Non-invasive ventilation at intensive care units in Colombia: a routine practice?

Ventilación no invasiva en las unidades de cuidado intensivo en Colombia: ¿Una práctica rutinaria?

Introduction: non-invasive mechanical ventilation (NIV) has seen important advances in its technique and applications
over the past 10 years. In Colombia, utilization of NIV in intensive care units (ICUs) appears to be limited, and its impact
unknown.

Objectives: to describe the current state of NIV in ICUs throughout Colombia under the aspects of knowledge, attitudes, perceptions, and practices.

Design: a descriptive, crosscut, observational study.

Materials and methods: a focal group was formed, and semi-structured interviews were conducted with patients, in order to define the areas to be surveyed. A pilot study was applied, for reasons of convenience, to five physicians who have worked in ICUs. Adult ICUs of Colombia were included. The directors of the ICUs received information by mail about the study and an invitation to schedule a telephonic appointment. Results: 136 ICUs were registered nationwide, 113 (83%) answered, 70% private; 30% in Bogotá, 21% in the Caribbean region, 17% in the central region, and 12% in Medellin; most ICUs (51%) had 7-12 beds.

Knowledge: the distribution of correct answers was as follows: Knowledge on indications in COPD 85%, other indications 43%. There are no significant differences in knowledge according to unit size (p > 0,05), but the difference by region is significant (p < 0,001) between the least and greatest percentage of correct answers. Practices: NIV was used in 80%% of the ICUs of Colombia. In Medellin it was used in 100% of them. The least rate of utilization took place in the country's central region (63%). Over the 90 days prior to the survey, the interviewed participants used mechanical ventilation in an average of 89 patients, of whom 12 (13%) were treated with NIV. 33% were eventually intubated. In the group of ICUs that had not used NIV, the main explanation was lack of resources (80%), whereas the reasons of lack of knowledge, lack of confidence, and not taking it into account added up to a total 20%. 76% of ICUs in Colombia did not have ventilators specifically meant for NIV, and only half of them had special masks. There were no differences concerning resources between private and public ICUs.

Attitudes and perceptions. Among the directors, the technique generates confidence and the sensation of being important for patient management. They said they thought it should be used more than it has been used until now. They perceived there were fewer complications than in intubated patients. They thought it was less costly than invasive ventilation under the aspects of staff, equipment, and accessories. The interviewed subjects perceived that the patient and his or her family more readily accepted non invasive ventilation than invasive ventilation.

Conclusions: the study was representative, since it surveyed more than 80% of the country's adult ICUs. There is lack of knowledge among ICU directors concerning NIV in critically ill patients, whereas their knowledge of its indication in COPD is satisfactory. The use of NIV in ICUs throughout Colombia was high, and it appeared to have made possible to avoid a great number of intubations, despite the lack of adequate resources. The perception about the technique was good.