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Research ArticleOriginal Research

Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations

Stéphanie Vaudan, Damian Ratano, Philippe Beuret, John Hauptmann, Olivier Contal and Nicolas Garin
Respiratory Care October 2015, 60 (10) 1404-1408; DOI: https://doi.org/10.4187/respcare.03844
Stéphanie Vaudan
Department of Physiotherapy
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  • For correspondence: [email protected]
Damian Ratano
Department of Intensive Care, University Hospital of Lausanne, Lausanne, Switzerland.
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Philippe Beuret
Department of Intensive Care
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John Hauptmann
Department of Physiotherapy
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Olivier Contal
University of Health Sciences (HESAV) and University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
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Nicolas Garin
Department of Medicine, Hospital Riviera-Chablais, Monthey, Switzerland.
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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
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Respiratory Care: 60 (10)
Respiratory Care
Vol. 60, Issue 10
1 Oct 2015
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Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations
Stéphanie Vaudan, Damian Ratano, Philippe Beuret, John Hauptmann, Olivier Contal, Nicolas Garin
Respiratory Care Oct 2015, 60 (10) 1404-1408; DOI: 10.4187/respcare.03844

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Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations
Stéphanie Vaudan, Damian Ratano, Philippe Beuret, John Hauptmann, Olivier Contal, Nicolas Garin
Respiratory Care Oct 2015, 60 (10) 1404-1408; DOI: 10.4187/respcare.03844
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Keywords

  • noninvasive ventilation
  • chronic obstructive pulmonary disease
  • COPD
  • acute respiratory failure
  • respiratory therapist
  • ICU
  • intubation rate
  • mortality rate
  • stay

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