Noninvasive ventilation for acute respiratory failure: a national survey of Veterans Affairs hospitals

Abstract

Background: The utilization of noninvasive ventilation (NIV) in the Veterans Affairs health-care system is not well characterized. A survey of physicians and respiratory therapists was conducted to better understand its use.

Methods: Three hospitals in each of 21 Veterans Affairs networks were selected based on severity of patient mix, level of staffing and workload. A request was sent via e-mail to Veterans Affairs respiratory therapists and critical care physicians at these hospitals to complete a 41-question survey using an Internet-based survey site.

Results: A total of 192/882 (22%) responses were received from a survey of about half (63/128) of the Veterans Affairs intensive care units (ICUs). Previous experience and training in NIV was limited. NIV is reported to be widely available and applied in both monitored (ICU, step-down, emergency department) and unmonitored (ward) settings. NIV was identified as a first-line option for COPD and CHF, but perceived use was less. Sixty-four percent of respiratory therapists felt NIV was used <50% of the time when indicated, compared to 29% of physicians (P<.001). Reported NIV use varied, with 45% treating 0-4 patients a month and 23% with >10 patients a month. Larger ICUs reported more frequent use of NIV (>10 patients a month) than smaller ICUs (P=.02). Written guidelines were noted by 65%, but only 27% had titration guidelines. The perceived efficacy of NIV was low, with a success rate of >50% noted by only 29% of respondents.

Conclusions: The perception of NIV use in the Veterans Affairs hospitals varies significantly. This survey revealed a wide range of training and experience, location of use, presence of written guidelines, and methods of delivery. Notable perceptual differences exist between respiratory therapists and physicians. Underutilization of NIV and low rates of perceived efficacy are major findings.