Chest
Volume 111, Issue 6, June 1997, Pages 1631-1638
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Clinical Investigations in Critical Care: NIPPV
Human and Financial Costs of Noninvasive Mechanical Ventilation in Patients Affected by COPD and Acute Respiratory Failure

https://doi.org/10.1378/chest.111.6.1631Get rights and content

Study objectives

It has been suggested that noninvasive mechanical ventilation (NIMV) may be a time-consuming procedure for medical and paramedical personnel. We carried out a prospective trial in 10 consecutive COPD patients aimed at assessing the human and economic resources needed to ventilate patients by NIMV and we compared these with those needed by a group of six patients receiving invasive mechanical ventilation (InMV).

Design

The daily cost and the minutes spent by medical doctors (MDs), respiratory therapists (RTs), and nurses (Ns) were recorded during the first 48 h of ventilation in 10 patients during NIMV (group A) and in six who received InMV (group B) after an initial unsuccessful attempt with NIMV. In two subgroups of patients (five for group A and four for group B), the analysis was also performed, except for RTs, for the total length of mechanical ventilation.

Setting

A respiratory ICU.

Patients

At hospital admission, the two groups of COPD patients did not differ for blood gas values (PaCO2=88.2±9.8 mm Hg for group A vs 90.5±12.8 mm Hg for group B, and pH=7.21+0.08 vs 7.20+0.08, respectively) or for clinical and neurologic status, but patients of group B had not tolerated NIMV.

Measurements and results

The total time spent at the bedside in the first 6 h did not differ between group A and B (group A=72.3 min [MD], 87.2 min [RT], and 178.8 min [N] vs 98.8 min [MD], 12.5 min [RT], and 197.6 min [N] for group B). In the following 42 h, a plateau was reached so that there was a significant reduction for both groups in the time of assistance given by Ns (p< 0.001) but not by MDs or RTs. The total costs were also not different between the two groups ($806±73 [US dollars per day] vs $864±44 for group A and B, respectively). In the subgroups monitored for the entire period of ventilation, a significant reduction in the time of assistance, for both MDs and Ns, was observed after approximately the first half.

Conclusions

We conclude that in the first 48 h of ventilation, daily NIMV is neither more expensive nor time-consuming and staff demanding than InMV. After the first few days of ventilation, NIMV was significantly less time-consuming than InMV, for MDs and Ns, so that medical and paramedical time expenditure seems not to be a major problem during NIMV.

Section snippets

Materials and Methods

This prospective study, approved by the Local Institutional Ethics Committee, was performed between June 1995 and March 1996 at the RICU of Montescano Rehabilitation Center. The patient/staff ratio was and is currently 3:1 for MDs, 2:1 for Ns, and 3:1 for RTs. Sixteen consecutive COPD patients requiring mechanical ventilation were studied. The precipitating cause of acute respiratory failure was respiratory tract infection, without radiologic evidence of pneumonia. All the patients were also in

Results

As illustrated in Table 2, the institution of both NIMV and InMV improved the arterial blood gas values of the patients by hospital discharge, although one patient from each group died before the weaning. The group A patient died of pneumonia on day 9. Multiple organ failure was the cause of death for the group B patient on day 7.

The upper part of Figure 1 illustrates the total Ns workload per patient in the first 48 h of MV. No significant differences were observed in the time of assistance

Discussion

There is now clear evidence that in “selected” populations of COPD patients, NIMV may replace endotracheal intubation during an episode of acute respiratory failure.6, 7 Besides the well-known side effects of NIMV, such as skin abrasion, mask leaks, and gastric distention,2 one of the major limitations to the use of this mode of ventilation is that it may be overly time-consuming for hospital personnel. This concern is mainly founded on an uncontrolled study performed in three patients with

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