The success of NIV was defined as the recovery from acute respiratory without endotracheal intubation among patients with full code (without limitation of therapy). Outcomes The primary outcome was to identify the incidence of use of NIV in patients with ARF and to identify the factors associated with the failure of the NIV among the same. The secondary outcome was to identify

the long term survival among the patients with ARF who were on palliative NIV. The survivors after the hospital discharge were followed till the end of 2010. The death date was identified from the EMR or death registration record Inhibitors,research,lifescience,medical of Minnesota, in case of out-of-hospital deaths. Statistical analysis All the continuous data was summarized as median

(interquartile range [IQR]). Categorical data was summarized as counts and percentages. Inhibitors,research,lifescience,medical Age and gender-specific incidence rate (95% confidence interval [CI]) for NIV use in the ICU was calculated assuming that the sellectchem entire selleck catalog population of Olmsted County (≥18years) was at risk. The incidence rate was adjusted to the projected 2006 United States population (utilizing the data from the 2000 U.S. population census and calculating an expected 1.9% population growth per year). Kaplan-Meier survival analysis with log-rank test was used to assess the long term survival among the ARF patients who were initiated Inhibitors,research,lifescience,medical on palliative NIV. A univariate and multivariate logistic regression analysis was used to identify the factors associated with failure

of NIV in full Inhibitors,research,lifescience,medical code patients. Significant variables on the univariate analysis (p < 0.2) were included in the multivariate logistic regression model. Stepwise forward and backward procedure was used to select variables included in the final analysis. Non-significant factors (p > 0.05) were eliminated (one at a time) Inhibitors,research,lifescience,medical until all remaining factors had a significant association with NIV failure. JMP statistical software (version 8.0, SAS, Cary, NC) was used Cilengitide for all the data analyses. The level of significance for all statistical tests was 2-sided, with P <0.05. Results In 2006, out of 1707 ICU admissions, a total of 1461 unique Olmsted County adult residents were identified. The study flowchart was shown in detail in Figure1. Three hundred and sixty four patients developed ARF and were ventilated in ICU, among which 146 (40%) were initiated on the NIV yielding a cumulative incidence of 180 episodes per 100,000 person-years (95% CI 154~206/100,000) (Figure1). The median age in years was 75 (IQR, 60–84), 48% were females and 88.7% were Caucasians. Eighteen patients (12%) were on CPAP mode and 128 (88%) were on NIPPV mode. Figure 1 Study outline of noninvasive mechanical ventilation use in the acute respiratory failure patients.