Changing use of noninvasive ventilation in critically ill XXXX : trends over 15  years in francophone countries.

@entity1 @entity1576 @entity3126
PURPOSE: Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of @entity1576 ( @entity1576 ) but some indications are debated. Current trends in NIV use are unknown. METHODS: Comparison of three multicenter prospective audits including all @entity1 receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries. RESULTS: Among the 4132 @entity1 enrolled, 2094 (51  %) required ventilatory support for @entity1576 and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37  % of mechanically ventilated @entity1 vs. 16  % and 28  %, P  <  0.05). In 2010/11, the use of first-line NIV for @entity1576 had reached a plateau (24  % vs. 16  % and 23  %, P  <  0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11  % vs. 4  % and 11  % vs. 7  %, respectively, P  <  0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in @entity3126 , but decreased in de novo @entity1576 (16  % in 2010/11 vs. 23  % in 2002, P  <  0.05). The NIV success rate increased from 56  % in 2002 to 70  % in 2010/11 and remained the lowest in de novo @entity1576 . NIV failure in de novo @entity1576 was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality. CONCLUSION: Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo @entity1576 suggest better @entity1 selection and greater proficiency of staff in administering NIV. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT01449331.
