2007 OPEN FORUM Abstracts
MECHANICAL VENTILATION IN THE EMERGENCY DEPARTMENT, ARE WE PROVIDING THE PROPER SUPPORT?
J. Cappiello1, M. Griffis1, J. Thalman1, N. MacIntyre1
Background: The use of mechanical ventilation to support the critically ill has changed. Noninvasive positive pressure ventilation (NPPV) is a frequently used support system in the emergency department due the literature, emergency medicine trained physicians, and equipment advances. The equipment we commomly used for this therapy was NPPV specific. Today, NPPV has become a part of our modern ventilator modes. To purchase ED ventilators, we felt it would be beneficial for our respiratory care department (RCD) to: 1. review our ED use of NPPV and invasive ventilatory support, 2.determine a cost per usage difference between our present system of separate noninvasive and invasive devices.
Methods: ED core team respiratory care practitioners (RCP) maintained individual databases on NPPV use and intubation which represents 75% of RCP ED time. A continuous 6 month period was studied. A concurrent 6 month review of the databases yielded 113 entries. The patients were divided into surgical and medical categories. Surgical patients included trauma, and those requiring airway protection for a procedure, the medical group included those in acute respiratory distress or failure.
Results: 24 surgical patients and 63 medical patients were treated with invasive ventilation for a total of 87. 0 surgical and 26 medical patients,for a total of 26 patients were treated noninvasively. Our cost/set up was $17.17 for invasive and $41.33 for noninvasive. NPPV was used in 23% of the total patients receiving ventilator support and in 29% of the medical patients. Based on our data, we estimate our ED NPPV usage at 68 patients a year. Projected cost for ED NPPV specific equipment is $2,810.44/year.
Discussion: These numbers reflect a large volume of ED NPPV usage. Greater than 25% of our ED ventilated patients were treated noninvasively. Presently, 33% of our ED ventilators are NPPV specific. A single device that could ventilate invasively as well as noninvasively with the same circuit could decrease our equipment budget and lessen important storage concerns. The estimated circuit cost savings is $1,642.88/year. NPPV equipment stocking issues would be absorbed in our current invasive ventilator equipment storage.
Conclusion: The growing use of NPPV, the lack of adequate storage space, the cost per use benefits, and the improved patient monitoring led us to recommend a mechanical ventilator capable of NPPV. Other respiratory care departments may find this analysis helpful.