2004 OPEN FORUM Abstracts
OUTCOMES OF NON-INVASIVE POSITIVE PRESSURE VENTILATION BEGUN ON THE REGULAR HOSPITAL WARD.
Ziad Ghamra, MD, Ed Hoisington, RRT,
Marty Lemin, RRT, James K Stoller, MD, MSc, FAARC, The Cleveland
Clinic Foundation, Cleveland, Ohio.
Background: In
the context that non-invasive positive pressure ventilation (NPPV)
has been shown to have efficacy in treating patients with
exacerbation of chronic obstructive pulmonary disease (COPD), NPPV is
now widely employed in many settings. However, little attention has
been given to the optimal venue in which to provide NPPV,
particularly whether it should be administered in the intensive care
unit (ICU) or on a regular nursing ward. Therefore, we started a
prospective observational study on the use of NPPV on the regular
inpatient wards of the Cleveland Clinic Foundation.
Methods:
Starting April 2004, all new patients receiving NPPV prescribed for
acute respiratory failure in non-ICU areas were identified. The chart
and radiograph of the patient were reviewed to identify the etiology
of respiratory failure and patients were followed prospectively by
one of the investigators (ZG) for the outcome of NPPV therapy.
Failure of NPPV on the floor was defined as need for ICU admission.
Patients with a “do not intubate (DNI)” order were
considered separately.
Results: Between April 1st
and July 15th 2004, 26 patients were started on NPPV for
acute respiratory failure on a regular hospital ward in the Cleveland
Clinic Hospital. The etiology of acute respiratory failure was COPD
exacerbation in 6 patients, pneumonia or acute lung injury (ALI) in
7, pulmonary edema in 6, obesity-hypoventilation in 4, neuromuscular
illness in 2, and narcotic overdose in 1. Five patients (19%) carried
a DNI order. Of the remaining 21 patients, 6 (29%) failed NPPV (3
with pneumonia, 1 each with neuromuscular illness,
obesity-hypoventilation, and pulmonary edema).
Table.
Percent of Patients Who Failed NPPV (by Diagnosis)
| Diagnosis | # Patients | # Who Failed BiPAP (% of n=21) |
| COPD exacerbation | 6 (29%) | 0 |
| Pneumonia/ALI | 5 (24%) | 3 (14%) |
| Pulmonary edema | 3 (14%) | 1 (5%) |
| Obesity-hypoventilation | 4 (19%) | 1 (5%) |
| Neuromuscular disease | 2 (10%) | 1 (5%) |
| Narcotic overdose | 1 (5%) | 0 |
| Total patients ( less 5 “DNI”) | n = 21 (100%) | n = 6 (29%) |
Conclusion:
Failure of NPPV was observed in 29% of patients treated on the
regular hospital ward. Further prospective study is ongoing to
identify correlates of NPPV success when used for acute respiratory
failure outside of the intensive care unit.