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.
|Invasive Pt?s ||408||382||463|
|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.