Noninvasive Ventilation Outside the Intensive Care Unit From the Patient Point of View: A Pilot Study

Cabrini, Luca; Moizo, Elena; Nicelli, Elisa; Licini, Gloria; Túri, Sándor; Landoni, Giovanni; Silvani, Paolo; Zangrillo, Alberto

doi:10.4187/respcare.01474

Cited by 50 publications

(50 citation statements)

References 23 publications

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“…Our study differs from the studies by Cabrini et al 25 and Schneider et al 28 The Cabrini study was not done in a true MET context, where a single anesthesiologist worked as the MET to manage NIV. Cabrini included around 40% emergency department patients, which are not served by MET in our hospital.…”

Section: Discussioncontrasting

confidence: 57%

“…30 However, with the growing shortage of ICU beds and lack of high dependence units in many hospitals, 19,25,31 the options are limited to either delaying NIV initiation or to starting it on the ward. Delay can result in patient deterioration and reduce the chance of NIV success.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24] Nonetheless, the concern for starting NIV without monitoring on the wards is legitimate, as non-responding patients can go unnoticed and may deteriorate suddenly in the absence of close observation. 1,25 Medical emergency teams (METs) provide immediate critical care expertise in evaluating, monitoring, treating, and triaging general ward patients. 26 In some hospitals, patients on the wards can be started on NIV during MET evaluation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…A number of studies have investigated the success of NIV treatment in non-ICU clinics. The reported success rates vary in a wide range between 44% and 90% according to the management units, patient groups, and disease stages (12,13). Little is known on the predictive factors of NIV failure in wards.…”

Section: Introductionmentioning

confidence: 99%

How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Ağca¹,

Akyıl²,

Duman³

et al. 2017

Eurasian J Pulmonol

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Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV) in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD)-related acute hypercapnic respiratory failure (AHRF). Methods:The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED) because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO 2 ) values were recorded. Baseline pH values were categorized as severe (pH<7.26), moderate (pH≥7.26-7.30), and mild (pH≥7.30) acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer.Results: Treatment resulted in success in 477 (88%) patients. Albumin levels were significantly low and the mean Charlson index (CI) score was significantly high in Group 2. Admission pH and PaCO 2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO 2 and lower pH values as well as a lower level of decrease in PaCO 2 values within 2 hours of treatment in ED. Similarly, higher PaCO 2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05). Conclusion:The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO 2 values after a few hours of treatment and not the baseline pH or PaCO 2 values are better predictors than the baseline pH and PaCO 2 values.

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“…7 We believe that further studies on application of NIV outside the ICU should be conducted. Further, the parameters for respiratory failure should be identified early, which would allow for a more focused implementation.…”

mentioning

confidence: 96%

Noninvasive mechanical ventilation as early intervention in hematopoietic SCT: protective, therapeutic or futile? The lungs may have the correct answer

Esquinas

Pieter

2012

Bone Marrow Transplant

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Noninvasive Ventilation Outside the Intensive Care Unit From the Patient Point of View: A Pilot Study

Abstract: Subjects reported a low level of involvement in the initial setting of NIV treatment, low satisfaction about communication with the caring staff, and a suboptimal safety level in case of emergency.

Cited by 50 publications

References 23 publications

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

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

How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Noninvasive mechanical ventilation as early intervention in hematopoietic SCT: protective, therapeutic or futile? The lungs may have the correct answer

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