The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

POST-ICU OUTCOME OF PATIENTS TREATED WITH NON-INVASIVE ASSISTED VENTILATION (NAV) FOR ACUTE RESPIRATORY FAILURE USING A REGISTRY & RESPIRATORY THERAPIST-DRIVEN PROTOCOL.

Allen G. Kendall RRT, Arlene Wenzel RN, Peter C. Gay MD. Mayo Foundation, Rochester, Mn. 55905.

We have seen an exponential increase in the use of NAV in the hospital setting and have now adapted our practice to take advantage of a therapist-driven protocol. Several reports have documented the results of NAV therapy in the acute care setting but little information is available regarding the follow-up of these patients beyond the ICU and following dismissal from the hospital. We routinely monitor patient care and outcome with a non-invasive ventilation registry and now report our most recent results over the last 5 months. The registry includes information regarding patient demographics and diagnosis, resuscitation and previous intubation status, ventilator settings, nasal vs full-face mask use, length of time on NAV, and outcome. The present patient population of 46 pts includes 26 males/20 females with a mean age of 65.6 yrs (range 17-92 yrs) with the following diagnoses: COPD- 25 pts; neuromuscular disease- 5 pts; obesity hypoventilation- 5 pts; cancer- 5 pts; kyphoscoliosis- 3 pts; other- 3 pts. There were 20 pts who were previously intubated during the present hospital admission and only 12 pts were a do not resuscitate status.' The mean inspiratory and expiratory pressure settings were 11.8 ±2.6 (Std Dev) and 4.6 ± 1.6 cmH_{2}O respectively. There were 45.7% of patients that used a triggered mode only while 54.3% also had a timed machine rate. A full face mask was utilized by 64.3% with the remainder using a nasal mask. The mean actual NAV use was 27.8 ± 26.5 hours over 3.7 ± 4 days during a total of 16.1 ± 14.8 hospital days. After dismissal from the ICU, 13 pts continued nocturnal or periodic daytime use of NAV and 9 pts were dismissed with equipment for home use. During the hospital stay, there were 25 pts who were either stabilized or improved and 21 pts either refused to continue (12 pts) or failed the therapy (9 pts) with 8 'failed' pts opting for intubation. Four pts expired in the hospital and 4 additional pts were not alive during our post- hospital inquiry period. Nine pts continued post-hospital use of nocturnal NAV and 28 of the 42 pts with follow-up contact are either stable or improved since discharge. For the COPD subgroup, 50% were stable or improved with NAV: 20% required intubation. We conclude that only 19.6% of pts actually failed NAV therapy and 2/3 of patients introduced to NAV for acute respiratory therapy continue to be stable or improved after discharge from the hospital. The refusal to continue NAV therapy does not necessarily portend a bad prognosis, as 8 of our 12 refusing patients are stable since hospital dismissal. We continue to utilize this therapy for patients with acute respiratory failure and hope to use the registry to clarify indicators of success for patients using NAV.

Reference: OF-96-135

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