PT  - JOURNAL ARTICLE
AU  - Khalid, Imran
AU  - Sherbini, Nahid
AU  - Qushmaq, Ismael
AU  - Qabajah, Mohammad R
AU  - Nisar, Amina
AU  - Khalid, Tabindeh J
AU  - Hamad, Wasfy J
TI  - Outcome of patients treated with noninvasive ventilation by Medical Emergency Team on the wards
AID  - 10.4187/respcare.02515
DP  - 2013 Jul 02
TA  - Respiratory Care
PG  - respcare.02515
4099  - http://rc.rcjournal.com/content/early/2013/07/02/respcare.02515.short
4100  - http://rc.rcjournal.com/content/early/2013/07/02/respcare.02515.full
AB  - Background: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical Emergency Teams (MET) provide acute care and monitoring to deteriorating patients on the general wards. Whether starting NIV in ward patients with respiratory distress in the context of MET is safe remains unclear. Methods: We evaluated 1123 MET calls in 30217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital. Patients with acute desaturation (<90%) and tachypnea (respiratory rate>28) on the wards, for whom MET was activated, were identified. Patients transferred to the intensive care unit (ICU) at the end of MET call were excluded. The remaining ward patients were divided into: (1) NIV Group (NIV-G): in which NIV was initiated by MET; (2) Non-NIV Group (Non-NIVG): NIV was not started by MET. The primary outcome was endotracheal intubation or ICU transfer within 48-hours of MET activation. Secondary outcome measures were 28-day mortality and ICU mortality. Results: 238 MET patients met the study criteria. 109 immediate ICU transfers were excluded. Out of remaining 129 ward patients, 54 were in the NIV-G and 75 in Non-NIVG. The NIV-G patients were relatively sicker than Non-NIVG (APACHE II 17.6±5.1vs.14.4±5;p<0.001). Patients with pulmonary edema, COPD or asthma exacerbations were more, and with pneumonia less likely to be placed on NIV. The primary outcome was reached in 2/54 (3.7%) of NIV-G patients and 12/75 (16%) of Non-NIVG patients (p=0.03). There was no statistical difference (p>0.3) between NIV-G and Non-NIVG in the secondary outcomes of 28-day mortality (7.4% vs. 13.3%) and ICU mortality (3.7% vs. 8%) respectively. Conclusion: NIV in select group of ward patients can be safely initiated in the context of MET. Future prospective studies should validate these results and focus on improving MET systems to accurately triage such patients.