Use and outcomes of noninvasive positive pressure ventilation in acute care hospitals in Massachusetts

Chest. 2014 May;145(5):964-971. doi: 10.1378/chest.13-1707.


Background: This study determined actual utilization rates and outcomes of noninvasive positive pressure ventilation (NIV) at selected hospitals that had participated in a prior survey on NIV use.

Methods: This observational cohort study, based at eight acute care hospitals in Massachusetts, focused on all adult patients requiring ventilatory support for acute respiratory failure during predetermined time intervals.

Results: Of 548 ventilator starts, 337 (61.5%) were for invasive mechanical ventilation and 211 (38.5%) were for NIV, with an overall NIV success rate of 73.9% (ie, avoidance of intubation or death while on NIV or within 48 h of discontinuation). Causal diagnoses for respiratory failure were classified as (I) acute-on-chronic lung disease (23.5%), (II) acute de novo respiratory failure (17.9%), (III) neurologic disorders (19%), (IV) cardiogenic pulmonary edema (16.8%), (V) cardiopulmonary arrest (12.2%), and (VI) others (10.6%). NIV use and success rates for each of the causal diagnoses were, respectively, (I) 76.7% and 75.8%, (II) 37.8% and 62.2%, (III) 1.9% and 100%, (IV) 68.5% and 79.4%, (V) none, and (VI) 17.2% and 60%. Hospital mortality rate was higher in patients with invasive mechanical ventilation than in patients with NIV (30.3% vs 16.6%, P < .001).

Conclusions: NIV occupies an important role in the management of acute respiratory failure in acute care hospitals in selected US hospitals and is being used for a large majority of patients with acute-on-chronic respiratory failure and acute cardiogenic pulmonary edema. NIV use appears to have increased substantially in selected US hospitals over the past decade.

Trial registry:; No.: NCT00458926; URL:

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Noninvasive Ventilation / statistics & numerical data*
  • Positive-Pressure Respiration / statistics & numerical data*
  • Prospective Studies
  • Registries*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Treatment Outcome

Associated data