• Alexandre Demoule, Sylvie Chevret, Annalisa Carlucci, Achille Kouatchet, Samir Jaber, Ferhat Meziani, Matthieu Schmidt, David Schnell, Céline Clergue, Jérôme Aboab, Antoine Rabbat, Béatrice Eon, Claude Guérin, Hugues Georges, Benjamin Zuber, Jean Dellamonica, Vincent Das, Joël Cousson, Didier Perez, Laurent Brochard, Elie Azoulay, oVNI Study Group, and REVA Network (Research Network in Mechanical Ventilation).
• Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. alexandre.demoule@psl.aphp.fr.
• Intensive Care Med. 2016 Jan 1; 42 (1): 82-92.

PurposeOver the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown.MethodsComparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries.ResultsAmong the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality.ConclusionIncreases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV.Trial RegistrationClinicaltrials.gov Identifier NCT01449331.

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