Noninvasive mechanical ventilation in clinical practice: A 2-year experience in a medical intensive care unit

Objective: To evaluate the feasibility and outcome results of noninvasive mechanical ventilation (NIV) in daily clinical practice outside any prospective protocol-driven trial. Design: An observational retrospective cohort study. Setting: A 22-bed medical intensive care unit in a university hospital. Patients: A consecutive cohort of 124 patients who underwent 143 NIV trials, regardless of the indication, over two consecutive years (1997-1998). Interventions: None. Results: A total of 604 acute respiratory failure patients underwent mechanical ventilation, and 143 NIVs were performed in 124 patients. The overall prevalence of NIV use was 143 of 604 patients (24%) in three groups: hypoxemic acute respiratory failure (29.5%), hypercapnic acute respiratory failure (41%), and weaning/postextubation (29.5%). Intubation was avoided in 92 of 143 of the NIVs performed (64%), 19 (13%) after changing the initial NIV mode (i.e., a success rate of 62%, 51%, and 86% in the three groups, respectively). A total of 35 of 51 intubated patients (69%) required intubation during the first 24 hrs of NIV. Intensive care unit stay was 12 +/- 10 days for the overall population, and mortality, when NIV failed, was 13 of 124 patients (10.5%). Arterial pH (p = .0527) and the Pao(2)/Fio(2) ratio (p = .0482) after 1 hr were the only independent predictive factors for NIV failure by multivariate analysis. Conclusions: This study confirms the results of controlled trials and demonstrates the feasibility and efficacy of NIV applied in daily clinical practice. These results suggest that NIV should be considered as a first-line ventilatory treatment in various etiologies of acute respiratory failure and as a promising weaning technique and postextubation ventilatory support. However, NIV should certainly be performed by a motivated and sufficiently trained care team.