Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

Abstract

Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit.During the first 24 h after enrolment, NIPSV was used for 6.7 3.2 h (mean SD) in group I and 5.6 3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47 12 and 11 7 min in group I, and 46 12 and 11 6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7 3.2 h . day -1 in group I and 4.9 3.5 h . day -1 in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44 10 and 7 4 min in group I, and 47 14 and 7 3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients.In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency. Methods of noninvasive pressure support ventilation (NIPSV) are being proposed more and more for patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure [1±6]. NIPSV can avoid the need for endotracheal intubation and its increasingly documented complications [7]. Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2, 4, 9, 10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].Three articles have demonstrated that the institution of noninvasive mechanical ventilation is not significantly more time-consuming for personnel than traditional medical therapy [4,12] or invasive mechanical ventilation [13]. However, two of these studies [12,13] were performed in respiratory intensive care units (ICUs) with a specialized activity, and where patient/staff ratios are generally lower than in general ICUs [13]. The authors consider that the problem lies not in comparing the workload linked to utilization of NIPSV with that linked to standard treatment or invasive mechanical ventilation, since it is advisable to use NIPSV to avoid intubation. It is more a question of know...

Where to perform noninvasive ventilation?

“…NPPV has been reported to be a time consuming procedure [42] but as with any new technique there is a learning curve and the same group have subsequently published more encouraging results [43]. A number of studies in the ICU, have shown that to start with a significant amount of time is required to establish the patient on NPPV, but this drops off substantially in subsequent days [3,44,45]. It is possible therefore that NPPV may have a much greater impact on nursing workload outside the ICU, where nurses have responsibility for a larger number of patients.…”

Noninvasive Mechanical Ventilation in Immunocompromised Patients

“…The protocol of sequential ventilation is appreciated by our staff and has contributed to the standardization of techniques of NIV in our ICU. 29 It has not been necessary to modify the organization of our unit since the introduction of these new techniques.…”

“…18,25 On the basis of our previous experience, we use NIV in a sequential mode. 16,[27][28][29] This mode is a discontinuous mode, with some specificity (ie, the predetermination of the duration of the ventilation sessions and of the time between the NIV sessions). One of the potential advantages of the sequential approach is a harmonious distribution of NIV sessions, plus a better acceptance and tolerance for the patients, and a better management by nursing staff.…”

“…[27][28][29] Between periods of ventilation, patients breathed oxygen spontaneously while SaO 2 was continuously monitored. NIV was automatically resumed when the arterial oxygen saturation was less than 85% or when dyspnea worsened, as evidenced by a respiratory rate of more than 30 breaths per minute.…”

Bronchialobstruktion in der Intensivmedizin

“…Deshalb gilt heute die nicht-invasive Beatmung in dieser Gruppe grundsätzlich als indiziert. Die nicht-invasive Therapie ist bei der Behandlung dieser Gruppe nicht mit einem höheren Ressourcenverbrauch als die invasive Beatmung verbunden [22].…”