Use of noninvasive positive pressure ventilation in patients admitted to the internal medicine service of a tertiary care hospital

OBJECTIVE: Noninvasive positive pressure ventilation (NIPPV) is commonly used in acute respiratory failure but is often applied outside evidence-based indications, particularly in low- and middle-income countries. Our objective is to assess the appropriateness of NIPPV use among internal medicine patients at a tertiary hospital in Pakistan. Appropriate use was defined as Type 1 or Type 2 respiratory failure, cardiogenic pulmonary edema, or chest wall/neuromuscular disease. Inappropriate use was defined as NIPPV applied outside standard indications. RESULTS: We conducted a cross-sectional study on 4369 patients who received NIPPV between 2019 and 2020 in the Internal Medicine unit at the Aga Khan University Hospital, Karachi. The mean age was 62.7 years, and 52.4% were male. Overall, 60.5% received NIPPV without documented respiratory failure, 21.5% had Type 1, and 18% had Type 2 failure. Metabolic acidosis accounted for 19.6% of inappropriate cases. Among Type 1 failure, pneumonia (43.1%), pulmonary edema (35.3%), and COPD (6.2%) were most common; in Type 2 failure, pulmonary edema (37.7%), pneumonia (25.8%), and COPD (15.1%) predominated. NIPPV was appropriately used in COPD and acute cardiogenic pulmonary edema but frequently applied outside evidence-based indications, particularly for metabolic acidosis. Structured protocols and research are needed on NIPPV use in LMICs.