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.
| Year | 1998 | 1999 | 2000 |
| # Non-invasivePt?s | 62 | 126 | 130 |
| Non-invasivedays | 182 | 370 | 425 |
| Invasive Pt?s | 408 | 382 | 463 |
| # Invasivedays | 1925 | 1166 | 2165 |
| Total MechV Days | 2107 | 1536 | 2590 |
| % Non-invasive | 9% | 24% | 16% |
| # Intubatedafter NI Trial | 6 | 22 | 27 |
| Rate of Success | 90% | 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.