• Dean R Hess, Jessica M Pang, and Carlos A Camargo.
• Respiratory Care Services, Ellison 401, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. dhess@partners.org
• Resp Care. 2009 Oct 1;54(10):1306-12.

ObjectiveTo determine the frequency of, and barriers to, use of noninvasive ventilation (NIV) for adult patients with acute asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) in academic emergency departments (EDs).MethodsA survey instrument was developed by the authors, pilot tested, and distributed to one physician (MD) and one respiratory therapist (RT) at the 132 hospitals with emergency medicine residencies.ResultsThe response rate was 90%. Ninety-nine percent of RTs and 64% of MDs are very familiar with NIV (P<.001). The reported time needed to initiate NIV was <10 min for 41% of sites (<20 min for 89%). Compared to the time requirement in other clinical areas, 60% of RTs reported that NIV "takes no additional time" in the ED. An RT is always present in 38% the EDs, and equipment for NIV is readily available in 76% of the EDs. The majority reported that NIV use is about right for acute COPD, CHF, and asthma. NIV is used infrequently for asthma (89% reported use in <20% of these patients), while 66% reported use in >20% of COPD patients and 67% reported use in >20% of CHF patients (P<.001, as compared to asthma). The perceived utility of NIV was significantly different between the 3 diagnoses (P<.001); there was more uncertainty about the utility of NIV for asthma. Bilevel ventilators and oronasal masks are most commonly used for NIV. Nearly all of the centers administer bronchodilators in-line with NIV.ConclusionsConsistent with available evidence, NIV use is more common in the ED for acute COPD and CHF than for acute asthma. Barriers to greater use of NIV in the ED include physician familiarity, availability of RT and equipment in the ED, and time required for NIV. For acute asthma, uncertainty about therapeutic benefits remains a challenge.

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