[Implementation of the German S3-Guideline of non-invasive ventilation for acute respiratory failure in daily practice].

BACKGROUND AND
OBJECTIVE: Application of non-invasive ventilation (NIV) in acute respiratory failure (ARF) since publication of the German S3 guideline in 2008.
METHODS: A questionnaire was sent to 145 regional hospitals representing 99 ICUs, asking for: responsibility for NIV, number of ICU-beds, awareness of the guideline and the detailed recommendations, its implementation, use of ventilators and interfaces, location of NIV application.
RESULTS: The response rate in relation to hospitals was 43.5%, 63 questionnaires were sent back (30 by internists, 33 by anesthesiologists). 97% of the participants reported to know the guideline; 20 (67%) of the internists and 16 (48,5%) of the anaesthesiologists who answered are aware of the detailed recommendations. 40 of 63 departments (63,5%) reported an increase of NIV since publication of the guideline. 22 of 33 (66%) anaesthesiologists and 18 of 30 (60%) internists reported to apply NIV in all forms of ARF. The others reported a differentiated application, mainly in pulmonary edema and hypercapnic respiratory failure, whereas NIV was rarely used in non-cardiac hypoxemic ARF. 92% of the participants used the guideline in decision-finding for NIV. Their decision was additionally influenced by clinical experience. In all clinics NIV took place on the ICU; furthermore in 6 medical clinics on specialized respiratory units. Mainly ICU-ventilators with NIV mode were used; 38% of the ICUs only held this type of ventilator. In 84 % full-face masks were preferred; 71% of the users only used a single type of mask.
CONCLUSION: The S3 guideline for NIV in ARF is well-known in intensive care in Germany, but not all are aware of the detailed re-commendations. The use of NIV in ARF has increased since publication of the guideline but nearly always follows additional clinical assessment in decision-making. In one third it is restricted to special indications, with very limited application in non-cardiac hypoxemic ARF. Full-face masks are preferred according to the guideline. All ICUs, that participated in the survey, hold ventilators for NIV. © Georg Thieme Verlag KG Stuttgart · New York.