Sodhi K, Kaur H, Sood T, Ditya D, Kumar M, Tuli S, Singla A, Singla I. Clinical and cost-effectiveness of noninvasive ventilation over invasive ventilation in acute respiratory failure: A single-center study from India. World J Crit Care Med 2025; 14(4): 108652 [DOI: 10.5492/wjccm.v14.i4.108652]
Corresponding Author of This Article
Kanwalpreet Sodhi, MD, Director, Head, Department of Critical Care, Deep Hospital, Model Town, Ludhiana 141002, Punjab, India. drkanwal2006@yahoo.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Control Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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Journal Information of This Article
Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sodhi K, Kaur H, Sood T, Ditya D, Kumar M, Tuli S, Singla A, Singla I. Clinical and cost-effectiveness of noninvasive ventilation over invasive ventilation in acute respiratory failure: A single-center study from India. World J Crit Care Med 2025; 14(4): 108652 [DOI: 10.5492/wjccm.v14.i4.108652]
Kanwalpreet Sodhi, Harmanpreet Kaur, Tanupriya Sood, Ditya Ditya, Anshul Singla, Department of Critical Care, Deep Hospital, Ludhiana 141002, Punjab, India
Manender Kumar, Department of Cardiac Anaesthesia and Critical Care, Fortis Hospital, Ludhiana 141001, Punjab, India
Sartaaj Tuli, Christian Medical College, Ludhiana 141002, Punjab, India
Ishrat Singla, Armed Forces Medical College, Pune 411040, Maharashtra, India
Author contributions: Sodhi K and Kaur H drafted the initial manuscript; Sodhi K, Kaur H, Sood T, Ditya D, and Singla A participated in the acquisition, analysis, and interpretation of the data; Sodhi K, Kumar M, and Singla I designed the research study; Sood T, Kumar M, Tuli S, and Singla I revised the article critically for important intellectual content; all authors have read and approved the final manuscript.
Institutional review board statement: Obtained the ethics clearance from the institutional ethics committee vide letter, No. ECR/525/Inst/Pb/2014/RR-26/2023-3.
Informed consent statement: Being an observational study, the informed consent from the patients was waved off.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: We agree to share our data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kanwalpreet Sodhi, MD, Director, Head, Department of Critical Care, Deep Hospital, Model Town, Ludhiana 141002, Punjab, India. drkanwal2006@yahoo.com
Received: April 21, 2025 Revised: May 28, 2025 Accepted: August 12, 2025 Published online: December 9, 2025 Processing time: 223 Days and 5.3 Hours
Abstract
BACKGROUND
There has been a growing interest in noninvasive ventilation (NIV) in comparison to invasive mechanical ventilation (IMV) as a standard of care for acute respiratory failure (ARF), especially in the post-covid era, but direct head-to-head cost comparisons between the two modalities are not available in literature.
AIM
To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.
METHODS
A prospective observational single-center case control study including adult patients with ARF (PaO2/FiO2 ratio < 300) admitted from January 1, 2024 to December 31, 2024 in medical intensive care unit (ICU) of a tertiary care hospital requiring either NIV or invasive ventilation. NIV and IMV groups were compared based on average length of ICU and hospital stay, mortality, net cost of ICU treatment, need for intubation and tracheostomy.
RESULTS
A total of 319 patients were included in the study (197 in NIV, 122 in IMV group). Statistically significant difference in length of ICU stay (NIV group: 5 ± 3.25 days, IMV group: 9 ± 2.6 days; P < 0.05) and mortality rate was seen (11% NIV vs 34% IMV; P < 0.01). On multivariate analyses, mortality showed a stronger association with IMV [odds ratio (OR) = 7.73; 95%CI: 3.12-19.18] as compared to ICU stay (OR = 2.73; 95%CI: 2.15-3.48). A total of 33 patients (17%) in NIV group required intubation of which 3 were tracheostomized, while 14 patients (11%) in IMV group needed tracheostomy. The net average cost of ICU stay was ₹83902 in NIV group while in IMV group, the net ICU cost was ₹476216. The average cost of ICU stay was five times higher with IMV.
CONCLUSION
NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
Core Tip: Mechanical ventilation being a major driver of the intensive care unit (ICU) costs, ventilation costs always need to be taken into account while measuring the financial burden of ICU settings. This is the first large prospective study making head-to-head cost comparison of the invasive and noninvasive ventilation (NIV) modalities in patients with acute respiratory failure. The net average cost of ICU stay was five times lower with NIV. There is an urgent need for further robust research to look into the economic aspects of NIV in comparison to invasive ventilation.
