2002
DOI: 10.1183/09031936.02.00297202
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Where to perform noninvasive ventilation?

Abstract: Noninvasive positive-pressure ventilation (NPPV) has been shown to be a means of reducing the need for endotracheal intubation, which when effective reduces the complication rate and improves outcome. Because paralysis and sedation are not needed and because the patient is not necessarily dependent upon a machine for respiration, ventilation outside the intensive care unit (ICU) is an option. A number of studies have shown that NPPV for acute exacerbations of chronic obstructive pulmonary disease (COPD) can be… Show more

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Cited by 124 publications
(72 citation statements)
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“…30 However, with the growing shortage of ICU beds and lack of high dependence units in many hospitals, 19,25,31 the options are limited to either delaying NIV initiation or to starting it on the ward. Delay can result in patient deterioration and reduce the chance of NIV success.…”
Section: Discussionmentioning
confidence: 99%
“…30 However, with the growing shortage of ICU beds and lack of high dependence units in many hospitals, 19,25,31 the options are limited to either delaying NIV initiation or to starting it on the ward. Delay can result in patient deterioration and reduce the chance of NIV success.…”
Section: Discussionmentioning
confidence: 99%
“…16 Under this perspective, delivering NIV outside the ICU can prevent withholding a beneficial intervention because of scarcity of resources. Ideally, NIV should be applied in a monitored setting with low patient-to-nurse ratio, 17 but in the real world, the shortage of ICU and HDU beds may lead to postponing or denying NIV application with potential detrimental effects, such as further deterioration, reduced chance of successful response to NIV, and therefore worsening of patient's outcome. 4,18,19 Guidelines advise NIV application for an exacerbation of COPD with pH Ͻ 7.35, 10 and recommend ICU or HDU admission when pH is Ͻ 7.25 or worsening despite NIV.…”
Section: Discussionmentioning
confidence: 99%
“…In a multicentre randomized controlled trial, Plant and colleagues showed that noninvasive ventilation in patients with a severe exacerbation of COPD was safe and effective in the general ward setting. 7 However, outcomes of patients in general wards who had more severe disease (arterial pH < 7.30 7 ) were not as good as those reported for patients in acute care locations, 8 where more sophisticated equipment and individual titration of ventilator settings were available.…”
Section: Best Practices For Noninvasive Ventilationmentioning
confidence: 85%