Extended utilization of noninvasive ventilation for acute respiratory failure and its clinical outcomes

Noninvasive ventilation (NIV) has increasingly been used for the treatment of acute respiratory failure. Despite recommendations supporting its utilization in a limited group of patients, NIV is frequently relied on as a first line treatment. We conducted a retrospective study to assess whether the extended use of NIV is associated with worse clinical outcomes.

This was a retrospective review of a data set consisting of patients admitted with respiratory failure and treated with NIV. Based on guidelines, we grouped the patients on whether they had indications and/or contraindications for NIV: NIV indicated and not contraindicated; NIV indicated and contraindicated; NIV not indicated and not contraindicated; NIV not indicated and contraindicated. The need for endotracheal intubation, hospital mortality, and stay were compared between these 4 groups.

Demographic data were not significantly different between the groups. Within the group of subjects with no contraindication for NIV, those with indication and with no indication intubation rates were 28% and 17%, respectively (P = .39). Among the group of subjects with indications for NIV, the rate of intubation was 28% for those with no contraindication and 56% in those with it (P = .13). In the group of subjects with no indication for NIV, the presence of contraindications was associated with higher rate of intubation, compared with those without contraindications (70% vs 17%, P = .002).

This study supports the extended utilization of NIV for subjects without contraindications, and for subjects with indications despite the presence or absence of contraindications.