was do-not-resuscitate status (OR 0.11 [95% CI 0.03 to 0.37]).
  
  
  CONCLUSIONS
  Significant variability existed in NIV use and associated outcomes among Canadian tertiary care centres. Assignment of do-not-resuscitate status prevented intubation.
authors.forename: Genevieve Christina
authors.initials: GC
authors.lastname: Digby
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parker
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.forename: Karen E
authors.initials: KE
authors.lastname: Burns
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Ronco
authors.forename: Demetrios J
authors.initials: DJ
authors.lastname: Kutsogiannis
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
authors.forename: Luc R
authors.initials: LR
authors.lastname: Berthiaume
authors.forename: Christine L
authors.initials: CL
authors.lastname: D'Arsigny
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Stollery
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D062606:Tertiary Care Centers