The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

Successful Implementation of a Non-invasive Ventilation Program USING A TEAM APPROACH

Carol Spada, RRT, Paul F. Nuccio, RRT, FAARC, Michael R. Jackson, CPFT, RRT-NPS, Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts.

Introduction: It has been well established that the use of Non-invasive Positive Pressure Ventilation (NPPV) results in a reduction in the complications associated with endotracheal intubation and mechanical ventilation.

Hypothesis: Positive outcomes associated with the use of NPPV are observed when appropriate patients are selected, and the therapy is administered and monitored by experienced clinicians.

Methods: All patients who received NPPV beginning in January 2002 at a 755-bed academic medical center have been monitored and reviewed by an NPPV Team consisting of the Medical Director, department management, and members of the respiratory care staff. The RT completes a NPPV Data Collection Sheet for each new patient who is started on NPPV. After completing all relevant data including diagnosis, indication for therapy, acid-base and oxygenation data, initial and stabilized ventilator settings, and preliminary outcome information, the patient's ongoing clinical status is documented on the back of this sheet. All patients are monitored during, and reviewed following, each patient's course of therapy. Outcomes are decided upon based on duration of therapy, discontinuation of therapy, and avoidance of intubation. The results of each case are documented in an ongoing log using MS ExcelÓ spreadsheet format.

Results: Our preliminary data suggests that approximately 369 patients, or 56% of those treated with NPPV, were able to avoid intubation. It was our experience early on that the most common cause of failure, when NPPV was applied using a critical care ventilator, was due to patient/ventilator dys-synchrony.

Conclusion: Staff education, device and interface selection, and proper patient selection each play a significant role in determining the level of success with the delivery of NPPV. Selecting the appropriate patient at the proper time plays a critical role in determining positive outcomes. The rate of success may be further enhanced with more rigid criteria for selection of patients, delivery device, and choice of interface. We conclude, based on clinician feedback, that the use of a portable, pressure-limited device specificallydesigned for the delivery of NPPV is preferable over the use of a critical care ventilator, although the latter has been shown to be effective as well. In our experience, the use of such a device has resulted in improved patient acceptance and tolerance with the therapy.

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