Humidification Practices During Non-Invasive Ventilation in Hospitalized Patients: A Multinational Survey

Non-invasive ventilation (NIV) provides respiratory support through a mask compared to invasive mechanical ventilation (IMV) using an endotracheal or tracheostomy tube. NIV has become a standard of care in managing acute respiratory failure, especially in acute exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, immunocompromised patients, and weaning from IMV. Over the past few decades, its use has increased drastically in these patients, reducing the need for IMV, morbidity, and mortality. However, various studies have reported NIV failure in 20-50% of patients owing to poor tolerance. Non-humidified inspired gases used in NIV and IMV are very dry, and their humidification can prevent their harmful effect on the respiratory system. Heat and Humidification in IMV is the standard of care worldwide, but no consensus or guidelines regarding its use during NIV. Although the upper airways are not bypassed in NIV, physiological air conditioning could be insufficient due to circuit leaks, high respiratory drive, a high fraction of inspired oxygen (FiO2), type of mask, mouth breathing, and use of dry air with ICU ventilators. Inadequate humidification in hospitalized patients with acute respiratory failure using NIV can lead to difficult intubation after NIV failure, life-threatening airway obstruction due to thick secretions, and increased airway reactivity. Based on various physiological and clinical studies, AARC clinical practice guidelines suggested humidification in patients with NIV. To date, the practice pattern of humidification during NIV is unknown.

This study aims to assess the practice pattern of physicians regarding humidification use during NIV in hospitalized adult patients. This study will recognize the gaps between current practice and available evidence.

Objective:

Primary Objective:

(a) Humidification utilization rate and their types