HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maheshwari, V. Articles by Hill, N. S. Search for Related Content PubMed PubMed Citation Articles by Maheshwari, V. Articles by Hill, N. S.

Utilization of Noninvasive Ventilation in Acute Care Hospitals^*

A Regional Survey

Vinay Maheshwari, MD; Daniela Paioli, MD; Robert Rothaar, MD and Nicholas S. Hill, MD, FCCP

^* From the Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New England Medical Center, Boston, MA. Dr. Hill is the Eli Lilly Distinguished Scholar in Critical Care of the Chest Foundation.

Correspondence to: Nicholas S. Hill, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New England Medical Center, 750 Washington St, No. 257, Boston, MA 02111; e-mail: nhill{at}tufts-nemc.org

Abstract

Purpose: Little information is available on the utilization of noninvasive positive-pressure ventilation (NPPV) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower rates of utilization, and the techniques used for application.

Methods: Using survey methodology, we developed a questionnaire consisting of 19 questions and distributed it by mail to directors of respiratory care at all 82 acute care hospitals in Massachusetts and Rhode Island. Nonresponders were contacted by phone to complete the survey. Responses were analyzed using standard statistics, including t tests and Mann-Whitney U tests where appropriate.

Results: We obtained responses from 71 of the 82 hospitals (88%). The overall utilization rate for NPPV was 20% of ventilator starts, but we found enormous variation in the estimated utilization rates among different hospitals, from none to > 50%. The top two reasons given for lower utilization rates were a lack of physician knowledge and inadequate equipment. In the 19 hospitals that provided detailed information, COPD and congestive heart failure constituted 82% of the diagnoses of patients receiving NPPV, but NPPV was still used in only 33% of patients with these diagnoses receiving any form of mechanical ventilation.

Conclusions: The utilization rates for NPPV vary enormously among different acute care hospitals within the same region. The perceived reasons for lower utilization rates include lack of physician knowledge, insufficient respiratory therapist training, and inadequate equipment. Educational programs directed at individual institutions may be useful to enhance utilization rates.

Key Words: acute care hospitals • acute respiratory failure • mechanical ventilation • noninvasive positive-pressure ventilation • surveys • United States • utilization

This article has been cited by other articles:

				M. J. Joo, T. A. Lee, and K. B. Weiss Geographic Variation of Spirometry Use in Newly Diagnosed COPD Chest, July 1, 2008; 134(1): 38 - 45. [Abstract] [Full Text] [PDF]

				L. Rubinson, J. L. Hick, J. R. Curtis, R. D. Branson, S. Burns, M. D. Christian, A. V. Devereaux, J. R. Dichter, D. Talmor, B. Erstad, et al. Definitive Care for the Critically Ill During a Disaster: Medical Resources for Surge Capacity: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL Chest, May 1, 2008; 133(5_suppl): 32S - 50S. [Abstract] [Full Text] [PDF]

				E. Garpestad, J. Brennan, and N. S. Hill Noninvasive Ventilation for Critical Care Chest, August 1, 2007; 132(2): 711 - 720. [Abstract] [Full Text] [PDF]