Chest
Volume 129, Issue 5, May 2006, Pages 1226-1233
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Original Research: Critical Care Medicine
Utilization of Noninvasive Ventilation in Acute Care Hospitals: A Regional Survey

https://doi.org/10.1378/chest.129.5.1226Get rights and content

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.

Section snippets

Materials and Methods

A survey methodology was employed, including item generation and reduction, pretesting, clinical sensibility, and test-retest reliability, to develop a questionnaire consisting of 19 questions (see “Appendix.”). This was mailed to the directors of respiratory care (ie, nonphysician respiratory therapists) of all 81 acute care hospitals in the states of Massachusetts and Rhode Island. Reminders were issued via telephone and e-mail to nonresponders. The survey took place between September 2002

Results

The initial response rate to the mailed survey was 33%, but respiratory care directors at a total of 71 of the 81 acute care hospitals (88%) eventually responded after follow-up contact via phone and e-mail. The follow-up survey of four additional questions elicited a response from 42 of the 71 hospitals (59%) that had responded to the initial survey. Not all questions were completely answered by all responders, so the number of replies varies by question.

The 71 hospitals represented a total of

Discussion

Our survey confirms our hypotheses that hospitals vary widely in their utilization of NPPV and that a substantial portion of hospitals have low utilization rates. We also found that, despite the prevalence of low utilizers, most respondents considered their experience with NPPV as good to excellent. Furthermore, larger institutions differed from smaller ones in that they used NPPV in a higher percentage of patients in whom mechanical ventilation was started and more often to facilitate weaning.

Appendix

References (21)

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