Delays to Non-Invasive Ventilation (NIV) are still happening. Why do clinicians in a tertiary hospital continue to do this?

Determinants of Noninvasive Ventilation Failure Among Neonates with Respiratory Distress Admitted to the Intensive Care Unit in Addis Ababa, Ethiopia: An Unmatched Case-Control Study Design

“…Possibly, it might be since delay in initiating NIV will result in increased severity of illness, which in turn leads to failure of NIV. Of the total study respondents, only 21.3% had NIV started within the first hour, 21 despite the best evidence and current guidance, clinicians are still delaying NIV initiation. Clinicians are still attempting to reverse respiratory acidosis with medical management and oxygen optimization despite current guidelines advocating the early use of NIV Furthermore, very preterm neonates were 2.99 times more likely at risk to develop NIV failure, which is in line with the previous study done that revealed that prematurity, shown to be a risk factor for NIV failure in multiple prior studies, [22][23][24][25] may be related to the immaturity of the respiratory system of preterm neonates along with an unstable chest wall that makes complaint airways easy to collapse.…”

“…Possibly, it might be since delay in initiating NIV will result in increased severity of illness, which in turn leads to failure of NIV. Of the total study respondents, only 21.3% had NIV started within the first hour, 21 despite the best evidence and current guidance, clinicians are still delaying NIV initiation. Clinicians are still attempting to reverse respiratory acidosis with medical management and oxygen optimization despite current guidelines advocating the early use of NIV…”