The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

TRIAGE OF NON-INVASIVE POSITIVE PRESSURE VENTILATION (NPPV) PATIENTS EVALUATED IN THE EMERGENCY DEPARTMENT (ED).

Richard Hinds1, Steven Holets1, Abdi Ahmed2, Michelle Hisdahl2, Sarah Kudrna2, Peter Gay3; 1Department of Respiratory Care, Mayo Clinic, Rochester, MN; 2Mayo School of Health Sciences and University of Minnesota’s Respiratory Care Program, Mayo Clinic, Rochester, MN; 3Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN

Background: NPPV is commonly used in patients with acute respiratory failure in the ED but the pathway of treatment varies widely with respect to admission criteria and appropriate hospital venue for monitoring and continued treatment. We hypothesized that a large cohort of NPPV patients could potentially be treated in a less resource intense environment. Method: The study was a retrospective chart review of all patients admitted to the Emergency Department who were administered NPPV within a 12 month period. Primary variables measured included hospital length of stay, ICU length of stay, arterial blood gases and hospital mortality. Cases were classified as respiratory failure, cardiac failure, mixed respiratory and cardiac failure or ‘other’ based on the medical record. Cases classified as respiratory failure were further analyzed to identify subjects with a pH less than 7.25, FiO2> 0.7, or those that required ICU monitoring and treatment for hemodynamic instability. Results: Between January 1st, 2008 to December 31st, 2008, there were 193 encounters of NPPV in the Emergency Department from 184 unique patients. There were 62.2% (n=120) with respiratory failure, 15% (n=29) with cardiac failure, 11.4% (n=22) patients with both respiratory and cardiac failure and 11.5% (n = 22) were classified as ‘other,’ and 12.4% (n=24) required intubation. Of the 24 patients intubated, 29.2% (n=7) were intubated in the ED and 70.8% (n=17) were intubated in the ICU. In the 108 patients with respiratory failure admitted to the ICU from the ED who were not intubated, 63 (58%) met criteria to be treated and monitored in the hospital ward area. Individual daily hospital bed charges would be reduced by 60%. 4. Conclusions: We recommend that institutional criteria be established to better triage NPPV patients after admission from the ED. This could result in substantial cost savings and better utilization of ICU resources. Sponsored Research - None