2004 OPEN FORUM Abstracts
IS NON-INVASIVE VENTILATION APPROPRIATELY SELECTED IN ADULT PATIENTS WITH RESPIRATORY FAILURE?
Renee Brett, AAS,
RRT, David Squeglia, BA, AS, RRT, Ross Thomas, RRT,
Barry Young BS, RRT, Suzanne M. Burns RN, MSN, RRT, ACNP, CCRN, FAAN,
FCCM, University of Virginia, Charlottesville, Virginia.
Background: Bi-PAP is a non-invasive method of ventilatory support that has been demonstrated to be effective in patients with sleep apnea and nighttime hypoventilation. Other, more acute uses of the therapy, such as to prevent intubation in acute respiratory failure, or to prevent reintubation, have also been reported. Because of the non-invasive nature of the method, Bi-PAP is increasingly being ordered for a variety of conditions found in critical care, ER and on acute care units. Unfortunately, little information about the clinical variables present at the initiation of the therapy and associated outcomes, is available to guide practice
Purpose: To determine the clinical variables and conditions that correlates with successful or non-successful use of Bi-PAP therapy in acutely ill adult patients at UVA.
Hypothesis: That selected clinical variables will correlate with success or failure of Bi-PAP therapy.
Materials and Methods: The sample included adult patients assigned to Bi-PAP in acute and critical care units in the hospital from June 2001 to July 2002. MICU study investigators were alerted to the use of Bi-PAP and conducted a retrospective chart review to collect the variables of interest. Variables of interest included those related to the clinical status of the patient prior to the initiation of the therapy and those noted after initiation of the therapy. In addition, the final outcome of the therapy and the relationship of outcome to clinical status variables were determined.
Analysis: Descriptive statistics were done for all variables and the Spearman coefficient was used to compare all variables with outcome variables of interest.
Results: 78 patients assigned to Bi-PAP were analyzed. The most common diagnoses were CHF (12 %), Respiratory failure (20%), and COPD (28%). The patients were predominately from the MICU (34%), the acute care units (27%) and the ER (24%). Fifty three percent of the patients were assigned to Bi-PAP for an episode of pulmonary edema. Prior to the initiation of Bi-PAP >50% of the patients experienced severe acidosis and hypercarbia (pH= <7.15-7.24 and PaCO2= > 76 mmHg) but not hypoxemia (SaO2= 90-100 mmHg). The duration of Bi-PAP was > 90 minutes in 64% of the patients with forty percent of the patients experiencing full resolution of the reason for the therapy. Seventeen percent required intubation and 12% refused the therapy and were removed from Bi-PAP. Relationships between variables of interest and outcomes are being analyzed and will be described.
Conclusion: Patients requiring Bi-PAP are often acutely ill with severe acid-base abnormalities. Since the therapy is both labor and time intensive, an understanding of the relationships between clinical status at the initiation of therapy and outcome will be helpful in developing guidelines for the appropriate use of the therapy at UVA.