Global practice patterns, determinants, and perceived impact of humidification during non-invasive ventilation in hospitalized adults: A cross-sectional survey from 70 countries.

BACKGROUND

Although a strong physiological rationale exists for humidification during non-invasive ventilation (NIV), its clinical relevance remains uncertain, and guideline recommendations are sparse and inconsistent.

OBJECTIVE

To understand the humidification use during NIV; factors influencing decisions to use or not use; disinfection practices; and beliefs about the impact on outcomes.

METHODS

We conducted a cross-sectional, web-based, international survey of clinicians who manage hospitalized adults receiving NIV for acute respiratory failure. Survey domains reflected device selection, decision-making factors, and the perceived impact on tolerance, compliance, and clinical outcomes. Descriptive statistics and Multiple Correspondence Analysis (MCA) were performed.

RESULTS

516 clinicians from 70 countries participated in this international survey; 70% reported using humidification during NIV, but only 33.5% reported having a written protocol. Use varied significantly by geographic region (p = 0.035). Among users, 46% always used humidification, 34.3% most often, and 19.7% sometimes. Devices included heat-and-moisture exchangers (HME; 22.2%), heated humidifiers (HH; 18%), or both (60%). Key drivers were equipment availability (80.6%), device type (80.9%), and NIV duration (70.9%), rather than evidence. Although most clinicians perceived benefits for tolerance (85.0%) and compliance (72.6%), few believed it affected length of stay (42.9%), infection rates (40.7%), or mortality (29.9%). MCA identified three distinct clinician profiles: "trouble-free responders" (low complication reporting), "high-issue responders" (frequent adverse events), and an "undecided/neutral group."

CONCLUSIONS

Among clinicians participating in this survey, humidification during NIV was commonly reported, but practices varied considerably across regions and institutions. These findings highlight important evidence gaps and support the need for well-designed trials.