The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A RETROSPECTIVE REVIEW OF NPPV AND ITS EFFECT ON OUTCOMES FOR CHRONIC OBSTRUCTIVE AIRWAY DISEASE (COA) PATIENTS ADMITTED VIA THE ED FOR RESPIRATORY COMPLIANTS.

Joel M. Brown1, Amy Prang1, Vinay Maheshwari2, John S. Emberger1



Background: When managing COA patients in respiratory distress it can often become very difficult to determine when to assist them with mechanical ventilation. Because of recent technological advancements, NPPV has played a major role in the management of COA patients with respiratory distress, with multiple studies that validate the use of NPPV in these situations. To date none of these studies have taken an extensive look at how effective NPPV is in this population with the consideration of clinical location. This study examines NPPV initiation in the ED versus the medical surgical floors and observed the outcomes.

Methods: Using our Respiratory Data Warehouse we retrospectively analyzed all adult COA patients who were admitted to the hospital via the emergency department (ED) for respiratory complaints over a 3 year period (2005 through 2007). Respiratory complaints were identified as reasons for admission including "respiratory distress", "wheezing", "COPD exacerbation", "difficulty breathing", "short of breath", "pneumonia", and/or "asthma". We then identified all patients who were placed on NPPV during their admission and excluded any patients who used invasive mechanical ventilation. All pregnant women were excluded. We identified patients who were placed on NPPV in the ED in one group (ED NPPV) and patients who were placed on NPPV on the medical surgical floors in another group (Non-ED NPPV). For each group we looked at average age, average sex, survival, and discharge status.

Results: Five thousand five hundred three (5,503) patients were placed on NPPV in our facility over a 3 year period. A total of 1,442 patients were identified as known COA patients admitted via the ED for respiratory complaints. The following results were found.

Conclusion: This retrospective review identifies differences in patient outcomes based on the location and timing of NPPV in patients with Chronic Obstructive Airway Disease. In those patients in whom NPPV was initiated in the ED, there was a lower overall hospital mortality as compared to those with NPPV initiated on MedSurg floors. Furthermore, those with earlier NPPV initiation in the ED were more likely to be discharged home. The reasons for this difference was not elucidated but may be due to NPPV leading to improved outcomes if initiated earlier, higher level of care at onset in those who received NPPV in ED, or perhaps missed opportunities in the ED.