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Research ArticleOriginal Contributions

Use of Noninvasive Positive-Pressure Ventilation on the Regular Hospital Ward: Experience and Correlates of Success

Samar Farha, Ziad W Ghamra, Edward R Hoisington, Robert S Butler and James K Stoller
Respiratory Care November 2006, 51 (11) 1237-1243;
Samar Farha
Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
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Ziad W Ghamra
Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, Carolina Health Care, Florence, South Carolina.
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Edward R Hoisington
Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
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Robert S Butler
Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio.
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James K Stoller
Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Though noninvasive positive-pressure ventilation (NPPV) is efficacious in treating patients with exacerbations of chronic obstructive pulmonary disease, little attention has been given to the optimal venue in which to provide NPPV. The aim of this prospective observational study was to assess the outcomes of NPPV initiated for acute respiratory failure on the regular in-patient ward.

METHODS: Starting in May 2004, all patients started on NPPV for acute respiratory failure on regular nursing floors of the Cleveland Clinic Hospital were identified. Patients were divided into 2 groups: do-not-intubate (DNI) and non-DNI. NPPV failure was defined as the need to transfer the patient to the intensive care unit (ICU).

RESULTS: Seventy-six patients were enrolled. The most common cause of acute respiratory failure was exacerbation of chronic obstructive pulmonary disease (41%), followed by pulmonary edema, pneumonia, obesity-hypoventilation, and neuromuscular illness. Of the 62 non-DNI patients, 19 (31%) failed NPPV on the regular ward and required transfer to the ICU. Variables associated with NPPV failure were amount of secretions (p = 0.04), etiology of respiratory failure (pneumonia was associated with the highest failure rate, p = 0.015), and infiltrate on the chest radiograph (p = 0.036). Seven of the 14 (50%) DNI patients died during hospitalization.

CONCLUSIONS: Results of this observational study show that noninvasive positive-pressure ventilation is frequently used on the regular hospital ward and that the success rate is similar to that reported in series in which NPPV is used in the ICU.

  • noninvasive positive-pressure ventilation
  • general hospital ward
  • acute respiratory failure
  • outcomes

Footnotes

  • Correspondence: James K Stoller MSc MD FAARC, Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, A90, 9500 Euclid Avenue, Cleveland OH 44195. E-mail: stollej{at}ccf.org.
  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2006 by Daedalus Enterprises Inc.
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Respiratory Care: 51 (11)
Respiratory Care
Vol. 51, Issue 11
1 Nov 2006
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Use of Noninvasive Positive-Pressure Ventilation on the Regular Hospital Ward: Experience and Correlates of Success
Samar Farha, Ziad W Ghamra, Edward R Hoisington, Robert S Butler, James K Stoller
Respiratory Care Nov 2006, 51 (11) 1237-1243;

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Use of Noninvasive Positive-Pressure Ventilation on the Regular Hospital Ward: Experience and Correlates of Success
Samar Farha, Ziad W Ghamra, Edward R Hoisington, Robert S Butler, James K Stoller
Respiratory Care Nov 2006, 51 (11) 1237-1243;
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Keywords

  • noninvasive positive-pressure ventilation
  • general hospital ward
  • acute respiratory failure
  • outcomes

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