Chest
Clinical Investigations in Critical CareEvaluation of a Practice Guideline for Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failurea
Section snippets
Setting
The study was conducted at St. Joseph’s Hospital, a tertiary care teaching hospital in Hamilton, ON, Canada. The hospital is a 386-bed hospital that consists of a 28-bed clinical teaching unit (CTU), 15-bed mixed medical-surgical ICU, an 8-bed coronary care unit (CCU), and a 10-bed respiratory care unit (RCU). The CTU has two teams each composed of an internist, three to five residents in internal medicine and family medicine, and three to five medical students. The ICU team consisted of an
Results
Every patient receiving NPPV for ARF in the preguideline and postguideline phases was included in this study. In the preguideline phase, 91 patients underwent 95 trials of NPPV. In the postguideline phase, 98 patients underwent 104 trials of NPPV. Patient characteristics (Table 1) were similar with respect to age, gender, most hospital admission diagnoses, neurologic status, and ABG levels (Table 2). There were significant differences at baseline with respect to hospital admission diagnoses of
Discussion
Following the introduction of a clinical practice guideline for the use of NPPV in the treatment of patients with ARF, we found significant changes in the processes of care, including more patients being managed in the ICU, improved cardiopulmonary monitoring, and increased consultation by the pulmonary service. Overall, we did not find any significant differences in ETI rates or ICU or hospital mortality. We did, however, find a trend toward less ETI in patients with CHF who had been treated
Acknowledgment
We thank the nurses, respiratory therapists, physicians, and residents at St. Joseph’s Hospital for their support of this study. We are grateful to Dr. S.P. Keenan for his critical review of the manuscript, Barbara Hill for her administrative support, Michelle Shilton for her help with the data collection, and the NPPV education committee (Barb Fiorino, Karl Weiss, Gail MacKenzie, and Darlene Saratsiotis).
References (36)
- et al.
The effect of positive airway pressure on mortality and need for intubation in cardiogenic pulmonary edema: a systematic review
Chest
(1998) - et al.
Noninvasive ventilatory support after lung resectional surgery
Chest
(1997) - et al.
Noninvasive positive pressure ventilation in status asthmaticus
Chest
(1996) - et al.
Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial
Lancet
(2000) - et al.
Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis
Crit Care Med
(1997) - et al.
Noninvasive ventilation in acute respiratory failure: a meta-analysis update
Crit Care Med
(2002) - et al.
Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of noninvasive ventilation
Am J Respir Crit Care Med
(1999) - et al.
Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting
Intensive Care Med
(1996) - et al.
Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning
Respirology
(1994) - et al.
Noninvasive pressure support ventilation in COPD patients with post extubation hypercapnic respiratory insufficiency
Eur Respir J
(1998)
Non-invasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized controlled trial
Ann Intern Med
Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study
Am J Respir Crit Care Med
Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure
N Engl J Med
Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial
JAMA
Noninvasive mechanical ventilation for cystic fibrosis patients: potential bridge to transplantation
Eur Respir J
Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial
JAMA
Noninvasive ventilation: experience at a community teaching hospital
Intensive Care Med
Noninvasive positive pressure ventilation for acute respiratory failure: a utilization review in a teaching hospital
Can Med Assoc J
Cited by (61)
Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation
2020, Archivos de BronconeumologiaCitation Excerpt :All adult patients (≥18 years old) admitted to the ICU by any cause, requiring NIMV support thorough an oro-nasal interface and simultaneously requiring a naso-enteric tube in place for nutrition, enteral decompression, or drug administration. NIMV was performed following the institutional protocol and international guidelines.16,17 Patients were excluded if they had any contraindication for NIMV use.
Does the application of an algorithm for non-invasive ventilation in chronic obstructive pulmonary disease improve the initiation process and patient outcomes?
2012, PhysiotherapyCitation Excerpt :The target range of oxygen saturation (85 to 90%) was taken from Plant et al. [17] and the BTS guidelines [2]. The algorithm differs from previous guidelines [4,5] in providing the user with specified actions and treatment progression. Synchronisation, tidal volume, oxygenation and comfort are highlighted; these aspects were chosen to reflect areas of care deemed important in local and national guidelines [2].
Noninvasive ventilation for acute respiratory failure: State of the art (II part)
2010, Italian Journal of MedicineNoninvasive ventilation for acute respiratory failure: State of the art (I part)
2009, Italian Journal of MedicineNoninvasive Mechanical Ventilation in Valencia, Spain: From Theory to Practice
2009, Archivos de Bronconeumologia
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).
Dr. Cook is a Critical Care Chair of the Canadian Institute of Health Research. Dr. Sinuff was supported by a Canadian Institute of Health Research Fellowship Award.