The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

Selection Criteria for Non-Invasive Ventilation (NIV) as a means of Avoiding Intubation in Patients with Acute Respiratory Failure.

Tate Bennett, RRT; John Davies, RRT; Joe Govert, MD Neil MacIntyre, MD; Duke University Medical Center, Durham, NC.

INTRODUCTION: The use of non-invasive ventilation is gaining popularity as a means of avoiding endotracheal intubation in selected patients. We developed a patient selection protocol for the use of NIV and sought to evaluate its effectiveness in preventing endotracheal intubation. The protocol is based on the International Consensus Conference in Intensive Care Medicine (Am J Respir Crit Care Med, vol 163, 2001).

Methods: Our selection protocol was as follows: Patients exhibiting signs of respiratory distress with respiratory rate > 24, accessory muscle use, paradoxical breathing, PaCO2 > 45 mmHg, pH < 7.35, P/F < 200. Exclusion criteria included being hemodynamically unstable (hypotensive shock, cardiac ischemia or life threatening arrhythmias), inability to protect the airway, excessive secretions, refusal to cooperate/agitation and facial trauma or burns. Data were collected from an initial group of patients prior to protocol development. These patients were put on NIV based on physician judgment. We then employed the selection protocol and assessed a second group of patients.

RESULTS: We observed a smaller percentage of patients requiring endotracheal intubation in the selection protocol group (41%) versus the physician judgment group (59%). Also, a much larger percentage were able to be weaned off NIV within 48 hours (56%) in the selection protocol group than in the physician judgment group (18%).

  # of Patients Improvement in 6 hours Off NIV within 48 hours Intubation Required
Physician Judgment Group 17 10 (59%) 3 (18%) 10 (59%)
Selection Protocol Group 27 20 (74%) 15 (56%) 11 (41%)


CONCLUSION: Our selection protocol identifies a patient population who benefit from NIV better than simple physician judgment.

1. The American Thoracic Society. International Consensus Conferences in Intensive Care Medicine: Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure. American Journal of Respiratory & Critical Care Medicine. 163(1):283-91, 2001 Jan.

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