The Use of Noninvasive Positive Pressure Ventilation in the Emergency Department

Wood, K; Lewis, Larry; Harz, Benjamin Von; Kollef, Marin H.

doi:10.1378/chest.113.5.1339

Cited by 253 publications

(131 citation statements)

References 30 publications

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“…In the literature, the success rate of NIV treatment in ED and wards has been reported to vary on a large scale between 44% and 90% (12)(13)(14)21). This rate depends on the patient-management unit, patient population, and experience of the medical caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…This rate depends on the patient-management unit, patient population, and experience of the medical caregivers. Wood et al (12) have evaluated the efficacy of NIV in reducing the need for endotracheal intubation and reported a NIV failure rate of 44% in a small number of patients. Schneider et al (21) have analyzed the efficacy of NIV in ED and reported a failure rate of 60%.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have investigated the success of NIV treatment in non-ICU clinics. The reported success rates vary in a wide range between 44% and 90% according to the management units, patient groups, and disease stages (12,13). Little is known on the predictive factors of NIV failure in wards.…”

Section: Introductionmentioning

confidence: 99%

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How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Ağca¹,

Akyıl²,

Duman³

et al. 2017

Eurasian J Pulmonol

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Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV) in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD)-related acute hypercapnic respiratory failure (AHRF). Methods:The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED) because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO 2 ) values were recorded. Baseline pH values were categorized as severe (pH<7.26), moderate (pH≥7.26-7.30), and mild (pH≥7.30) acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer.Results: Treatment resulted in success in 477 (88%) patients. Albumin levels were significantly low and the mean Charlson index (CI) score was significantly high in Group 2. Admission pH and PaCO 2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO 2 and lower pH values as well as a lower level of decrease in PaCO 2 values within 2 hours of treatment in ED. Similarly, higher PaCO 2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05). Conclusion:The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO 2 values after a few hours of treatment and not the baseline pH or PaCO 2 values are better predictors than the baseline pH and PaCO 2 values.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Ağca¹,

Akyıl²,

Duman³

et al. 2017

Eurasian J Pulmonol

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“…19 Bizim çalışmamız-da başarısızlık, toplam 35 hastanın 8'inde (%23) saptanmıştır. Başarısızlık çalışmamızda, erken dönem başarısızlık olarak değerlendirilmiştir.…”

Section: Bulgularunclassified

Comparison of Noninvasive Mechanical Ventilation Volume Assured Pressure Support Mode With Manual Pressure Support in Acute Respiratory Failure of Chronic Obstructive Pulmonary Disease

Rollas¹,

Berktas²,

Berkoğlu³

2012

Solunum

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ÖZETAmaç: Kronik obstrüktif akciğer hastalığına (KOAH) bağlı akut hiperkapnik solunum yetmezliğinin düzeltilmesinde, volüm garantili basınç desteği (average volume assured pressure support: AVAPS) stratejisinin manuel basınç desteği ile, etkinlik ve tolerabilite açısından karşılaştırılmasıdır. ABSTRACTAim: The aim of this study was to compare the efficacy and tolerability of average volume assured pressure support (AVAPS) strategy with the support of manual pressure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Materials and Methods:Thirty-five patients treated for acute hypercapnic respiratory failure due to COPD were included in the study. Ventilation was applied with the same bilevel device respectively, 45 minutes with manual pressure support ventilation, 45 minutes with AVAPS and again 45 minutes with manual pressure support ventilation modes. Between each sequence 60 minutes without noninvasive mechanical ventilation (NIMV) was provided. Thirteen patients with pressure support and 11 patients with AVAPS mode continued the application of NIMV for approximately 24 hours overenight. At the beginning and at the end of each period of NIMV; arterial blood gases, respiratory rates, dyspnea scores (BORG visual analogue scale, 0 = no dyspnea, 10 = severe dyspnea), heart rate, arterial blood pressure, ventilatory parameters (volume, pressure) and mask leaks were recorded.Results: Twenty three of 35 patients included in the study were male and 12 were female. The mean value of body mass index was 27.2±5.6 kg/m 2 . With respect to the initial values of pH and PaCO 2 improvements was observed in each NIMV period (for both values p<0.001), but no difference was found between AVAPS and manuel pressure support (p>0.05). After 24 hour follow-up, in two patients continuing with AVAPS group

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“…9 This highly time-consuming task is best achieved by specifically trained personal. Indeed, studies have reported that NIV success depends on the permanent availability of a trained staff, [10][11][12][13] and the performance level of the NIV team also predicts technique efficacy.…”

Section: Introductionmentioning

confidence: 99%

Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations

Vaudan¹,

Ratano

Beuret³

et al. 2015

Respir Care

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BACKGROUND: Compared with usual care, noninvasive ventilation (NIV) lowers the risk of intubation and death for subjects with respiratory failure secondary to COPD exacerbations, but whether administration of NIV by a specialized, dedicated team improves its efficiency remains uncertain. Our aim was to test whether a dedicated team of respiratory therapists applying all acute NIV treatments would reduce the risk of intubation or death for subjects with COPD admitted for respiratory failure. METHODS: We carried out a retrospective study comparing subjects with COPD admitted to the ICU before (2001-2003) and after (2010 -2012) the creation of a dedicated NIV team in a regional acute care hospital. The primary outcome was the risk of intubation or death. The secondary outcomes were the individual components of the primary outcome and ICU/hospital stay. RESULTS: A total of 126 subjects were included: 53 in the first cohort and 73 in the second. There was no significant difference in the demographic characteristics and severity of respiratory failure. Fifteen subjects (28.3%) died or had to undergo tracheal intubation in the first cohort, and only 10 subjects (13.7%) in the second cohort (odds ratio 0.40, 95% CI 0.16 -0.99, P ‫؍‬ .04). In-hospital mortality (15.1% vs 4.1%, P ‫؍‬ .03) and median stay (ICU: 3.1 vs 1.9 d, P ‫؍‬ .04; hospital: 11.5 vs 9.6 d, P ‫؍‬ .04) were significantly lower in the second cohort, and a trend for a lower intubation risk was observed (20.8% vs 11% P ‫؍‬ .13). CONCLUSIONS: The delivery of NIV by a dedicated team was associated with a lower risk of death or intubation in subjects with respiratory failure secondary to COPD exacerbations. Therefore, the implementation of a team administering all NIV treatments on a 24-h basis should be considered in institutions admitting subjects with COPD exacerbations.

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The Use of Noninvasive Positive Pressure Ventilation in the Emergency Department

Cited by 253 publications

References 30 publications

How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Comparison of Noninvasive Mechanical Ventilation Volume Assured Pressure Support Mode With Manual Pressure Support in Acute Respiratory Failure of Chronic Obstructive Pulmonary Disease

Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations

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