The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

Rate ofsuccess of a non-invasive ventilator program

Lahsha Welch,RRT, RosaWoodrum, RRT, Wayne Wallace, BA, RRT Kaiser Permanente West Los AngelesMedical Center, Los Angeles, CA

BACKGROUND: KaiserPermanente?s West Los Angeles Medical Center is an acute care hospital servingthe HMO?s members on the west side of Los Angeles. In 1997, the medical centerinstituted an aggressive non-invasive ventilator program with the goal thatbetween 10-20% of all mechanical ventilation would be delivered non-invasively.Patients were treated with non-invasive ventilatory techniques primarily inthe hospital?s telemetry unit and ICU, although some patients were initiatedin the Emergency Department.

Methods: LeadRCPs attended a ?train-the-trainers? educational program about non-invasiveventilation sponsored by an equipment manufacturer. The lead RCPs, in turn,trained the department?s staff and instituted the program. Patients sufferingfrom respiratory failure were offered non-invasive ventilation if they couldcooperate with verbal commands, handle their own secretions, and had an intactgag reflex. To ensure adequate patient-ventilator interaction a trained RCPremained with the patient for the initial 45 minutes of therapy.

Results: In 1997,the program treated 52 patients (partial year data) and has expanded steadilysince then. Patients using long-term non-invasive ventilation were excludedfrom the data. Adverse reactions were tracked and the only items reported wereinstances of mild facial rash or skin redness. The results are summarized inthe following table.

Year199819992000
# Non-invasivePt?s62126130
Non-invasivedays182370425
Invasive Pt?s 408382463
# Invasivedays192511662165
Total MechV Days210715362590
% Non-invasive 9%24%16%
# Intubatedafter NI Trial62227
Rate of Success90%83% 79%

 

EXPERIENCE:A well-implemented non-invasive ventilator program can offer carefully selectedrespiratory failure patients a safe treatment option with an acceptable rateof success.

Conclusions: Inorder to avoid the well-known complications associated with invasive mechanicalventilation, our hospital pursued the non-invasive ventilation option. A successfulimplementation program can increase an organization?s acceptance of new treatmentstrategies for respiratory failure.

OF-01-036

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