Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure

Cabrini, Luca; Idone, Cristina; Colombo, Sergio; Monti, Giacomo; Bergonzi, P. C.; Landoni, Giovanni; Salaris, Davide; Leggieri, Carlo; Torri, G.

doi:10.1007/s00134-008-1350-y

Cited by 62 publications

(34 citation statements)

References 21 publications

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“…Although first proposed years ago, 3,6,7 the use of NIV outside the ICU has increased, in particular in those countries where tight spending reviews reduce healthcare resources. 15 Because these constraints do not exclude ICU services, physicians often face the dilemma of guaranteeing proper treatments at contained costs.…”

Section: Discussionmentioning

confidence: 99%

“…This earlier usage allows for safe application outside a more closely monitored setting. 1,3,[5][6][7][8] Compared with both ICU and HDU, general wards are characterized by reduced house staff availability, especially during the SEE THE RELATED EDITORIAL ON PAGE 144 night shift. The possibility of detecting NIV-related adverse events, such as air leaks, accidental disconnection, oxygen desaturation, and mask intolerance, is then arguably lower than in ICU and HDU, and adequate NIV application may not be guaranteed, especially overnight.…”

Section: Introductionmentioning

confidence: 99%

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Does Noninvasive Ventilation Delivery in the Ward Provide Early Effective Ventilation?

Olivieri¹,

Carenzo

Vignazia³

et al. 2014

Respir Care

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BACKGROUND: Although noninvasive ventilation (NIV) is increasingly used in general wards, limited information exists about its ability to provide effective ventilation in this setting. We aim to evaluate NIV delivered in the ward by assessing (1) overall time of application and occurrence of adverse events and (2) differences between daytime and nighttime NIV application. METHODS: We studied subjects with hypercapnic acute hypercapnic respiratory failure not fulfilling strict criteria for ICU admission, and excluded those who interrupted NIV prior to 48 h. Time spent on NIV, presence and extent of air leaks, and occurrence of desaturations were assessed for the overall study period, and compared between daytime and nighttime. RESULTS: We enrolled 42 subjects, 25 of whom received NIV for at least 48 h and were included in the data analysis. NIV was successful for 20 subjects, who did not reach criteria for ICU admission. Both P aCO 2 and pH significantly improved on average after 2 h and at the end of the study period. NIV was applied for 64.5% of the overall study period and had absent or compensated air leaks for 62.3% of the overall 48-h period. NIV was applied for 55.8% of daytime and for 79.3% of nighttime (P < .01). Effective NIV application was significantly longer overnight (76.9%) than during daytime (53.2%) (P < .01). CONCLUSIONS: In selected subjects with hypercapnic acute respiratory failure not fulfilling criteria for ICU admission, the application of NIV in the ward is feasible; in addition, NIV can be safely administered overnight.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Noninvasive Ventilation Delivery in the Ward Provide Early Effective Ventilation?

Olivieri¹,

Carenzo

Vignazia³

et al. 2014

Respir Care

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“…Cabrini et al applied NIV in a wide variety of settings outside the ICU, with a high success rate and few complications. 27 However, in another study, by Schneider et al, 60% of the patients placed on NIV were ultimately transferred to an ICU or high-dependence unit, which suggests against this practice. 28 These dissimilarities led us to investigate this question further.…”

Section: Introductionmentioning

confidence: 98%

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

et al. 2013

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BACKGROUND: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical emergency teams (METs) provide acute care and monitoring to deteriorating patients on the general wards. Whether it is safe for an MET to start NIV in ward patients with respiratory distress remains unclear. METHODS: We evaluated 1,123 MET calls in 30,217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital. We identified ward patients with acute desaturation (< 90%) and tachypnea (breathing frequency > 28 breaths/min), for whom an MET was called. Subjects transferred to the ICU at the end of an MET call were excluded. The remaining ward subjects were divided into 2 groups: patients who were not started on NIV by the MET; versus patients who were started on NIV by the MET. The primary outcome was endotracheal intubation or ICU transfer within 48 hours of MET activation. Secondary outcome measures were 28-day mortality and ICU mortality. RESULTS: Two hundred thirty-eight MET subjects met the study criteria, and 109 immediate ICU transfers were excluded. Of the remaining 129 ward subjects, 54 were in the NIV group, and 75 in the no-NIV group. The NIV group subjects were sicker (mean Acute Physiology and Chronic Health Evaluation II score 17.6 ؎ 5.1 versus 14.4 ؎ 5, P < .001). Subjects with pulmonary edema, COPD exacerbation, or asthma exacerbation were more likely, while those with pneumonia were less likely to be placed on NIV. The primary outcome was reached in 2/54 (3.7%) of the NIV subjects and 12/75 (16%) of the no-NIV subjects (P ‫؍‬ .03). There was no significant difference (P > .30) between the groups in 28-day mortality (7.4% vs 13.3%) or ICU mortality (3.7% vs 8%). CONCLUSIONS: In selected ward patients, especially those with COPD or pulmonary edema, NIV can be safely initiated by an MET.

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“…Preliminary reports confirmed NIV efficacy even in a general ward setting. 5 Previously published surveys performed on this topic highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy in general wards. [6][7][8][9][10][11][12][13][14][15][16] Moreover, they revealed a marked heterogeneity even with regard to staff training and technical and organizational aspects of NIV use.…”

Section: Introductionmentioning

confidence: 99%

An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

et al. 2014

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BACKGROUND: Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. METHODS: A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The multiple-choice anonymous questionnaire to be filled out online was distributed worldwide by mail, LinkedIn, and Facebook professional groups. RESULTS: One-hundred fifty-seven questionnaires were filled out and analyzed. Respondents were from 51 countries from all 5 continents. NIV application in general wards was reported by 66% of respondents. Treatments were reported as increasing in 57% of cases. Limited training and human resources were the most common reasons for not using NIV in general wards. Overall, most respondents perceived that NIV avoids tracheal intubation in most cases; worsening of ARF, intolerance, and inability to manage secretions were the most commonly reported causes of NIV failure. CONCLUSIONS: Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting.

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Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure

Abstract: Under the supervision of a MET, in our institution NIV could be applied in a wide variety of settings, outside the ICU, with a high success rate and with few complications.

Cited by 62 publications

References 21 publications

Does Noninvasive Ventilation Delivery in the Ward Provide Early Effective Ventilation?

Does Noninvasive Ventilation Delivery in the Ward Provide Early Effective Ventilation?

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

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