The Science Journal of the American Association for Respiratory Care

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%


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