The Science Journal of the American Association for Respiratory Care

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.

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