2006 OPEN FORUM Abstracts
NOINVASIVE POSITIVE PRESSURE VENTILATION IN DO NOT RESUSCITATE/ DO NOT INTUBATE PATIENTS
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: Noninvasive Positive Pressure Ventilation (NPPV) has
been a successful therapy in patient care.
NPPV in the Do Not Resuscitate/Do Not Intubate (DNR/DNI) patient is
becoming an important option in end-of-life care for our patients at Brigham
and Women's Hospital.
Hypothesis: The use of NPPV in the DNR/DNI patient can be a useful
and effective tool in the caring for the patient at the end of life.
Methods: Our NPPV team reviewed all DNR/DNI patients that
received NPPV beginning in January of 2003 through April 2006. (see Table 1.)
This team consists of the medical director, department management, and clinic
coordinators. The RT completes the NPPV
data collection sheet for each patient.
The patient's status is documented on this sheet. All patients are
monitored during, and reviewed following therapy. Success in this population is judged in three
ways:
1.
the ability to
provide relief to the dyspneic patient
2. the ability to
provide life support to the patient while a family or team meeting is taking
place
3. the ability to
provide life support to a patient at his or her request until family members
arrive at the hospital, allowing the patient the opportunity to say good-by
Conclusion: NPPV
has been shown to provide significant relief from dyspnea. Providing comfort to a patient during the
end-of-life process can frequently be accomplished through the use of
non-invasive ventilation. One of the
benefits of utilizing NPPV for this patient population is that it can be
discontinued quickly and easily at the patient's request. It is clear to our team at the Brigham and
Women's Hospital that NPPV plays an important role in the DNR/DNI patient. We
continue to closely monitor each patient to ensure that suffering is not
prolonged needlessly by NPPV.
| Figure 1, DNR/DNI Patients on NPPV | |||
| Total Patients | DNR/DNI | % | |
| 2003 | 202 | 10 | 4.90% |
| 2004 | 262 | 16 | 6.10% |
| 2005 | 457 | 29 | 6.30% |
| 2006 (4 Months) | 126 (378 projected) | 19 (57 projected) | 15.10% |