Operator dependent factors implicated in failure of non-invasive positive pressure ventilation (NIPPV) for respiratory failure (original) (raw)
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Non-Invasive Positive Pressure Ventilation Utilization In Children With Respiratory Failure
American Journal of …, 2010
The use of noninvasive positive-pressure ventilation (NIPPV) for acute respiratory failure (ARF) has become more widespread over the past decade, but its prescription, use and outcomes in the clinical setting remain uncertain. The objective of this study was to review the use of NIPPV for ARF with respect to clinical indications, physician ordering, monitoring strategies and patient outcomes. Methods: A total of 91 consecutive adult patients admitted between June 1997 and September 1998 to a university-affiliated tertiary care hospital in Hamilton, Ont., who received 95 trials of NIPPV for ARF were included in an observational cohort study. Data abstraction forms were completed in duplicate, then relevant clinical, physiologic, prescribing, monitoring and outcome data were abstracted from the NIPPV registry and hospital records. Results: The most common indications for NIPPV were pulmonary edema (42 of 95 trials [44.2%]) and exacerbation of chronic obstructive pulmonary disease (23 of 95 trials [24.2%]). NIPPV was started primarily in the emergency department (62.1% of trials), however, in terms of total hours of NIPPV the most frequent sites of administration were the intensive care unit (30.9% of total hours) and the clinical teaching unit (20.2% of total hours). NIPPV was stopped in 48.4% of patients because of improvement and in 25.6% because of deterioration necessitating endotracheal intubation. The median time to intubation was 3.0 hours (interquartile range 0.8-12.2 hours). The respirology service was consulted for 28.4% of the patients. Physician orders usually lacked details of NIPPV settings and monitoring methods. We found no significant predictors of the need for endotracheal intubation. The overall death rate was 28.6%. The only independent predictor of death was a decreased level of consciousness (odds ratio 2.9, 95% confidence interval 1.0-8.4). Interpretation: NIPPV was used for ARF of diverse causes in many hospital settings and was started and managed by physicians with various levels of training and experience. The use of this technique outside the critical care setting may be optimized by a multidisciplinary educational practice guideline.
Critical Care Medicine, 1999
While non-invasive positive pressure ventilation (NIPPV) has become an accepted management approach for patients with acute hypercapnia, it remains unclear whether it can also be beneficial in stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. Randomised controlled trials (RCT) with a maximum duration of 3 months showed contradictory effects in blood gasses, dyspnoea, sleep efficiency and health-related quality of life. On the other hand, several uncontrolled trials did show positive results in patients with hypercapnia. Recently, an RCT compared the combination of NIPPV and long-term oxygen treatment (LTOT) with LTOT alone for a period of 2 years in hypercapnic patients. After this period dyspnoea decreased and health-related quality of life improved in the NIPPV compared to the LTOT group. Reasons for the contradictory results in the different trials are probably patient selection, adequacy of ventilation, and length of ventilation. Therefore, at this moment there is no conclusive evidence that NIPPV should be provided routinely to stable patients with COPD. However, a selected group of patients might have clinical benefits from it. Patients who are clearly hypercapnic, who can tolerate an effective level of ventilatory support, and who get enough time to adjust to the ventilator might show clinical benefits even after 3 months. A trial with ventilatory support in this group of patients can be considered.
Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2000
The use of noninvasive positive-pressure ventilation (NIPPV) for acute respiratory failure (ARF) has become more widespread over the past decade, but its prescription, use and outcomes in the clinical setting remain uncertain. The objective of this study was to review the use of NIPPV for ARF with respect to clinical indications, physician ordering, monitoring strategies and patient outcomes. A total of 91 consecutive adult patients admitted between June 1997 and September 1998 to a university-affiliated tertiary care hospital in Hamilton, Ont., who received 95 trials of NIPPV for ARF were included in an observational cohort study. Data abstraction forms were completed in duplicate, then relevant clinical, physiologic, prescribing, monitoring and outcome data were abstracted from the NIPPV registry and hospital records. The most common indications for NIPPV were pulmonary edema (42 of 95 trials [44.2%]) and exacerbation of chronic obstructive pulmonary disease (23 of 95 trials [24.2...
Panacea Journal of Medical Sciences, 2023
Abstract Background: Failure of respiratory system in one or both of its gas-exchanging functions- oxygenation of pulmonary arterial blood and carbon-dioxide elimination from mixed venous blood. Non-Invasive Ventilation is an alternative to invasive ventilation in many conditions it is a valuable component in patient management. Its use in acute respiratory failure is widely accepted and well known. Aim: To Study the indications, outcomes, and complications of NIV. Materials and Methods: This is a prospective observational study conducted on 100 patients admitted with either Type-I or Type -II respiratory failure. Results: Various common indications for use of NIV in acute Respiratory Failure are COPD, ILD, Bronchiectasis, Pneumonia, Pulmonary Thromboembolism, Kyphoscoliosis, and Pulmonary Tuberculosis in that order. The overall success rate of NIV is 84%. Conclusion: NIV helps in improving gas exchange in acute respiratory failure irrespective of its type, reduces intubation and length of hospital stay hence, its use as the first modality of treatment in patients without overt contraindications is recommended. Overall, NIV is safe and effective in patients with acute respiratory failure as there are no major complications associated with its use. Keywords: Respiratory failure, Complications, NonInvasive Ventilation
Intensive Care Medicine, 2001
Context: In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study. Results: NPPV failed in 30 % (108/ 354) of patients. The highest intubation rate was observed in patients with ARDS (51 %) or communityacquired pneumonia (50 %). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10 %) and pulmonary contusion (18 %). Multivariate analysis identified age > 40 years (OR 1.72, 95 % CI 0.92±3.23), a simplified acute physiologic score (SAPS II) ³35 (OR 1.81, 95 % CI 1.07±3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95 % CI 2.25±6.24), and a PaO 2 :FiO 2 £146 after 1 h of NPPV (OR 2.51, 95 % CI 1.45±4.35) as factors independently associated with failure of
Noninvasive positive pressure ventilation in the acute care setting: where are we?
European Respiratory Journal - EUR RESP J, 2008
Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions. Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NPPV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury, acute respiratory distress syndrome, or during bronchoscopy. NPPV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available. A trained team, ca...
Protocol-based noninvasive positive pressure ventilation for acute respiratory failure
Journal of Anesthesia, 2010
Purpose Noninvasive positive pressure ventilation (NPPV) has been suggested to be associated with adverse outcomes in emergency patients with acute respiratory failure (ARF), possibly because of a delay in tracheal intubation (TI). We hypothesized that protocol-based NPPV (pNPPV) might improve the outcomes, compared with individual physician-directed NPPV (iNPPV). Methods To guide decision making regarding the use of NPPV, we developed an NPPV protocol. Observational data were collected before and after protocol implementation in consecutive patients with ARF and compared between the pNPPV and the iNPPV groups. Results The results for pNPPV (n = 37) were compared with those for iNPPV (n = 37). No significant baseline differences in patient characteristics were observed between the two groups except for mean age, which was higher in the pNPPV group than in the iNPPV group (P = 0.02). Rate of TI and duration of mechanical ventilation were similar in the two groups. However, the time from the start of NPPV until TI tended to be shorter in the pNPPV group than in the iNPPV group (P = 0.11). The hospital mortality rate was significantly lower in the pNPPV group than in the iNPPV group (P = 0.049). Although the length of hospital stay was shorter in the pNPPV group than in the iNPPV group, this trend did not reach statistical significance (P = 0.14). Conclusions The present study suggests that pNPPV is effective and likely to improve the mortality rate of emergency patients with ARF.
Conventional Vs Non Invasive Ventilation In Acute Respiratory Failure
Australian Journal of …, 2009
Treatment of patients with acute respiratory failure (ARF) often involves mechanical ventilation via endotracheal intubation. Non-invasive positive pressure ventilation (NIV) using Bi-level positive airway pressure (BiPAP) can be a safe and effective means of improving gas exchange. The aim of the present study is to: 1) Assess non-invasive positive pressure ventilation (BiPAP) as an alternative way for ventilation in ARF, and to 2) Determine factors that can predict the successful use of BiPAP. Thirty patients with acute respiratory failure (both type I and II) were enrolled in the study and divided into two groups. Group I included 10 patients who were subjected to invasive mechanical ventilation. Group II included 20 patients were subjected to NIV using BiPAP. Both groups were compared regarding the following parameters: arterial blood gases (ABG) on admission, 30 minutes after beginning of mechanical ventilation, 1 ½ hour then once daily. Complications namely ventilator 2 associated pneumonia (VAP), skin necrosis and CO narcosis; static compliance and resistance were measured at day one and day two. Compared to group I, group II patients were associated with similar improvement in ABGs data at 30 minutes and at discontinuation of ventilation (Table 1). Group II patients showed significantly lower incidence in VAP (20% vs 80%), shorter duration of mechanical ventilation (3±3 vs 6±5 days, P = 0.006), with shorter length of hospital stay (5.8±3.6