2011 OPEN FORUM Abstracts
NONINVASIVE POSITIVE PRESSURE VENTILATION USAGES: A SURVEY OF RESPIRATORY THERAPISTS.
Degen D. Clow, Michael E. Anders; Respiratory and Surgical Technologies, University of Arkansas for Medical Sciences, Little Rock, AR
Background: Increasingly, respiratory therapists (RTs) apply Noninvasive Positive Pressure Ventilation (NPPV) for patients with terminal or end-stage disease at the end of life. A task force on the palliative use of NPPV sought to improve the understanding of the goals of NPPV with a three category approach: Category 1- to restore health in patients who want subsequent intubation and invasive mechanical ventilation if necessary and indicated; Category 2- to restore health in patients who do not want intubation and invasive mechanical ventilation; Category 3- to maximize comfort at end of life. For each, the task force recommended: (a) eliciting patient preferences and goals, (b) communicating a rationale, and (c) outlining parameters for success and failure. The purpose of this study was to examine the extent that RTs report the implementation of the task force's recommendations and are comfortable with each category, as well as correlates of their comfort with Category 3 NPPV. Method: RTs in five hospitals were invited to complete a questionnaire. For each category of NPPV usage, the questionnaire elicited the frequency of implementation of the task force's recommendations and the RTs comfort administering it. Responses were reported on a scale of 0-10 (0 = "Not at All;" 10 = "Most Possible"). Descriptive, paired-t, and regression analyses (alpha < .01) were performed. Results: Of 234 RTs eligible for the study, 165 (71%) participated. A majority (56%) lacked training in care at the end-of-life. On a 0-10 scale, the mean comfort level for administering NPPV progressively decreased: Category 1 = 8.7; Category 2 = 8.3; Category 3 = 6.1. Compared to Categories 1 and 2, the frequency of eliciting patient preferences and goals, communicating a rationale, and outlining parameters for success and failure were each lower for Category 3 (p < .01). In a multivariable regression, only outlining the parameters for success and failure was correlated with increased comfort with administering Category 3 NPPV (p < .01). Conclusion: The study results suggest that compared to Categories 1 and 2, the task force's recommendations for NPPV usage are implemented for Category 3 to a lesser extent. Moreover, RTs appear to be less comfortable administering Category 3 when parameters for success and failure are lacking. An opportunity exists to improve NPPV usage through protocols and education that focuses on NPPV usage at the end of life.
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