P221 Temporal Trends in Severity and In-Hospital Mortality in Acute Hypercapnic Respiratory Failure (AHRF) at a Respiratory Ward-Based Non-Invasive Ventilation (NIV) Unit

Lewis, Hannah; Wharton, Cathryn; Agarwal, Shruti; Beauchamp, Ben; Chakraborty, B. N.; Banerjee, Dev; Turner, AM; Mukherjee, Rahul

doi:10.1136/thoraxjnl-2012-202678.282

Cited by 2 publications

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“…It has been shown that caring for a higher volume of NIV patients in ICU may develop local expertise and lead to better NIV outcomes [ 11 ]. We have seen similar effects of patient volume on local expertise when analysing temporal trends at a single, large ward-based NIV unit, recording that more severely ill acute hypercapnic respiratory failure patients are being treated with no significant change in mortality [ 12 ]. Ward-based NIV is consistently emerging as a sustainable tool to deal with acute exacerbations of COPD as well as other patients with ventilatory insufficiency leading to hospital admissions due to respiratory failure, who are now living longer with various comorbidities.…”

Section: Summary and Prospectmentioning

confidence: 99%

Early ward-based acute noninvasive ventilation: a paper that changed practice

Mukherjee

Nenna

Turner

2018

Breathe

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Noninvasive ventilation (NIV) is now an established evidence-based treatment for acute hypercapnic respiratory failure (AHRF), predominantly for defined patients admitted with exacerbations of chronic obstructive pulmonary disease (COPD), but also a range of other conditions including obesity-related respiratory failure and chest wall deformities requiring an acute hospital admission. Over the past two decades, there has been a significant shift towards greater use of NIV in place of invasive mechanical ventilation (IMV) in this group of patients. Here we set out to discuss a landmark paper in this respect: the report of the YONIV trial (Yorkshire Noninvasive Ventilation Trial), published in June 2000, which addressed the key practical questions around the early use of ward-based NIV at the time [1]. A recent narrative review on the epidemiology of NIV for acute respiratory failure in COPD patients concluded that this dramatic increase in NIV use is probably due to the increased experience of the medical teams, treating sicker patients with comorbidities and utilising NIV outside the intensive care unit (ICU), further confirming the pivotal role of the original trial enabling the early use of acute NIV on medical wards [2].

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Section: Summary and Prospectmentioning

confidence: 99%

Early ward-based acute noninvasive ventilation: a paper that changed practice

Mukherjee

Nenna

Turner

2018

Breathe

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“…NIV for an exacerbation of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure is the most common scenario for ventilatory support in the pulmonary or the general ward [16]. A study by Dave et al even suggests that it is safe to ventilate patients with a pH of 7.6 outside of the ICU [17].…”

Section: Copd Exacerbationmentioning

confidence: 99%

Non-Invasive Ventilation in a Non-Standard Setting – Is it Safe to Ventilate Outside the ICU?

Boyadzhieva

Kovacheva

Bektashev

et al. 2020

Acta Medica Bulgarica

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Non-invasive ventilation (NIV) is considered a fundamental method in treating patients with various disorders, requiring respiratory support. Often the lack of beds in the intensive care unit (ICU) and the concomitant medical conditions, which refer patients as unsuitable for aggressive treatment in the ICU, highlight the need of NIV application in general non-monitored wards and unusual settings – most commonly emergency departments, high-dependency units, pulmonary wards, and even ambulances. Recent studies suggest faster improvement of all physiological variables, reduced intubation rates, postoperative pulmonary complications and hospital mortality with better outcome and quality of life by early well-monitored ward-based NIV compared to standard medical therapy in patients with exacerbation of a chronic obstructive pulmonary disease, after a surgical procedure or acute hypoxemic respiratory failure in hematologic malignancies. NIV is a ceiling of treatment and a comfort measure in many patients with do-not-intubate orders due to terminal illnesses. NIV is beneficial only by proper administration with appropriate monitoring and screening for early NIV failure. Successful NIV application in a ward requires a well-equipped area and adequately trained multidisciplinary team. It could be initiated not only by attending physicians, respiratory technicians, and nurses but also by medical emergency teams. Ward-based NIV is supposed to be more cost-effective than NIV in the ICU, but further investigation is required to establish the safety and efficacy in hospital wards with a low nurse to patient ratio.

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P221 Temporal Trends in Severity and In-Hospital Mortality in Acute Hypercapnic Respiratory Failure (AHRF) at a Respiratory Ward-Based Non-Invasive Ventilation (NIV) Unit

Abstract: Wilcoxon rank sum test: p=0.03134; pH significantly lower in Period 2 Wilcoxon rank sum test: p=0.

Cited by 2 publications

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Early ward-based acute noninvasive ventilation: a paper that changed practice

Early ward-based acute noninvasive ventilation: a paper that changed practice

Non-Invasive Ventilation in a Non-Standard Setting – Is it Safe to Ventilate Outside the ICU?

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