title: Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries.
abstract: OBJECTIVE
  Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown.
  
  
  METHODS
  Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries.
  
  
  RESULTS
  Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality.
  
  
  CONCLUSIONS
  Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier NCT01449331.
authors.affiliation: Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. alexandre.demoule@psl.aphp.fr.|UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France. alexandre.demoule@psl.aphp.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Demoule
authors.affiliation: Département de biostatistique et d'Information médicale, et INSERM UMR-717, Hôpital Saint-Louis, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Respiratory Intensive Care Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Carlucci
authors.affiliation: Réanimation médicale et Médecine hyperbare, Centre Hospitalier Universitaire, Angers, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: Département d'Anesthésie et Réanimation, Hôpital Saint-Eloi, Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
authors.affiliation: Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Service de Réanimation médicale, Hôpital Saint-Louis, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.affiliation: Service Réanimation polyvalente, Centre Hospitalier Sud Francilien, Evry, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Clergue
authors.affiliation: Service de Réanimation Médicochirurgicale, Hôpital Raymond Poincaré, Garches, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Aboab
authors.affiliation: Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: UMR 7268 ADéS, Aix-Marseille Université/Espace éthique méditerranéen, Réanimation des Urgences et Médicale-Hôpital La Timone 2, Marseille, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Eon
authors.affiliation: Service de Réanimation médicale, Hôpital de la Croix Rousse, Lyon, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
authors.affiliation: Service de Réanimation Polyvalente et Maladies Infectieuses, Centre Hospitalier, Tourcoing, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zuber
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de l'Archet, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dellamonica
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier André Grégoire, Montreuil, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Das
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Robert Debré, Reims, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Cousson
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Louis Pasteur, Dole, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Perez
authors.affiliation: Keenan Research Centre and Li Ka Shing Institute, Saint-Michael's Hospital, Toronto, ON, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: Service de Réanimation médicale, Hôpital Saint-Louis, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000208:Acute Disease; D000368:Aged; D001530:Belgium; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000639:trends; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000639:trends; D012131:Respiratory Insufficiency / Q000628:therapy*; D015996:Survival Rate / Q000639:trends*
keywords: Acute respiratory failure; Mechanical ventilation; Non-invasive ventilation; Outcome