What Do the Observational Studies Tell Us?

According to current guidelines [17], the use of NIV is not clearly recommended in acute hypoxemic respiratory failure, but it is interesting to see how NIV is used in real life by physicians. In an observational survey performed in France in 42 intensive care units and published in 2001, Carlucci et al. reported that NIV was employed in 14% of patients with acute hypoxemic respiratory failure [18]. More recently, a cohort study in acute care hospitals in Massachusetts reported that between 2004 and 2007, NIV was used in 37.8% of de novo acute hypoxemic respiratory failure [19]. In an Ontario practice survey, Burns and colleagues reported that 25% of the respondents have used NIV in ARDS/ALI [20]. A population-based study reported that in the USA, the proportion of patients without COPD who received NIV increased from 1.2% in 2000 to 6.0% in 2009 [21]. Interestingly, recent data coming from a longitudinal observational study comparing trends of the use of NIV on a 10-year period, from 2002 to 2010/2011 and performed mostly in France, show slightly different results [22]. In this last study, Demoule et al. described a recent decrease in the use of NIV in de novo acute hypoxemic respiratory failure, from 23% in 2002 to 16% in 2010/2011 [22]. The most recent report is coming from the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) which reported that among 2813 patients with ARDS, 436 (15%) were treated initially with NIV [23].

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