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Canadian Respiratory Journal
Volume 22 (2015), Issue 6, Pages 331-340
http://dx.doi.org/10.1155/2015/971218
Original Article

Noninvasive Ventilation Practice Patterns for Acute Respiratory Failure in Canadian Tertiary Care Centres: A Descriptive Analysis

Geneviève C Digby,1 Sean P Keenan,2 Christopher M Parker,1 Tasnim Sinuff,3 Karen E Burns,4 Sangeeta Mehta,5 Juan J Ronco,6 Demetrios J Kutsogiannis,7 Louise Rose,3,8 Najib T Ayas,9 Luc R Berthiaume,10 Christine L D’Arsigny,1 Daniel E Stollery,11 and John Muscedere1

1Department of Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
2Department of Critical Care, Fraser Health and Division of Critical Care, University of British Columbia, Vancouver, British Columbia, Canada
3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada
4Interdepartmental Division of Critical Care Medicine, the Keenan Research Centre and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Canada
5Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
6Department of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
7Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
8Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
9Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
10Department of Critical Care Medicine, University of Calgary, Calgary, Canada
11Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: The extent of noninvasive ventilation (NIV) use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.

OBJECTIVE: To describe NIV practice variation in the acute setting.

METHODS: A prospective observational study involving 11 Canadian tertiary care centres was performed. Data regarding NIV indication, mode and outcomes were collected for all adults (>16 years of age) treated with NIV for acute respiratory failure during a four-week period (between February and August 2011). Logistic regression with site as a random effect was used to examine the association between preselected predictors and mortality or intubation.

RESULTS: A total of 330 patients (mean [± SD] 30±12 per centre) were included. The most common indications for NIV initiation were pulmonary edema (104 [31.5%]) and chronic obstructive pulmonary disease (99 [30.0%]). Significant differences in indications for NIV use across sites, specialty of ordering physician and location of NIV initiation were noted. Although intubation rates were not statistically different among sites (range 10.3% to 45.4%), mortality varied significantly (range 6.7% to 54.5%; P=0.006). In multivariate analysis, the most significant independent predictor of avoiding intubation was do-not-resuscitate status (OR 0.11 [95% CI 0.03 to 0.37]).

CONCLUSION: Significant variability existed in NIV use and associated outcomes among Canadian tertiary care centres. Assignment of do-not-resuscitate status prevented intubation.