SESSION TITLE: Respiratory Care Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Average Volume Assured Pressure Support (AVAPS) is a form of noninvasive ventilation that provides a targeted tidal volume with adjustable inspiratory and expiratory pressures. AVAPS is being used for patients with chronic hypercapnic respiratory failure due to COPD, thoracic rib cage or neuromuscular disease, or obesity hypoventilation syndrome. The aim of our study was to determine the impact of AVAPS initiation on hospital admissions.
METHODS: We retrospectively evaluated patients admitted to Christiana Care Health System (Newark, DE) from December 2012 to December 2014 with acute on chronic hypercapnic respiratory failure who were initiated on AVAPS at time of discharge. Baseline data collected included sex, age, BMI, pH and pCO2. The number of all-cause and respiratory admissions were analyzed 1 year prior to and 1 year after AVAPS initiation.
RESULTS: There were 80 subjects initiated on AVAPS during the evaluation period. 34 subjects (42.5%) were male; mean age 64 ± 13 years, BMI 40 ± 14 kg/m2. Admission arterial blood gas revealed a mean pH 7.31 ± 0.09, mean pCO2 67 ± 19 mm Hg. and mean total CO2 37 ± 8 mmol/L. There were 247 admissions (mean 3.1 ± 2.9 admissions per subject) the year prior to AVAPS initiation, and 138 admissions (mean 1.7 ± 2.4 admissions per subject) the year after AVAPS initiation. 78.7% of subjects were admitted at least once during the year prior to AVAPS initiation and 62.5% of subjects had at least one admission during the year after AVAPS initiation. The admission rates pre and post AVAPS initiation at 30, 90 and 180 days were 94 vs. 46 (p<0.001), 152 vs. 83 (p=0.036), and 175 vs. 88 (p=0.010) respectively. The respiratory admission rates pre and post AVAPS initiation at 30, 90 and 180 days were 29 vs. 14 (p = 0.012), 54 vs. 25 (p = 0.018) and 62 vs. 25 (p=0.004) respectively.
CONCLUSIONS: The initiation of AVAPS for use at home in subjects hospitalized for acute on chronic hypercapnic respiratory failure led to a significant reduction in hospital admissions.
CLINICAL IMPLICATIONS: Patients with chronic hypercapnic respiratory failure are frequent utilizers of the health care system. Initiation of AVAPS in this high-risk population has been shown to reduce admissions. This intervention may lead to decreased health care expenditures and improved quality of life.
DISCLOSURE: The following authors have nothing to disclose: Jacki Cherry, Carol Gray, John Emberger, Gerald O'Brien, Patty McGraw, Jeffrey Stewart
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