Increased use of noninvasive ventilation in French intensive care units

• Published in: Intensive care medicine 2006-11, Vol.32 (11), p.1747-1755
• Main Authors: DEMOULE, Alexandre, GIROU, Emmanuelle, RICHARD, Jean-Christophe, TAILLE, Solenne, BROCHARD, Laurent
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute respiratory distress syndrome; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Artificial respiration; Biological and medical sciences; Care and treatment; Chronic obstructive pulmonary disease; Clinical death. Palliative care. Organ gift and preservation; Coma; Coma - therapy; Edema; Emergency and intensive respiratory care; France; Health aspects; Health Care Surveys; Hospital patients; Humans; Intensive care; Intensive care medicine; Intensive Care Units; Intubation; Intubation, Intratracheal - utilization; Logistic Models; Medical sciences; Multivariate Analysis; Oxygen therapy; Patients; Pneumonia; Pneumonia - therapy; Prospective Studies; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary Edema - therapy; Respiration, Artificial - methods; Respiration, Artificial - trends; Respiratory failure; Respiratory Insufficiency - therapy; Success; Surveys; Task forces; Treatment Outcome; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-006-0229-z

A prospective survey of French intensive care units (ICUs) in 1997 showed moderate and variable use of noninvasive ventilation (NIV). This study examined changes in NIV use in French ICUs after the intervening 5years. Patients were enrolled in a prospective survey in 70 French ICUs. Three-week survey, with prospective inclusion of all patients requiring ventilatory support. Overall 1,076 patients received ventilatory support (55% of admissions). First-line NIV was significantly more common than 5years earlier, overall (23% vs. 16%) and especially in patients not intubated before ICU admission (52% vs. 35%). Reasons for respiratory failure were coma (33%), cardiogenic pulmonary edema (8%), acute-on-chronic respiratory failure (17%), and de novo respiratory failure (41%). Significant increases in NIV use were noted for acute-on-chronic respiratory failure (64% vs. 50%) and de novo respiratory failure (22% vs. 14%). Among patients given NIV, 38% subsequently required endotracheal intubation (not significantly different). Independent risk factors for NIV failure were high SAPS II and de novo respiratory failure, whereas factors associated with success were good NIV tolerance and high body mass index. NIV use has significantly increased in French ICUs during the past 5years, and the success rate has remained unchanged. In patients not previously intubated, NIV is the leading first-line ventilation modality. The proportion of patients successfully treated with NIV increased significantly over the 5-year period (13% vs. 9% of all patients receiving ventilatory support).