PURPOSE: Non-invasive positive pressure ventilation (NIPPV) is a treatment modality for both acute and chronic respiratory failure. The popularity of NIPPV as the primary treatment for patients with advance directives in respiratory failure has increased over the years. The goal of our project was to investigate whether the usage of NIPPV was appropriately instituted at NYHQ.
METHODS: This is a retrospective observational study evaluating proper use and outcomes of NIPPV following the recommendations from the British Thoracic Society Standards of Care Committee and the American Thoracic Society discussed during the International Consensus Conferences in 2000.
RESULTS: Of the patients placed on NIPPV from February 2009 to November 2009, 148 randomly selected charts were reviewed. Mean age of the selected patients was 70.4 years. On ABG, mean pH was 7.265 and mean pCO2 was 56.8 mmHg. Major indications for initiation included COPD (35%), acute pulmonary edema/CHF (23%), OSA/OHS (13%) and pneumonia (11%). Other indications were post-extubation, asthma and other/unknown. 26% had multiple indications for NIPPV use. An ABG was obtained prior to initiation in 64.2% of the patients, but was lacking in 35.8%. 26% of the patients had a follow-up ABG done 1 hour after initiation, while 73.7% did not. Similarly, 31.1% of the patients had a 5-hour follow-up ABG, while 68.9% did not. NIPPV was initiated in ER on 33.1% of the patients, on various telemetry and general medical floors on 41.3% of the patients, and on 14.9% in MICU. 37.2% of the patients survived to discharge, while 25.7% were intubated and 15.5% expired.
CONCLUSION: Our study concluded that vast majority of the patients lacked proper ABGs at various hours of being placed on NIPPV. These findings highlight the need to achieve higher success in performing initial and subsequent follow-up ABGs after the initiation of NIPPV.
CLINICAL IMPLICATIONS: We plan to accomplish proper following of the ATS and BTS recommendations in all realms of the NYHQ health care systems by educating physicians, house staffs, nurses, respiratory therapists, and the ancillary staff.
DISCLOSURE: Maryam Sheikh, No Financial Disclosure Information; No Product/Research Disclosure Information