An International Survey on the Use of NIV Outside the ICU (NIV-Safety Study)

BACKGROUND Non-invasive ventilation (NIV) has been an essential tool in respiratory care since its introduction and remains a cornerstone in managing respiratory failure. Evidence-based guidelines recommend NIV as the first-line treatment for acute episodes in four key conditions: COPD exacerbations, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and as a weaning strategy for COPD patients post-extubation [1]. Over the years, NIV has been widely adopted for managing acute respiratory failure across various conditions [2]. It is an effective alternative to invasive mechanical ventilation, helping to prevent intubation and reducing the risk of reintubation after extubation. While traditionally used in intensive care units (ICUs), its application has expanded beyond the ICU to settings such as emergency departments, general wards, high-dependency units (HDUs), and long-term care facilities [3]. Early initiation of NIV has been shown to reduce the need for intubation, lower mortality rates in acute COPD exacerbations, and decrease both hospital costs and length of stay [4]. Despite these benefits, several challenges persist, including inconsistencies in clinical protocols, inadequate staff training, and disparities in resource availability across healthcare systems. Additionally, there is a significant gap in comprehensive global data on NIV use and patient outcomes in non-ICU settings [5]. Understanding the international landscape of NIV implementation, including current practices, protocols, and barriers, is essential for optimizing patient care and establishing standardized guidelines. The NIV-Safety Study aims to bridge this gap by evaluating the prevalence of non-invasive ventilation (NIV) use outside the intensive care unit (ICU), global trends, indications, and challenges associated with NIV use outside the ICU.

RATIONALE FOR CURRENT STUDY:

Early initiation of NIV has been shown to reduce the need for intubation, lower mortality rates in acute COPD exacerbations, and decrease both hospital costs and length of stay [4]. While traditionally used in intensive care units (ICUs), its application has expanded beyond the ICU to settings such as emergency departments, general wards, high-dependency units (HDUs), and long-term care facilities [3]. Despite these benefits, several challenges persist, including inconsistencies in clinical protocols, inadequate staff training, and disparities in resource availability across healthcare systems. Additionally, there is a significant gap in comprehensive global data on NIV use and patient outcomes in non-ICU settings [5]. Understanding the international landscape of NIV implementation, including current practices, protocols, and barriers, is essential for optimizing patient care and establishing standardized guidelines. To date, no study has examined the use of NIV outside the ICU. A lack of data hampers the transfer of the benefits of scientific research to patients. This study aimed to evaluate global trends, indications, and challenges associated with NIV use outside the ICU.

OBJECTIVE

1. Primary To assess the prevalence of non-invasive ventilation (NIV) use outside the ICU
2. Secondary