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

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.