2010 OPEN FORUM Abstracts
NONINVASIVE VENTILATION WITHIN AN ACADEMIC MEDICAL CENTER: A UTILIZATION REVIEW.
Brian Costa, Jhaymie Cappiello, Brady Scott, Jan Thalman; Duke University Hospital, Durham, NC
Background: The growing use of noninvasive ventilation (NIV) requires routine evaluation of departmental as well as hospital policies, procedures and equipment. An equipment utilization review may provide valuable information for departmental resource allocation. We provide a retrospective review to evaluate NIV usage in our adult intermediate and intensive care settings. Method: Using our electronic charting systems, we randomly selected 16 dates over a 3 month period and analyzed data on 126 patients that required NIV. Recorded data included: diagnosis, location of use, mode, settings, and patient-owned vs. hospital owned equipment. Patients from our Emergency Department and Post Anesthesia Care Unit were excluded from analysis. Results: Of the 126 patients reviewed, ninety-two patients (73%) were diagnosed with obstructive sleep apnea (OSA), eighteen patients (14%) presented with acute respiratory failure (ARF), and sixteen patients (13%) were diagnosed with chronic hypoventilation syndrome (CHS). Ninety-nine patients (79%) were treated in an intermediate care area while twenty-seven patients (21%) were treated in an intensive care unit. Eighty-six patients (68%) were treated with continuous positive airway pressure (CPAP) while forty patients (32%) were treated with bi-level positive airway pressure. Forty-three (34%) were patient-owned noninvasive ventilators while eighty-three (66%) were hospital-owned devices. Mean FiO2 was 32%; bi-level was 43% while CPAP was less than 28%. Conclusions: 64% of patients in our institution receiving NIV therapy required CPAP with a mean FiO2 < 27% for treatment of OSA. In considering resource allocation, supportive data on institutional use as well as monitoring requirements would prove beneficial. Lower tier NIV devices may provide an effective alternative over newer-generation multi-mode ventilators for the delivery of CPAP or diagnoses requiring minimal support. Personnel responsible for making equipment purchasing decisions may benefit by reviewing their institutions NIV utilization before purchasing noninvasive ventilators. Sponsored Research - None