Abstract
BACKGROUND: Compared with usual care, noninvasive ventilation (NIV) lowers the risk of intubation and death for subjects with respiratory failure secondary to COPD exacerbations, but whether administration of NIV by a specialized, dedicated team improves its efficiency remains uncertain. Our aim was to test whether a dedicated team of respiratory therapists applying all acute NIV treatments would reduce the risk of intubation or death for subjects with COPD admitted for respiratory failure.
METHODS: We carried out a retrospective study comparing subjects with COPD admitted to the ICU before (2001–2003) and after (2010–2012) the creation of a dedicated NIV team in a regional acute care hospital. The primary outcome was the risk of intubation or death. The secondary outcomes were the individual components of the primary outcome and ICU/hospital stay.
RESULTS: A total of 126 subjects were included: 53 in the first cohort and 73 in the second. There was no significant difference in the demographic characteristics and severity of respiratory failure. Fifteen subjects (28.3%) died or had to undergo tracheal intubation in the first cohort, and only 10 subjects (13.7%) in the second cohort (odds ratio 0.40, 95% CI 0.16–0.99, P = .04). In-hospital mortality (15.1% vs 4.1%, P = .03) and median stay (ICU: 3.1 vs 1.9 d, P = .04; hospital: 11.5 vs 9.6 d, P = .04) were significantly lower in the second cohort, and a trend for a lower intubation risk was observed (20.8% vs 11% P = .13).
CONCLUSIONS: The delivery of NIV by a dedicated team was associated with a lower risk of death or intubation in subjects with respiratory failure secondary to COPD exacerbations. Therefore, the implementation of a team administering all NIV treatments on a 24-h basis should be considered in institutions admitting subjects with COPD exacerbations.
- noninvasive ventilation
- chronic obstructive pulmonary disease
- COPD
- acute respiratory failure
- respiratory therapist
- ICU
- intubation rate
- mortality rate
- stay
Footnotes
- Correspondence: Stéphanie Vaudan, Rue des Morasses 8, 1920 Martigny, Switzerland. E-mail: stephanie.vaudan{at}hopitalrivierachablais.ch.
Ms Vaudan presented a version of this paper at the European Respiratory Society International Congress 2014, held September 8, 2014, in Münich, Germany. Dr Ratano presented a version of this paper at the Congress of the Swiss Society for Intensive Medicine, held October 30, 2014, in Interlaken, Switzerland.
The authors have disclosed no conflicts of interest.
- Copyright © 2015 by Daedalus Enterprises