Department of Anesthesia and Intensive Care, Vita-Salute University and San Raffaele Hospital, Milan, Italy.
Minerva Anestesiol. 2011 Mar;77(3):313-22.
Non-invasive ventilation (NIV) is increasingly utilized for patients with acute respiratory failure (ARF). The shortage of Intensive Care Unit (ICU) beds, a growing confidence with the technique, and the opportunity to treat ARF in a more responsive phase lead to the application of NIV outside of the ICU. The Study Group on Emergency of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) promoted a national survey to collect data on NIV use outside of the ICU.
An anonymous questionnaire was developed, focusing on the location and modalities of NIV treatments, organizational and technical aspects, monitoring, estimated outcomes, the presence of protocols, and complications. The questionnaire was mailed to all members of the Scientific Society.
Forty-six respondents were from 46 hospitals. Thirty-seven (80%) respondents applied NIV in the Emergency Department and/or General Wards. In the majority of hospitals (72%), training preceded NIV introduction. NIV could be applied in all ordinary wards in 28% of the hospitals. Patients remained in their ward in 89% of the hospitals, and a protocol was present in 70% of the hospitals. Monitoring was usually limited to continuous pulse-oxymetry and EKG; 18% of respondents did not have a monitoring standard. Reported complications and practical problems were potentially severe. Few hospitals (15%) collected data on NIV treatments. The efficacy of NIV was perceived as low, as 73% of respondents estimated that NIV avoided tracheal intubation in less than half of the treated patients.
In Italy, NIV is extensively applied in non-intensive wards, and its use is not free from criticalities and contradictions. Further prospective studies and possibly guidelines are needed.
无创通气（NIV）越来越多地用于急性呼吸衰竭（ARF）患者。由于 ICU 床位短缺、对该技术的信心不断增强以及有机会在更具反应性的阶段治疗 ARF，导致 NIV 在 ICU 之外得到应用。意大利麻醉、镇痛、复苏和重症监护学会（SIAARTI）急救研究组开展了一项全国性调查，以收集 NIV 在 ICU 之外使用的数据。
开发了一份匿名问卷，重点关注 NIV 治疗的位置和方式、组织和技术方面、监测、估计结果、存在的协议和并发症。该问卷被邮寄给所有科学学会的成员。
46 名受访者来自 46 家医院。37 名（80%）受访者在急诊室和/或普通病房应用 NIV。在大多数医院（72%）中，在引入 NIV 之前进行了培训。在 28%的医院中，所有普通病房都可以应用 NIV。89%的医院患者仍留在病房，70%的医院有协议。监测通常仅限于连续脉搏血氧饱和度和心电图监测；18%的受访者没有监测标准。报告的并发症和实际问题可能很严重。很少有医院（15%）收集 NIV 治疗数据。NIV 的疗效被认为较低，因为 73%的受访者估计，NIV 在不到一半的治疗患者中避免了气管插管。
在意大利，NIV 在非重症病房中广泛应用，其使用并非没有问题和矛盾。需要进一步进行前瞻性研究，可能还需要制定指南。
