Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years

Carlucci, Annalisa; Delmastro, Monica; Rubini, F; Fracchia, Claudio; Nava, Stefano

doi:10.1007/s00134-002-1574-1

Cited by 157 publications

(92 citation statements)

References 29 publications

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“…This is in agreement with previously published data that showed that increasing experience with NIV may progressively allow more severely ill patients to be treated without changing the NIV success rate. 33 The crude mortality rates found in the 2 Italian RHDCU surveys are similar to those reported for COPD exacerbations managed with NIV (10 -25%). [34][35][36] However, those data were obtained from hospital discharge sheets, which lack information about important confounders such as disease severity, comorbidities, and interventions.…”

Section: Interventions Diseases and Outcomessupporting

confidence: 75%

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Scala¹,

Corrado

Confalonieri

et al. 2011

Respir Care

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.03), and the physician-to-patient mean ratio and the nurse-to-patient mean ratio per shift were lower (P ‫؍‬ .001 and P ‫؍‬ .002, respectively). Admissions for only monitoring decreased (P < .001), and admissions for active interventions increased: noninvasive ventilation (P ‫؍‬ .002), invasive ventilation (P < .001), weaning from invasive ventilation (P < .001), and tracheal decannulation (P < .001). The complexity of RHDCU patients' conditions increased: there was a reduction in the percentage of COPD patients (P < .001) and an increase in the percentage of patients with neuromyopathies (P < .001) and de novo hypoxemia (P ‫؍‬ .006). CONCLUSIONS: Between 1997 and 2007 there was an increase in the number and expertise of Italian RHDCUs, with a shift toward less expensive care, and greater complexity of interventions and patient dysfunctions. These findings support the crucial role of RHDCUs in the management of respiratory critical patients.

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Section: Interventions Diseases and Outcomessupporting

confidence: 75%

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Scala¹,

Corrado

Confalonieri

et al. 2011

Respir Care

View full text Add to dashboard Cite

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“…Indeed, it is our policy to treat all patients with a COPD exacerbation with respiratory failure and a pH Ͼ 7.25 in the respiratory ward. 30 Only a small proportion of our patients were discharged to home from the RICU, in line with data reported by Bigatello et al, 19 who reported that only 2% of their patients were discharged to home.…”

Section: Discussionsupporting

confidence: 91%

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

Valentini¹,

Pacilli²,

Carbonara³

et al. 2013

Respir Care

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BACKGROUND:The outcomes of patients admitted to a respiratory ICU (RICU) have been evaluated in the past, but no study has considered the influence of location prior to RICU admission. METHODS: We analyzed prospectively collected data from 326 consecutive patients admitted to a 7-bed RICU. The primary end points were survival and severity of morbidity-related complications, evaluated according to the patient's location prior to RICU admission. Three admission pathways were considered: step-down for patients transferred from the ICUs of our hospital; step-up for patients coming from our respiratory wards or other medical wards; and directly for patients coming from the emergency department. The secondary end point was the potential influence of several risk factors for morbidity and mortality. RESULTS: Of the 326 subjects, 92 (28%) died. Overall, subjects admitted in a step-up process had a significantly higher mortality (P < .001) than subjects in the other groups. The mortality rate was 64% for subjects admitted from respiratory ward, 43% for those from medical wards, and 18% for subjects from both ICU and emergency department (respiratory ward vs medical ward P ‫؍‬ .04, respiratory ward vs emergency department P < .001, respiratory ward vs ICU P < .001, medical ward vs emergency department P < .001, and medical ward vs ICU P < .001). Subjects admitted from a respiratory ward had a lower albumin level, and Simplified Acute Physiology Score II was significantly higher in subjects following a step-up admission. About 30% of the subjects admitted from a respiratory ward received noninvasive ventilation as a "ceiling treatment." The highest odds ratios related to survival were subject location prior to RICU admission and female sex. Lack of use of noninvasive ventilation, younger age, female sex, higher albumin level, lower Simplified Acute Physiology Score II, higher Barthel score, and absence of chronic heart failure were also statistically associated with a lower risk of death. CONCLUSIONS: The pathway of admission to a RICU is a determinant of outcome. Patients following a step-up pattern are more likely to die. Other major determinants of survival are age, nutritional status and female sex.

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“…However, the reported data do not necessarily imply that there is a lack of awareness about NIV failure risk; on the contrary, they could 18,19 NIV use in general wards is an area of research that has been largely neglected compared with studies performed in ICUs. The fact that almost all published studies on NIV were performed in ICUs could be misleading, as the results might not accurately represent where NIV is currently used in the real world.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 88%

An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

et al. 2014

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BACKGROUND: Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. METHODS: A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The multiple-choice anonymous questionnaire to be filled out online was distributed worldwide by mail, LinkedIn, and Facebook professional groups. RESULTS: One-hundred fifty-seven questionnaires were filled out and analyzed. Respondents were from 51 countries from all 5 continents. NIV application in general wards was reported by 66% of respondents. Treatments were reported as increasing in 57% of cases. Limited training and human resources were the most common reasons for not using NIV in general wards. Overall, most respondents perceived that NIV avoids tracheal intubation in most cases; worsening of ARF, intolerance, and inability to manage secretions were the most commonly reported causes of NIV failure. CONCLUSIONS: Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting.

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Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years

Abstract: We conclude that, over time, experience with NIV may progressively allow more severely ill patients to be treated without changing the rate of success. The daily cost of NIV per patient can be reduced by treating less severely ill patients outside the RICU.

Cited by 157 publications

References 29 publications

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

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