The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

A 2 YEAR RETROSPECTIVE REVIEW OF NONINVASIVE VENTILATION IN AN EMERGENCY DEPARTMENT SETTING

J Brady Scott, Michael A. Gentile, Jhaymie L. Cappiello, Janice Thalman, Neil MacIntyre; Duke Medical Center, Durham, NC

Background: Noninvasive Ventilation (NIV) has been shown to be safe and effective in supporting Acute Respiratory Failure (ARF). The decision to use NIV in the emergency department (ED) is often a clinical choice based on assessment, vital signs, symptoms and available medical history. The successful use of NIV in this setting is dynamic and demands skilled practitioner support. Our Respiratory Care Department staffs our ED with a core group of practitioners. To assess our use of this practice, we reviewed a NIV database maintained by ED core team Respiratory Care Practitioners (RCP’s). Methods: Following IRB approval, we reviewed our database between 1/2005 and 8/2007 for NIV patients that presented in ARF as defined by any three of the following: 1.Acute onset of moderate to severe SOB as determined by ED clinician from history and physical 2.Initial RR>25 3.SpO2<90% on RA 4.Need for supplemental O2 5.Chest X-ray consistent with pulmonary edema 6.ABG showing PaO2<60 mmHg or PaCO2>50 mmHg or pH < 7.3 Recorded data was then tabulated to determine average age of patient, degree of respiratory distress, length of NIV support, disposition, requisite intubation and noted complications. Results: 88 patients presented in ARF requiring NIV with an age of 61 ±13 years. On arrival, the room air pulse oximetry revealed a saturation of 84 ± 9%, respiratory rate of 30 ± 9. Initial blood gas values were: pH 7.26 ± 0.1 and PaCO2 66 ± 24. The average initial NIV settings were: Pinsp 15 ± 3, Pexp 7 ± 2 and a FiO2 of 0.55 ± 0.23. Average length of NIV usage was 3.9 ± 2.9 hours. 40% were admitted to an intensive care unit. 8% required subsequent intubation. The length of NIV usage for patients intubated was 2.6 ± 1.8 hours. All patients requiring intubation were in a critical care setting during NIV usage. No complications from NIV were noted as defined by loss of responsiveness, hypoxia, hemodynamic instability or emesis. The diagnoses and their presenting frequencies are as follows: Acute Pulmonary Edema 40, Asthma 19, COPD 17, Pneumonia 5, Sepsis, Malignant Effusions, Narcotic Overdose and Pulmonary Embolism 5. Conclusion: Our current practice for NIV in the ED appears safe and effective as determined by the lack of complications and low intubation rates for the presenting respiratory distress. Sponsored Research - None

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