Perception of non-invasive ventilation in adult Swiss intensive care units

Salvadé, Igor; Domenighetti, Guido; Jolliet, Philippe; Maggiorini, Marco; Rothen, Hans-Ueli

doi:10.4414/smw.2012.13551

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…The results have shown that financing is recognised worldwide as the most important factor responsible for NIV limitation in both acute and chronic respiratory failure in all economies, but the economic burden is highest in poorer countries ( tables 2 and 3 ) [ 5 ]. Our findings are not in agreement with previously published work indicating that lack of physician knowledge, insufficient respiratory therapist training and inadequate equipment are the most important factors limiting NIV use [ 6 , 7 ]. We have confirmed that medical doctors are still mainly involved in NIV provision, although respiratory therapists are well trained and may be cost-effective in comparison with employing medical doctors at the patient's bedside [ 8 ].…”

Section: Discussioncontrasting

confidence: 99%

Survey on accessibility and real-life application of noninvasive ventilation

2018

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Noninvasive mechanical ventilation (NIV) is an accepted method of respiratory failure treatment; however, at present, little is known about the global factors limiting NIV application.A survey designed to determine NIV accessibility and limiting factors in world economies and regions was developed. The questionnaire was sent to members of the European Respiratory Society (ERS) Respiratory Intensive Care Assembly and all ERS National Delegates.Replies to the survey were collected from 161 respondents from 46 countries. NIV was found to be provided most frequently by pulmonologists and intensivists. In high-income economies (HIEs), NIV reimbursement in chronic respiratory failure treatment was found to be independent of the underlying disease and supplementary insurance (p<0.0001), whereas in upper-middle-income economies (UMIEs) it was found to be dependent on the underlying disease (p<0.0001). In chronic respiratory failure, NIV was not reimbursed in lower-middle-income economies (LMIEs) (p<0.0001). In LMIEs and UMIEs, the lack of financial resources was the main limiting factor in acute (p=0.007) and chronic respiratory failure (p<0.0001). In the income-level-based assessment, financing was recognised as relevant in LMIEs and UMIEs (p<0.0001), equipment in LMIEs and UMIEs (p=0.03), medical staff in all economies (p=0.02), and legal regulations in LMIEs (p=0.0005). It was confirmed that NIV in acute and chronic respiratory failure is reimbursed based on government regulations in UMIEs and HIEs (p<0.0001), and is not reimbursed and probably will not be reimbursed in the near future in LMIEs (p<0.0001).We conclude that financial constraints are still considered a major limiting factor for NIV use.

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Section: Discussioncontrasting

confidence: 99%

Survey on accessibility and real-life application of noninvasive ventilation

2018

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“…7 NIV is increasingly being used in many countries, but NIV use remains highly variable. It is used mainly for COPD exacerbations and CPE 89,90,[92][93][94] ; use for hypoxic respiratory failure and earlier extubation is still infrequent and mainly at specialized centers. 9 In Europe the rate of NIV use in ICUs is approximately 35% of ventilated patients, and 60% in respiratory ICUs and emergency departments.…”

Section: Real-life Applicationmentioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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“…A questionnaire developed in adult ICus in Switzerland found that overall utilization rate for noninvasive ventilation (nIv) was 26% of all mechanical ventilations, also showing that the preferred location of nIv initiation in the acute hospital was the ICu (86%), not the emergency department 31 . We showed that only one ICu did not implement this method.…”

Section: Discussionmentioning

confidence: 99%

Importance of Acute Cardiac Care Registries at the National Level

Đuzel

Pavlov

Babić

2020

ACC

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Improving organization and patient care quality in intensive care units is increasingly important as intensive care unit diagnostic and therapeutic procedures account for a growing proportion of hospital services. We identified the lack of comprehensive national and international registries available in the contemporary literature. This paper aims to describe and analyze cardiac intensive care unit (CICu) network at the national level in Croatia and its comparison with more developed countries. Thirty-four representatives from all Croatian acute hospitals (response rate of 100%) filled in a web based questionnaire on CICu organization and competence during September and October 2016. Organization and available technical procedures for health care in general, and especially in very expensive CICu treatment, highly depends on gross domestic product (gdP) per capita. That is why one could expect that Croatia, with the second lowest gdP among european union countries and 4.7 CICu per million inhabitants will have worse results in this field in comparison with most of these countries. results such as one nurse responsible for a mean of 2.7 CICu patients, 52% of cardiologists among physicians during working hours but 37% during night shifts, 24/7 transesophageal echocardiography in only 26.5% of CICus, one-third without therapeutic hypothermia, and 23.5% without extracorporeal membrane oxygenation treatment are some of these results, revealing much room for improvement. This representative, nationwide sample of Croatian CICus also demonstrated considerable variation of key elements of structures with respect to hospital size, academic status and financial issues, as well as a trend towards current guidelines. This kind of investigation is very important for proposing standards, reimbursement master plan, or quality assessment of the national health system.

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Perception of non-invasive ventilation in adult Swiss intensive care units

Cited by 8 publications

References 27 publications

Survey on accessibility and real-life application of noninvasive ventilation

Survey on accessibility and real-life application of noninvasive ventilation

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Importance of Acute Cardiac Care Registries at the National Level

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