Alexandre Demoule1,2, Sylvie Chevret3, Annalisa Carlucci4, Achille Kouatchet5, Samir Jaber6, Ferhat Meziani7, Matthieu Schmidt8,9, David Schnell10, Céline Clergue11, Jérôme Aboab12, Antoine Rabbat13, Béatrice Eon14, Claude Guérin15, Hugues Georges16, Benjamin Zuber17, Jean Dellamonica18, Vincent Das19, Joël Cousson20, Didier Perez21, Laurent Brochard22,23, Elie Azoulay10. 1. Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. alexandre.demoule@psl.aphp.fr. 2. UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France. alexandre.demoule@psl.aphp.fr. 3. Département de biostatistique et d'Information médicale, et INSERM UMR-717, Hôpital Saint-Louis, Paris, France. 4. Respiratory Intensive Care Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy. 5. Réanimation médicale et Médecine hyperbare, Centre Hospitalier Universitaire, Angers, France. 6. Département d'Anesthésie et Réanimation, Hôpital Saint-Eloi, Montpellier, France. 7. Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 8. Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. 9. UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France. 10. Service de Réanimation médicale, Hôpital Saint-Louis, Paris, France. 11. Service Réanimation polyvalente, Centre Hospitalier Sud Francilien, Evry, France. 12. Service de Réanimation Médicochirurgicale, Hôpital Raymond Poincaré, Garches, France. 13. Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin, Paris, France. 14. UMR 7268 ADéS, Aix-Marseille Université/Espace éthique méditerranéen, Réanimation des Urgences et Médicale-Hôpital La Timone 2, Marseille, France. 15. Service de Réanimation médicale, Hôpital de la Croix Rousse, Lyon, France. 16. Service de Réanimation Polyvalente et Maladies Infectieuses, Centre Hospitalier, Tourcoing, France. 17. Service de Réanimation Médicale, Hôpital Cochin, Paris, France. 18. Service de Réanimation Médicale, Centre Hospitalier Universitaire de l'Archet, Nice, France. 19. Service de Réanimation Polyvalente, Centre Hospitalier André Grégoire, Montreuil, France. 20. Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Robert Debré, Reims, France. 21. Service de Réanimation Polyvalente, Centre Hospitalier Louis Pasteur, Dole, France. 22. Keenan Research Centre and Li Ka Shing Institute, Saint-Michael's Hospital, Toronto, ON, Canada. 23. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Abstract
PURPOSE: Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown. METHODS: Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries. RESULTS: Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality. CONCLUSION: Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01449331.
PURPOSE: Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown. METHODS: Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries. RESULTS: Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality. CONCLUSION: Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01449331.
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