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Clinical Investigations in Critical Care; ArticlesFinancial Implications of Noninvasive Positive Pressure Ventilation (NPPV)
Section snippets
Enrollment Criteria
Prior to enrollment and admission to the VRU for NPPV, patients had to have maximization of medical therapy and fulfill at least two clinical and physiologic criteria for noninvasive ventilation as described in Table 1. All patients were first treated for 48 h with maximally effective doses of inhaled bronchodilators (eg, β-agonists, anticholinergic agents), systemic and inhaled corticosteroids, and supplemental oxygen. Following maximization of medical therapy, patients who then fulfilled the
Clinical Outcome
Baseline demographic data of the 27 patients demonstrated that 14 patients had COPD as the cause of respiratory failure and 13 patients had a variety of restrictive diseases (kyphoscoliosis [3], obesity-hypoventilation [5], neuromuscular [4], fibrothorax [1]).
Patient age was 69±9 years; 19 were females. Overall, patients were moderately to severely ill, with 48% (13/27) of patients demonstrating cor pulmonale by physical examination, chest radiograph, or ECG. Overall, patients spent 8±15 days
Discussion
Our data reinforce previous studies1, 2, 3, 4, 5, 6, 7, 8 and show that NPPV may have an important beneficial effect on gas exchange and functional status in patients with chronic respiratory failure. In addition, our data show that patients with chronic respiratory failure secondary to severe underlying disease have significant costs associated with their care when treated with NPPV. Moreover, our data show that the present DRG payment scale does not adequately reflect the costs incurred in
ACKNOWLEDGMENTS
We would like to acknowledge the efforts of Michael Beatrice and Herbert White in the compilation of financial data, the secretarial assistance of Darlene Macon, the illustration assistance of John Travaline, and the helpful comments of Gilbert d'Alonzo.
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Supported in part by a grant 29-P-99401/3-01 from the Health Care Financing Administration (HCFA).