Intensive Care Medicine

, Volume 32, Issue 11, pp 1747–1755 | Cite as

Increased use of noninvasive ventilation in French intensive care units

  • Alexandre Demoule
  • Emmanuelle Girou
  • Jean-Christophe Richard
  • Solenne Taillé
  • Laurent Brochard
Original

Abstract

Objectives

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 5 years.

Settings

Patients were enrolled in a prospective survey in 70 French ICUs.

Methods

Three-week survey, with prospective inclusion of all patients requiring ventilatory support.

Measurements and results

Overall 1,076 patients received ventilatory support (55% of admissions). First-line NIV was significantly more common than 5 years 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.

Conclusions

NIV use has significantly increased in French ICUs during the past 5 years, 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).

Keywords

Acute respiratory failure Cardiogenic pulmonary edema Chronic obstructive pulmonary disease Pneumonia Endotracheal intubation 

Notes

Acknowledgements

Physicians and centers participating in the study: Angers, Centre Hospitalier Universitaire: A. Kouatchet MD, A. Mercat MD; Argenteuil, Hôpital Victor Dupouy: G. Bleichner MD, H. Mentec MD; Arles, Centre Hospitalier J Imbert: C. Crombé MD, D. Selzer MD; Aubenas, Centre Hospitalier: P. Fernandez MD; Beaune, Hôpital Philippe le Bon: P. Noël MD; Belfort, Centre Hospitalier de Belfort-Montbéliard: O. Ruyer MD; Bordeaux, Hôpital Pellegrin Tripode: G. Hilbert MD, F. Vargas MD; Boulogne-Billancourt, Hôpital Ambroise-Paré: S. Prin MD, A. Vieillard-Baron MD; Brest, CHU la Cavale Blanche: A. Renault MD, E. l'Her MD; Briis Sous Forges, CMC Bligny: P. Andrivet MD; Calais, Centre Hospitalier de Calais: K. Guego MD, H. Peneau MD; Clamart, Hôpital Antoine Béclère: F. Brivet MD, F. Jacobs MD; Colombes, Hôpital Louis Mourier: D. Dreyfuss MD, J.-D. Ricard MD; Corbeil-Essonnes, Centre Hospitalier Sud Francilien: D. Caen MD, D. Larbi MD; Créteil, Centre Hospitalier Intercommunal: O. Gilhodes MD; Dieppe, Centre Hospitalier de Dieppe: M. Pinsard MD, F. Bougerol MD; Dourdan, Centre Hospitalier Général: J.-P. Colin MD; Draguignan, Centre Hospitalier: P. Brofferio MD; Elbeuf, Centre Hospitalier: M. Canonne MD, O. Delastre MD; Etampes, Centre Hospitalier d'Etampes: S. Percheron MD, S. Siami MD; Fréjus, CHI Fréjus Saint-Raphaël: M. Kaidomar MD, A. Besançon MD; Garches, Hôpital Raymond Poincaré: D. Annane MD, D. Orlikowski MD; Helfaut, Centre Hospitalier de la Région de. Saint-Omer: B. Sergent MD; La Roche sur Yon, CH Départemental: E. Clementi MD, L. Martin Lefèvre MD; Le Kremlin-bicêtre, Hôpital de Bicêtre: V. Zarka MD, C. Richard MD; Le Plessis Robinson, Centre Chirurgical Marie Lannelongue: I. Auriant MD, F. Parquin MD; Lyon, Hôpital de la Croix Rousse: C. Guerin MD; Mâcon, Centre Hospitalier de Mâcon: D. Debatty MD; Marseille, CHU La Conception: J. Billot MD; Maubeuge, Hôpital Sambre-Avesnois, W. Joos MD; Meaux, Centre Hospitalier: A. Combes MD; Metz, Hôpital Bon Secours: T. Jacques MD, J.-F. Poussel MD; Montpellier, Hôpital Gui de Chauliac: L. Landreau MD; Montpellier, Hôpital Lapeyronie: P. Chardon MD, JP. Roustan MD; Montreuil, Centre Hospitalier André Grégoire: E. Obadia MD, J.-L. Pallot MD; Moulins, Centre Hospitalier Moulins-Yzeure: F. Nicolas MD; Nancy, Hôpital Central: A. Cravoisy MD; Nantes, Hôpital Laennec: S. Chollet MD, J.-R. Ordronneau MD; Niort, Centre Hospitalier de. Niort: F. Barraud MD; Oloron Sainte Marie, Centre Hospitalier Général: J.-M. Mazou MD, Y. Gauthier MD; Orléans, Centre Hospitalier Régional: T. Boulain MD, I. Runge MD; Orsay, Centre Hospitalier Général d'Orsay: D. Benichou MD; Paris, Fondation Hôpital St Joseph: J. Carlet MD, W. Marie MD; Paris, Groupe Hospitalier Pitié-Salpêtrière: A. Duguet MD, H. Prodanovic MD, T. Similowski; Paris, Hôpital Bichat Claude Bernard: F. Schortgen MD, J.-F. Timsit MD; Paris, Hôpital Cochin: J.-D. Chiche MD, N. Nciri MD; Paris, Hôpital Européen Georges Pompidou: J.-L. Diehl MD, E. Guerot MD; Paris, Hôpital Saint-Antoine: E. Maury MD, G. Offenstadt MD; Paris, Hôpital Saint-Louis: E. Azoulay MD, G. Thiery MD; Paris, Hôpital Tenon: M. Fartoukh MD, F. Vincent MD; Paris, Hôtel Dieu: A. Lefebvre MD, A. Rabbat MD; Pessac, Clinique Mutualiste: R. Bedry MD; Poissy, CHI Poissy-Saint-Germain: S. Delerme MD, J.-C. Lacherade MD; Poitiers, Centre Hospitalier Universitaire: D. Chatellier MD; Pontoise, Centre Hospitalier René Dubos: J. Richecoeur MD; Rambouillet, Centre Hospitalier de. Rambouillet: N. Fadel MD; Reims, Hôpital Robert Debré: J. Cousson MD; Reims, Polyclinique Saint-André: J.-C. Farkas MD, B. Lafon MD; Roanne, Centre Hospitalier: P. Beuret MD; Roubaix, Hôpital Victor Provo: P. Herbecq MD, M. Nyunga Makenga MD; Rouen, CHU, Hôpital Charles Nicolle: J. Aboab MD, G. Minaret MD; Saint-Germain en Laye, CHI Poissy-Saint-Germain: J.-L. Ricome MD; Saintes, Centre Hospitalier: Y. Lefort MD; Suresne, Hôpital Foch: M. Djibre MD; Tulle, Centre Hospitalier: O. Hirtz MD; Valence, Centre Hospitalier: J.-Y. Petit MD; Villefranche sur Saone, Centre Hospitalier Général: L. Liron MD; Villejuif, Institut Gustave Roussy: F. Blot MD.

References

  1. 1.
    Brochard L, Isabey D, Piquet J, Amaro P, Mancebo J, Messadi AA, Brun-Buisson C, Rauss A, Lemaire F, Harf A (1990) Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 323:1523–1530PubMedCrossRefGoogle Scholar
  2. 2.
    Bott J, Keilty SE, Elliott MW, Moxham J, Carroll MP, Conway JH, Brown AM, Godfrey RC, Ward EM, Paul EA, Wedzicha JA (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557PubMedCrossRefGoogle Scholar
  3. 3.
    Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRefGoogle Scholar
  4. 4.
    Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ (1991) Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 325:1825–1830PubMedCrossRefGoogle Scholar
  5. 5.
    Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, Gasparetto A, Meduri GU (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435PubMedCrossRefGoogle Scholar
  6. 6.
    Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMedGoogle Scholar
  7. 7.
    Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto Meduri G (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591PubMedGoogle Scholar
  8. 8.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMedCrossRefGoogle Scholar
  9. 9.
    Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823PubMedCrossRefGoogle Scholar
  10. 10.
    Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525PubMedCrossRefGoogle Scholar
  11. 11.
    Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241PubMedCrossRefGoogle Scholar
  12. 12.
    Auriant I, Jallot A, Herve P, Cerrina J, Le Roy Ladurie F, Fournier JL, Lescot B, Parquin F (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235PubMedGoogle Scholar
  13. 13.
    Masip J, Betbese AJ, Paez J, Vecilla F, Canizares R, Padro J, Paz MA, de Otero J, Ballus J (2000) Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 356:2126–2132PubMedCrossRefGoogle Scholar
  14. 14.
    Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G (1999) Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med 160:86–92PubMedGoogle Scholar
  15. 15.
    Hilbert G, Gruson D, Portel L, Gbikpi-Benissan G, Cardinaud JP (1998) Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J 11:1349–1353PubMedCrossRefGoogle Scholar
  16. 16.
    Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128:721–728PubMedGoogle Scholar
  17. 17.
    Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 355:1931–1935PubMedCrossRefGoogle Scholar
  18. 18.
    Evans TW (2001) International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care Med 27:166–178PubMedCrossRefGoogle Scholar
  19. 19.
    Demoule A, Girou E, Taille S, Brochard L, SRLF Collaborative Group on Mechanical Ventilation (2003) Current use of non-invasive ventilation: results from a 2002 multicenter French survey. Intensive Care Med 29:S64CrossRefGoogle Scholar
  20. 20.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  21. 21.
    Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. a new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810PubMedCrossRefGoogle Scholar
  22. 22.
    McCabe WR, Jackson GG (1962) Gram negative bacteriemia. I. Etiology and ecology. Arch Intern Med 110:845–847Google Scholar
  23. 23.
    Girou E, Brun-Buisson C, Taille S, Lemaire F, Brochard L (2003) Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 290:2985–2991PubMedCrossRefGoogle Scholar
  24. 24.
    Weinert CR, Gross CR, Marinelli WA (2003) Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals. Am J Respir Crit Care Med 167:1304–1309PubMedCrossRefGoogle Scholar
  25. 25.
    Greco PJ, Eisenberg JM (1993) Changing physicians' practices. N Engl J Med 329:1271–1273PubMedCrossRefGoogle Scholar
  26. 26.
    Kanouse DE, Jacoby I (1988) When does information change practitioners' behavior? Int J Technol Assess Health Care 4:27–33PubMedCrossRefGoogle Scholar
  27. 27.
    Kanouse DE, Brook RH, Winkler JD, Kosecoff JB, Berry SH, Carter GM, Kahan JP, McCloskey L, Rogers WH, Winslow CM, Anderson GM, Brodsley L, Fink A, Meredith LS (1989) Changing medical practice through technology assessment: an evaluation of the NIH Consensus Development Program. Health Administration Press, Ann ArborGoogle Scholar
  28. 28.
    Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR (1999) Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465PubMedCrossRefGoogle Scholar
  29. 29.
    Misset B, Artigas A, Bihari D, Carlet J, Durocher A, Hemmer M, Langer M, Nicolas F, de Rohan-Chabot P, Schuster HP, Tensillon A (1996) Short-term impact of the European Consensus Conference on the use of selective decontamination of the digestive tract with antibiotics in ICU patients. Intensive Care Med 22:981–984PubMedGoogle Scholar
  30. 30.
    Durand-Zaleski I, Bonnet F, Rochant H, Bierling P, Lemaire F (1992) Usefulness of consensus conferences: the case of albumin. Lancet 340:1388–1390PubMedCrossRefGoogle Scholar
  31. 31.
    Anton A, Guell R, Tarrega J, Sanchis J (2002) Non-invasive ventilation. Thorax 57:919PubMedCrossRefGoogle Scholar
  32. 32.
    Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F, Pennisi MA, Arcangeli A, Proietti R, Passariello M, Meduri GU (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728PubMedCrossRefGoogle Scholar
  33. 33.
    Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S (2000) Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med 28:1785–1790PubMedCrossRefGoogle Scholar
  34. 34.
    Chu CM, Chan VL, Wong IW, Leung WS, Lin AW, Cheung KF (2004) Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation. Crit Care Med 32:372–377PubMedCrossRefGoogle Scholar
  35. 35.
    Meduri GU, Fox RC, Abou-Shala N, Leeper KV, Wunderink RG (1994) Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. Crit Care Med 22:1584–1590PubMedCrossRefGoogle Scholar
  36. 36.
    Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577PubMedGoogle Scholar
  37. 37.
    Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444PubMedCrossRefGoogle Scholar
  38. 38.
    Jolliet P, Abajo B, Pasquina P, Chevrolet JC (2001) Non-invasive pressure support ventilation in severe community-acquired pneumonia. Intensive Care Med 27:812–821PubMedCrossRefGoogle Scholar
  39. 39.
    Wysocki M, Tric L, Wolff MA, Millet H, Herman B (1995) Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 107:761–768PubMedGoogle Scholar
  40. 40.
    Domenighetti G, Gayer R, Gentilini R (2002) Noninvasive pressure support ventilation in non-COPD patients with acute cardiogenic pulmonary edema and severe community-acquired pneumonia: acute effects and outcome. Intensive Care Med 28:1226–1232PubMedCrossRefGoogle Scholar
  41. 41.
    Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Med 25:662–667PubMedCrossRefGoogle Scholar
  42. 42.
    Prinianakis G, Delmastro M, Carlucci A, Ceriana P, Nava S (2004) Effect of varying the pressurisation rate during noninvasive pressure support ventilation. Eur Respir J 23:314–320PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Alexandre Demoule
    • 1
    • 2
  • Emmanuelle Girou
    • 2
    • 3
    • 4
  • Jean-Christophe Richard
    • 5
  • Solenne Taillé
    • 1
  • Laurent Brochard
    • 1
    • 2
    • 6
  1. 1.Service de Réanimation MédicaleAP-HP, Hôpital Henri MondorCréteilFrance
  2. 2.Faculté de MédecineUniversité Paris 12CréteilFrance
  3. 3.CEPIAP-HP, Hôpital Henri MondorCréteilFrance
  4. 4.CeRBEP-INSERM U657Institut PasteurParisFrance
  5. 5.Réanimation MédicaleHôpital Charles NicolleRouenFrance
  6. 6.INSERM U 651CréteilFrance

Personalised recommendations