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Respiratory Care |

Noninvasive Mechanical Ventilation Use in the Elderly: Appropriateness of Therapy, Assessment of Cardiopulmonary Status, and Eventual Outcomes

Tarak Rambhatla; Andrew Miller; Adam Bierzynski; Robert Graham
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Internal Medicine, Lenox Hill Hospital, New York, NY


Chest. 2014;146(4_MeetingAbstracts):899A. doi:10.1378/chest.1991948
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Abstract

SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To analyze the appropriateness of the application of non-invasive positive pressure ventilation (NIPPV) at our institution and to compare the quality of patient selection for NIPPV among the elderly patients to the younger population and their outcomes.

METHODS: Retrospective study of all NIPPV ordered for all medical patients over a two-month period at a single center university-affiliated teaching hospital. 127 patients ordered for NIPPV identified by respiratory therapy records and a retrospective chart review with the use of MAR to collect data on each patient prior to and during the course NIPPV therapy.

RESULTS: Group 1 was defined as elderly with ages 70 years or older and group 0 below 70. Chronic obstructive pulmonary disease and congestive heart failure accounted for less than 50% of admission diagnoses in either group. There was no significant difference in echocardiographic evaluation (63% vs. 57.4%, p=0.586), or cardiac function (19.7% vs. 11.5%, p=0.429). 59.1% of the elderly group had an arterial blood gas (abg) performed prior to ordering NIPPV (vs. 32.8%, p=0.003). There was no significant difference in acid-base status amongst the groups nor was there a significant difference in patients that had a repeat abg while being treated with NIPPV (30.3% vs. 23.0%, p=0.424). Group 1 had NIPPV therapy ordered for a longer duration of time (5.82 days vs. 4.95 days, p=0.045) and total length of use was longer (5.38 days vs. 4.61 days, p = 0.06). Group 1 was more likely to have a pulmonary infiltrate (66.7% vs. 45.9%, p = 0.021) and more likely to be treated with antibiotics (72.7% vs. 47.5%, p=0.006). The elderly population had 13 patients that required escalation of care while 4 patients in the younger population required an escalation of care (19.7% vs. 6.6%, p = 0.026).

CONCLUSIONS: We found NIPPV was consistently being ordered for conditions not proven to benefit from NIPPV and there was an inadequate assessment of oxygenation/ventilation status prior to and during the course of NIPPV therapy for all ages. We also found the elderly population, despite not showing a significant difference in cardiac function or oxygenation/ventilation status were being treated with NIPPV for longer periods of time, had more lung infiltrates, use of antibiotics, and had more patients requiring escalation of care.

CLINICAL IMPLICATIONS: Further investigation into NIPPV use in elderly patients may help identify which factors predict an adverse outcome in this patient population.

DISCLOSURE: The following authors have nothing to disclose: Tarak Rambhatla, Andrew Miller, Adam Bierzynski, Robert Graham

No Product/Research Disclosure Information


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