title: What prevents critically ill patients with respiratory failure from using non-invasive positive pressure ventilation: A mixed-methods study.
abstract: OBJECTIVE
  To identify the factors that prevent patients in respiratory failure from using noninvasive positive pressure ventilation (NPPV). The following were evaluated: (i) the patients who converted from NPPV to endotracheal intubation; and (ii) the patients who abandoned NPPV.
  
  
  METHODS
  Patients were interviewed regarding their experience with NPPV. Next, the factors that prevented the continuation of NPPV were identified and those data were collected retrospectively from medical records. The participants included adult patients in intensive care who were undergoing NPPV. The data from the interviews of nine participants were analyzed by using content analysis. Data that were collected from the medical records of 126 participants contributed to the identification of the characteristics that affected the implementation of NPPV. The factors were entered into a model by using logistic regression and decision-tree analysis.
  
  
  RESULTS
  An interview content analysis revealed eight aspects of the patients' experiences. In the medical record analysis, the specific factors that were associated with the conversion to intubation were the Acute Physiology and Chronic Health Evaluation II scores, breathing becoming easier, arterial oxygen partial pressure to fractional inspired oxygen ratio, and realizing the necessity of NPPV. The factors that were associated with the abandonment of NPPV included sleep loss, delirium, discomfort, and the arterial oxygen partial pressure to fractional inspired oxygen ratio. Realizing the necessity of NPPV was not statistically significant. With regard to the decision-tree analysis, the factors that were selected were similar to those that were selected in the factor analysis.
  
  
  CONCLUSIONS
  In the initial stage of NPPV, focusing on dyspnea, sleep loss, discomfort, delirium, and the realization of the necessity of NPPV were critical in deciding on continuing this intervention or the early conversion to intubation.
authors.affiliation: Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Murata
authors.affiliation: National College of Nursing, Tokyo, Japan.|Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011175:Positive-Pressure Respiration / Q000379:methods*; D012107:Research Design; D012131:Respiratory Insufficiency / Q000451:nursing / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies
keywords: critical care; mixed-methods; non-invasive positive pressure ventilation; respiratory care