Extended utilization of noninvasive ventilation for acute respiratory failure and its clinical outcomes.

BACKGROUND: Noninvasive ventilation (NIV) has increasingly been used for the treatment of acute respiratory failure. Despite recommendations supporting its utilization in a limited group of patients, NIV is frequently relied on as a first line treatment. We conducted a retrospective study to assess whether the extended use of NIV is associated with worse clinical outcomes.

METHODS: This was a retrospective review of a data set consisting of patients admitted with respiratory failure and treated with NIV. Based on guidelines, we grouped the patients on whether they had indications and/or contraindications for NIV: NIV indicated and not contraindicated; NIV indicated and contraindicated; NIV not indicated and not contraindicated; NIV not indicated and contraindicated. The need for endotracheal intubation, hospital mortality, and stay were compared between these 4 groups.

RESULTS: Demographic data were not significantly different between the groups. Within the group of subjects with no contraindication for NIV, those with indication and with no indication intubation rates were 28% and 17%, respectively (P = .39). Among the group of subjects with indications for NIV, the rate of intubation was 28% for those with no contraindication and 56% in those with it (P = .13). In the group of subjects with no indication for NIV, the presence of contraindications was associated with higher rate of intubation, compared with those without contraindications (70% vs 17%, P = .002).

CONCLUSIONS: This study supports the extended utilization of NIV for subjects without contraindications, and for subjects with indications despite the presence or absence of contraindications.