0
Original Research: Critical Care |

Use and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in MassachusettsNoninvasive Ventilation in Acute Care

Aylin Ozsancak Ugurlu, MD; Samy S. Sidhom, MD, MPH; Ali Khodabandeh, MD; Michael Ieong, MD; Chester Mohr, MD; Denis Y. Lin, MD; Irwin Buchwald, MD, FCCP; Imad Bahhady, MD; John Wengryn, MD, FCCP; Vinay Maheshwari, MD, FCCP; Nicholas S. Hill, MD, FCCP
Author and Funding Information

From the Department of Pulmonary Disease (Dr Ozsancak Ugurlu), Başkent University, Istanbul, Turkey; Division of Pulmonary, Critical Care and Sleep Medicine (Drs Sidhom and Hill), Tufts Medical Center, Boston, MA; St. Elizabeth’s Medical Center (Dr Khodabandeh), Steward Health Care, Boston, MA; Boston Medical Center (Dr Ieong), Boston, MA; Cape Cod Health Systems (Dr Mohr), Cape Cod Healthcare Inc, Hyannis, MA; Lowell General Hospital (Dr Lin), Lowell, MA; Saints Medical Center (Dr Buchwald), Lowell, MA; Morton Hospital (Dr Bahhady), Steward Health Care, Taunton, MA; Jordan Hospital (Dr Wengryn), Plymouth, MA; and Pulmonary Associates (Dr Maheshwari), Newark, DE.

Correspondence to: Nicholas S. Hill, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, 800 Washington St #257, Boston, MA 02111; e-mail: nhill@tuftsmedicalcenter.org


Funding/Support: Dr Hill received support from the Eli Lilly Distinguished Scholar Award of The CHEST Foundation of the American College of Chest Physicians. The study also received support from a generous gift from Respironics, Inc/Koninklijke Philips N.V. Dr Ozsancak Ugurlu received a research grant from The Scientific and Technological Research Council of Turkey (TUBITAK).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):964-971. doi:10.1378/chest.13-1707
Text Size: A A A
Published online

Background:  This study determined actual utilization rates and outcomes of noninvasive positive pressure ventilation (NIV) at selected hospitals that had participated in a prior survey on NIV use.

Methods:  This observational cohort study, based at eight acute care hospitals in Massachusetts, focused on all adult patients requiring ventilatory support for acute respiratory failure during predetermined time intervals.

Results:  Of 548 ventilator starts, 337 (61.5%) were for invasive mechanical ventilation and 211 (38.5%) were for NIV, with an overall NIV success rate of 73.9% (ie, avoidance of intubation or death while on NIV or within 48 h of discontinuation). Causal diagnoses for respiratory failure were classified as (I) acute-on-chronic lung disease (23.5%), (II) acute de novo respiratory failure (17.9%), (III) neurologic disorders (19%), (IV) cardiogenic pulmonary edema (16.8%), (V) cardiopulmonary arrest (12.2%), and (VI) others (10.6%). NIV use and success rates for each of the causal diagnoses were, respectively, (I) 76.7% and 75.8%, (II) 37.8% and 62.2%, (III) 1.9% and 100%, (IV) 68.5% and 79.4%, (V) none, and (VI) 17.2% and 60%. Hospital mortality rate was higher in patients with invasive mechanical ventilation than in patients with NIV (30.3% vs 16.6%, P < .001).

Conclusions:  NIV occupies an important role in the management of acute respiratory failure in acute care hospitals in selected US hospitals and is being used for a large majority of patients with acute-on-chronic respiratory failure and acute cardiogenic pulmonary edema. NIV use appears to have increased substantially in selected US hospitals over the past decade.

Trial registry:  ClinicalTrials.gov; No.: NCT00458926; URL: www.clinicaltrials.gov

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543