Missed opportunities for noninvasive positive pressure ventilation: A utilization review

The Total Face Mask Is More Comfortable than the Oronasal Mask in Noninvasive Ventilation but Is Not Associated with Improved Outcome

“…In some situations, its role as first-line support ventilation is solid whereas in others, a trial may be worthwhile before proceeding to tracheal intubation, as long as there is no contraindication. Although widely available, NPPV is underused even among patients with chronic obstructive pulmonary disease exacerbations and cardiogenic pulmonary edema, the 2 best and widely accepted indications [19]. One of the main reasons for NPPV failure is intolerance of the mask, and for this reason, new masks were designed to overcome this problem, including the total face mask and the helmet.…”

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

“…133,[165][166][167] Increased utilization requires that clinicians view it as often superior to invasive ventilation, that it is perceived as compatible with existing approaches to mechanical ventilation, and that it is not too difficult to apply. 112,168 Barriers to NIV use include lack of awareness of the evidence, lack of agreement with the evidence, lack of self-efficacy, unrealistic outcome expectations, and the inertia of previous practice.…”

Embracing Dissemination and Implementation Research in Cardiac Critical Care

“…In one review of patients who had intensive care unit admitting diagnoses of COPD or heart failure and met explicit criteria for a trial of NPPV, only 20 of 59 patients (33.9%) received a trial of NPPV; the remaining 39 patients (66%) were intubated [15]. Similarly, a survey of the directors of respiratory care of all 81 acute care hospitals in the states of Massachusetts and Rhode Island between September 2002 and January 2003 found an overall utilization rate for NPPV of 20% of ventilator starts, with enormous variation in the estimated utilization rates among different hospitals, from none to >50% [12].…”