1995 OPEN FORUM Abstracts
TRADITIONAL VERSUS NON-TRADITIONAL METHODS OF SHORT TERM POSITIVE PRESSURE VENTILATION: A COMPARISON STUDY
Wendy L. LaChaunce, RRT Joan Blondin, BS, RRT Fletcher Allen Health Care, MCHV Campus, 111 Colchester Avenue, Burlington, Vermont, 05401.
In an effort to address the continued shortage of intensive care unit beds and to improve the quality of care for our patients, we formed a team of professionals to compare the effectiveness of non-invasive positive pressure ventilation (N-IPPV), to invasive intubation and conventional mechanical ventilation. The comparison study included 36 patients who were diagnosed with progressive respiratory failure. Of the 36 patients, the primary causes of respiratory failure included: acute pulmonary edema (n=11), COPD (n=10), post-op extubation respiratory failure (N=8), limited support, DNR (N=4), neuromuscular disease (N=2) and chest trauma (N=1). A physician makes the decision to institute N-IPPV based on pre-established criteria: RR>30, PH < 7.30 with PC02>55, and Pa02< 55 or 02 sat < 90 (that does not respond to supplemental 02). A respiratory practitioner then initiates N-IPPV and adjusts the settings according to a therapist driven protocol. The results to date are very encouraging. Of the 36 patients studied, 75% (N=27) improved and did not require intubation, 14% (N=5) worsened and required intubation, and 11% (N=4) died (per advance directives, DNR). The most favorable response to N-IPPV was noted in the acute pulmonary edema (91% improved without intubation) and COPD (80% improved without intubation) groups. Throughout the study, no significant complications were noted, and no additional staffing was required to institute treatment. Using historical patient data from a six month pre-project period, we estimated the average length of intubation and mechanical ventilation, of patients with similar diagnosis and degree of respiratory failure, to be approximately 4 days. We compared this to an average length of N-IPPV of 2 days. Since N-IPPV is non-invasive, patients did not always require an ICU bed. Seven of our 36 study patients were managed on the general wards, and 29 required an ICU bed. The two day drop in ICU stay translates into a dollar savings of $156,015 in six months. Other benefits realized include increased patient and employee satisfaction as evidenced by interviews and patient satisfaction surveys and a reduction in the risk factors associated with intubation and conventional ventilation. In conclusion, we feel that N-IPPV is a safe and effective alternative to intubation and mechanical ventilation in some patient populations. N-IPPV can eliminate the need for intubation and reduce the length of stay in the ICU thereby conserving valuable and expensive resources and reducing the cost of care to the patients and the institution.