The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

IMPLEMENTATION OF A NONINVASIVE POSITIVE PRESSURE VENTILATION PROTOCOL THAT EMPHASIZES EARLY INTERVENTION IN A LARGE COMMUNITY HOSPITAL SETTING AND ITS IMPACT ON INTUBATION

Paul Luehrs BSRT, Jack Edge RRT CoxHealth Springfield MO

BACKGROUND: Noninvasive Positive Pressure Ventilation (NPPV) is a standard of care for many medical conditions. It has been shown to reduce the need for intubation in specific groups of patients. (5) Avoiding intubation reduces the risk of complications for the patient and can result in significant cost savings. Complications related to intubation and mechanical ventilation may include aspiration of gastric contents; trauma to the teeth, hypopharynx, esophagus, larynx, and trachea; cardiac arrhythmias; hypotension; bleeding; and mediastinitis. (2) Conditions that have been shown to respond well to NPPV are exacerbations of Chronic Obstructive Pulmonary Disease (COPD), congestive heart failure (CHF) and neuromuscular diseases among others. (1,4,5)

METHODS: Our institution implemented a therapist driven NPPV protocol, which emphasizes " early intervention" , in fiscal year (FY) 2002. When a patient reaches the threshold Fi02 of > 0.5 an assessment is triggered and if inclusion criteria are met NPPV per protocol is initiated with a physician order. The protocol was designed to care for patients requiring NPPV for various conditions in the critical care unit and on general care floors. Our protocol utilizes respiratory therapy assessments and specific algorithmic strategies depending upon hypercapnic or hypoxemic failure processes.

RESULTS: Our data has shown that with the implementation of an NPPV program that emphasizes " early intervention" , intubation and subsequent Invasive Positive Pressure Ventilation (IPPV) rates can be lowered. From FY2000 through FY2004 we had a 141% increase in NPPV hours and a 34% decrease in IPPV hours there was a 8% decrease in total adult ventilation. During this time we had a 5% increase in patient admissions.

CONCLUSION: By implementing a therapist driven NPPV protocol, that emphasizes " early intervention" , an institution can impact the intubation rate independent of admission rate and influence the potential risk and cost incurred by the patient and the hospital as a result.

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