Clinical and cost-effectiveness of noninvasive ventilation over invasive ventilation in acute respiratory failure: A single-center study from India.

BACKGROUND

There has been a growing interest in noninvasive ventilation (NIV) in comparison to invasive mechanical ventilation (IMV) as a standard of care for acute respiratory failure (ARF), especially in the post-covid era, but direct head-to-head cost comparisons between the two modalities are not available in literature.

AIM: To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.

METHODS

A prospective observational single-center case control study including adult patients with ARF (PaO2/FiO2 ratio < 300) admitted from January 1, 2024 to December 31, 2024 in medical intensive care unit (ICU) of a tertiary care hospital requiring either NIV or invasive ventilation. NIV and IMV groups were compared based on average length of ICU and hospital stay, mortality, net cost of ICU treatment, need for intubation and tracheostomy.

RESULTS

A total of 319 patients were included in the study (197 in NIV, 122 in IMV group). Statistically significant difference in length of ICU stay (NIV group: 5 ± 3.25 days, IMV group: 9 ± 2.6 days; P < 0.05) and mortality rate was seen (11% NIV vs 34% IMV; P < 0.01). On multivariate analyses, mortality showed a stronger association with IMV [odds ratio (OR) = 7.73; 95%CI: 3.12-19.18] as compared to ICU stay (OR = 2.73; 95%CI: 2.15-3.48). A total of 33 patients (17%) in NIV group required intubation of which 3 were tracheostomized, while 14 patients (11%) in IMV group needed tracheostomy. The net average cost of ICU stay was INR 83902 in NIV group while in IMV group, the net ICU cost was INR 476216. The average cost of ICU stay was five times higher with IMV.

CONCLUSION

NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.