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Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes

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Abstract

Purpose

Noninvasive ventilation (NIV) had proven benefits in clinical trials that included selected patients admitted to highly skilled centers. Whether these benefits apply to every patient and in everyday practice deserves appraisal. The aim of the study was to assess the use and outcomes of NIV over the last 15 years.

Methods

Multicenter database study of critically ill patients who required ventilatory support for acute respiratory failure between 1997 and 2011. The impact of first-line NIV on 60-day mortality was evaluated using a marginal structural model. Follow-up was censored on day 60.

Results

Of 3,163 patients, 1,232 (39 %) received NIV. Over the study period, first-line NIV increased from 29 to 42 %, and NIV success rates increased from 69 to 84 %. NIV decreased 60-day mortality [adjusted hazard ratio (aHR), 0.75; 95 % confidence interval (95 % CI), 0.68–0.83; P < 0.0001]. This protective effect was observed in patients with acute-on-chronic respiratory failure (aHR, 0.71; 95 % CI, 0.57–0.90; P = 0.004), but not in patients with cardiogenic pulmonary edema (aHR, 0.85; 95 % CI, 0.70–1.03; P = 0.10) or in patients with hypoxemic ARF, either immunocompetent (aHR, 1.18; 95 % CI, 0.87–1.59; P = 0.30) or immunocompromised (aHR, 0.89; 95 % CI, 0.70–1.13; P = 0.35). NIV failure was an independent time-dependent risk factor for mortality (aHR, 4.2; 95 % CI, 2.8–6.2; P < 0.0001).

Conclusions

The use of NIV increased steadily over the study period. First-line NIV was associated with better 60-day survival and fewer ICU-acquired infections compared to first-line intubation. Survival benefits from NIV occurred only in patients with acute-on-chronic respiratory failure and immunocompromised patients.

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Conflicts of interest

No conflict of interest relevant to this study occurred for any of the authors.

Author information

Authors and Affiliations

  1. Réanimation médicale, Medical ICU, Hôpital Saint-Louis, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France

    David Schnell & Élie Azoulay

  2. UFR de Médecine, University Paris-7 Paris-Diderot, 75010, Paris, France

    David Schnell & Élie Azoulay

  3. Medical Polyvalent ICU, Grenoble University Hospital, 38043, Grenoble, France

    Jean-François Timsit & Carole Schwebel

  4. Team 11: Outcome of Respiratory Cancers and Mechanically Ventilated Patients, Integrated Research Center U823, Albert Bonniot Institute, Rond Point de la Chantourne, 38706, La Tronche Cedex, France

    Jean-François Timsit, Aurélien Vesin & Maite Garrouste-Orgeas

  5. Medical-Surgical ICU, Saint-Etienne University Hospital, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France

    Michael Darmon

  6. Jacques Lisfranc Medical School, Jean Monnet University, 42000, Saint-Etienne, France

    Michael Darmon

  7. Polyvalent ICU, Gonesse General Hospital, 25 rue Bernard Février, BP 30071, 95503, Gonesse Cedex, France

    Dany Goldgran-Toledano

  8. Surgical ICU, Hôpital Antoine Beclère, AP-HP, 157 rue de la Porte de Trivaux, 92141, Clamart Cedex, France

    Anne-Sylvie Dumenil

  9. Polyvalent ICU, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Maite Garrouste-Orgeas

  10. Polyvalent ICU, Centre Hospitalier de Saint Denis, 2 rue du Docteur Pierre Delafontaine, 93205, Saint-Denis, France

    Christophe Adrie

  11. Medical ICU, Hôpital Bichat, Claude Bernard, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France

    Lila Bouadma

  12. Polyvalent ICU, Centre hospitalier André Mignot, 177 rue de Versailles, 78157, Le Chesnay, France

    Benjamin Planquette

  13. Medical ICU, Hôpital Avicenne, AP-HP, 125 rue de Stalingrad, 93000, Bobigny, France

    Yves Cohen

  14. Surgical ICU, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Lila Soufir

  15. Polyvalent ICU, Centre Hospitalier Simone Veil, 14 Rue de Saint-Prix, 95600, Eaubonne, France

    Samir Jamali

  16. Medical ICU, Gabriel Montpied University Hospital, 58 boulevard Montalembert, 63003, Clermont-Ferrand Cedex 1, France

    Bertrand Souweine

Authors
  1. David Schnell
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  2. Jean-François Timsit
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  3. Michael Darmon
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  4. Aurélien Vesin
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  5. Dany Goldgran-Toledano
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  6. Anne-Sylvie Dumenil
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  7. Maite Garrouste-Orgeas
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  8. Christophe Adrie
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  9. Lila Bouadma
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  10. Benjamin Planquette
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  11. Yves Cohen
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  12. Carole Schwebel
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  13. Lila Soufir
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  14. Samir Jamali
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  15. Bertrand Souweine
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  16. Élie Azoulay
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Corresponding author

Correspondence to Élie Azoulay.

Additional information

Take-home message: The use of NIV as the first-line ventilatory support in patients with acute respiratory failure is increasing. Compared to first-line IMV, first-line NIV markedly improves survival in patients with acute-on-chronic respiratory failure but not in other settings.

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Schnell, D., Timsit, JF., Darmon, M. et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med 40, 582–591 (2014). https://doi.org/10.1007/s00134-014-3222-y

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  • DOI: https://doi.org/10.1007/s00134-014-3222-y

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