Models of care for non‐invasive ventilation in the Acute COPD Comparison of three Tertiary hospitals (ACT3) study

Abstract

In acute hypercapnic Chronic obstructive pulmonary disease (COPD) patients, the Ward model of NIV care achieved equivalent clinical outcomes, whilst being more cost-effective than HDU or ICU models.

Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV

“…and economic assessment between differing settings (ward based, high dependency unit and ICU) for the provision of NIV in treating AHRF demonstrated the ward environment produced equivalent clinical outcomes at a lower cost per patient [23] again supporting the delivery of service in this environment.…”

Observational cohort study of outcomes in patients admitted to the intensive care unit for acute exacerbation of chronic obstructive pulmonary disease

“…A decision at discharge from ICU not to consider readmission in the future furthermore might have introduced a selection bias. 29 The length of stay in ICU was not significantly different between any groups but patients with LOMT stayed a median 2 days longer in hospital. 10 While the overall evidence was heterogeneous with most studies of low quality, neither age, functional capacity, previous hospital or ICU admissions or long-term oxygen therapy were found to be significant predictors of intermediate-term mortality, 34 but associated with longer term poor outcome similar to other reviews.…”

“…A ward based model to provide NIV was recently demonstrated to be cost-effective. 29 The length of stay in ICU was not significantly different between any groups but patients with LOMT stayed a median 2 days longer in hospital.…”

“…26 This study found a much higher prevalence of LOMT at 32% of admitted patients but it must be noted that this includes decisions made both at the time of admission and also during the ICU stay based on clinical progress. 29 There are no prognostic systems reported that demonstrate sufficient precision to provide adequate guidance in ICU triage decisions for AECOPD patients. A recent Australian study demonstrated that ward-based provision of NIV achieved similar clinical outcomes while being more cost-effective, compared to NIV delivered in a high-dependency unit or ICU.…”

“…A recent Australian study demonstrated that ward-based provision of NIV achieved similar clinical outcomes while being more cost-effective, compared to NIV delivered in a high-dependency unit or ICU. 29 There are no prognostic systems reported that demonstrate sufficient precision to provide adequate guidance in ICU triage decisions for AECOPD patients. [30][31][32] While routinely used systems such as APACHE III and SAPS II may have an overall prognostic efficiency of up to 90%, 32 the APACHE III is known to overestimate the in-hospital mortality for AECOPD in Australian/New Zealand ICU.…”