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Education, Research, and Quality Improvement |

Characteristics and Outcomes of Patients Admitted to a Specialized Noninvasive Ventilation Unit

Kim Hoong Yap*, MBBS; Poh Seo Quek, APN; Benjamin C. H. Ho, MMed
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Tan Tock Seng Hospital, Singapore, Singapore


Chest. 2012;142(4_MeetingAbstracts):543A. doi:10.1378/chest.1385018
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Abstract

SESSION TYPE: Outcomes/Quality Control Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Non-invasive ventilation (NIV) is well established in reversing hypercapnic respiratory failure from exacerbation of chronic obstructive pulmonary disease (COPD) although its use for other etiologies remains controversial. In patients with “do-not intubate” (DNI) orders, NIV can be used as a ceiling of therapy. We aim to describe characteristics and outcomes of patients admitted to a dedicated non-invasive ventilation unit (NIVU).

METHODS: Retrospective study of 130 patients admitted to a 4-bedded NIVU of an academic hospital in 2009. Demographics and clinical data were obtained from patient records.

RESULTS: Of all patients admitted, 17 (13.1%) were from emergency department, 76 (58.5%) from general wards while the remainder were transferred in from intensive care unit (ICU). Mean (± standard deviation) age was 73.7±10.9 years. Median (inter-quartile range) length of stay in NIVU was 5 (2-10) days. Charlson Co-morbidity Index > 2 was recorded in 20.8% of patients. Thirty-eight percent of patients had baseline moderate to severe functional impairment (Eastern Cooperative Oncology Group scale ≥ 2). Exacerbation of COPD was the main cause of admission (47.7%) followed by pneumonia (20%), obstructive sleep apnea (OSA, 8.5%), pulmonary edema (6.9%), bronchiectasis (6.9%), interstitial lung disease (ILD, 4.6%), asthma (3.1%) and others (2.3%). Of those admitted for pneumonia, 42.3% had underlying COPD. Three patients (2.3%) were transferred to ICU for invasive mechanical ventilation while 9 (6.9%) withdrew NIV. Overall, in-NIVU and in-hospital mortality were 13.8% and 21.5% respectively. Fifty-five percent of all patients admitted had DNI orders. ECOG scale ≥ 2 was associated with DNI orders (p=0.003) but not in-hospital mortality (p=0.064). DNI orders according to diagnosis were COPD (50%), pneumonia (61.5%), OSA (27.3%), pulmonary edema (66.7%), bronchiectasis (88.9%), ILD (66.7%), asthma (25%) and others (100%).

CONCLUSIONS: Patients with various causes of respiratory failure were treated with NIV in our unit. More than 50% had DNI orders.

CLINICAL IMPLICATIONS: A specialized NIV unit can be a viable alternative to the ICU in managing patients with respiratory failure amenable to NIV, including patients with DNI orders.

DISCLOSURE: The following authors have nothing to disclose: Kim Hoong Yap, Poh Seo Quek, Benjamin CH Ho

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Tan Tock Seng Hospital, Singapore, Singapore

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