USE OF NONINVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN GENERAL MEDICAL WARDS Export

@article{citeulike:3822998, abstract = {PURPOSE:in last years non invasive ventilation (NIV) reached an important role in Acute Respiratory Failure (ARF) also outside Intensive Care Units (ICU): improves clinical parameters and arterial gases, decrease mortality and intubation (ETI). Objective of the study: to determine applicability of NIV in a general non-respiratory medical-ward. METHODS:50 consecutive Pts with Hypoxemic or Hypercapnic ARF: 22Pts(44\%) ACPE, 18Pts(36\%) AECOPD, 5(10\%) Pneumonia, 5(10\%) ALI/ARDS. Baseline characteristics: mean RR 36/min, mean neurological Kelly score 2.77, mean pH 7.22, mean PaCO2 70mmHg, mean PaO2 49 mmHg, mean age 83. In addition to conventional treatment Pts received:-ACPE: CPAP10cmH2O-COPD: PSV(10-15 cmH2O)+PEEP(4-6 cmH2O)+aerosol therapy with short-acting beta2agonists-ALI/ARDS, Pneumonia: CPAP or bi-level pressure ventilation. RESULTS:Primary outcome: NIMV failure defined as "need for intubation" or "death". Nine Pts (18\%) failed: eight of these (16\%) needed ETI (5 ALI/ARDS p<0.0001, 3COPD=failure rate 16.6\%p=0.58): one Patient (2\%) died (Pneumonia). No ACPE Pts failed (p=0.0027). Secondary outcomes:-Significant improvement (p<0.05) in RR, Kelly-Score, pH, PaCO2, PaO2 versus baseline data.-Median duration of treatment: 16:06hours with differences depending on aetiology: COPD Pts 18:54hours, ACPE 4:15, Pneumonia 20. -Mean length of hospitalisation of responder Pts: 8.66 days-No patients discontinued NIV for side effects. CONCLUSION:Results of this study are consistent with literature's data. Failure rate of NIV (18\%) is similar to those reported in studies performed in ICU, ED and Ward setting. Hypoxemic ARF related to ALI/ARDS and pneumonia show a worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. For the treatment of ARF due to AECOPD and ACPE NIV is feasible, safe and effective in a general medical-ward: improves clinical parameters, arterial blood gases values and can prevent ETI, ICU transfer and invasive-ventilation events related to high mortality rate, complications, longer hospitalisation. CLINICAL IMPLICATIONS:These findings should encourage the diffusion of NIV in general medical-wards. According to strong evidences in literature, NIV should be considered a first-line and standard treatment in ACPE and AECOPD irrespective of the setting. DISCLOSURE:Federico Lari, No Financial Disclosure Information; No Product/Research Disclosure Information}, author = {Lari, Federico and Bragagni, Gianpaolo and Giostra, Fabrizio and Ferrari, Rodolfo and Di Battista, Nicola}, citeulike-article-id = {3822998}, citeulike-linkout-0 = {http://meeting.chestjournal.org/cgi/content/abstract/134/4/p123001}, day = {1}, journal = {Chest}, keywords = {arf, copd, general, niv, ward}, month = {October}, number = {4}, pages = {p123001+}, posted-at = {2008-12-24 12:51:53}, priority = {2}, title = {USE OF NONINVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN GENERAL MEDICAL WARDS}, url = {http://meeting.chestjournal.org/cgi/content/abstract/134/4/p123001}, volume = {134}, year = {2008} }

TY - JOUR ID - citeulike:3822998 L3 - citeulike-article-id:3822998 N2 - PURPOSE:in last years non invasive ventilation (NIV) reached an important role in Acute Respiratory Failure (ARF) also outside Intensive Care Units (ICU): improves clinical parameters and arterial gases, decrease mortality and intubation (ETI). Objective of the study: to determine applicability of NIV in a general non-respiratory medical-ward. METHODS:50 consecutive Pts with Hypoxemic or Hypercapnic ARF: 22Pts(44%) ACPE, 18Pts(36%) AECOPD, 5(10%) Pneumonia, 5(10%) ALI/ARDS. Baseline characteristics: mean RR 36/min, mean neurological Kelly score 2.77, mean pH 7.22, mean PaCO2 70mmHg, mean PaO2 49 mmHg, mean age 83. In addition to conventional treatment Pts received:-ACPE: CPAP10cmH2O-COPD: PSV(10-15 cmH2O)+PEEP(4-6 cmH2O)+aerosol therapy with short-acting beta2agonists-ALI/ARDS, Pneumonia: CPAP or bi-level pressure ventilation. RESULTS:Primary outcome: NIMV failure defined as "need for intubation" or "death". Nine Pts (18%) failed: eight of these (16%) needed ETI (5 ALI/ARDS p<0.0001, 3COPD=failure rate 16.6%p=0.58): one Patient (2%) died (Pneumonia). No ACPE Pts failed (p=0.0027). Secondary outcomes:-Significant improvement (p<0.05) in RR, Kelly-Score, pH, PaCO2, PaO2 versus baseline data.-Median duration of treatment: 16:06hours with differences depending on aetiology: COPD Pts 18:54hours, ACPE 4:15, Pneumonia 20. -Mean length of hospitalisation of responder Pts: 8.66 days-No patients discontinued NIV for side effects. CONCLUSION:Results of this study are consistent with literature's data. Failure rate of NIV (18%) is similar to those reported in studies performed in ICU, ED and Ward setting. Hypoxemic ARF related to ALI/ARDS and pneumonia show a worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. For the treatment of ARF due to AECOPD and ACPE NIV is feasible, safe and effective in a general medical-ward: improves clinical parameters, arterial blood gases values and can prevent ETI, ICU transfer and invasive-ventilation events related to high mortality rate, complications, longer hospitalisation. CLINICAL IMPLICATIONS:These findings should encourage the diffusion of NIV in general medical-wards. According to strong evidences in literature, NIV should be considered a first-line and standard treatment in ACPE and AECOPD irrespective of the setting. DISCLOSURE:Federico Lari, No Financial Disclosure Information; No Product/Research Disclosure Information IS - 4 JF - Chest TI - USE OF NONINVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN GENERAL MEDICAL WARDS VL - 134 SP - p123001 KW - arf KW - copd KW - general KW - niv KW - ward AU - Lari, Federico AU - Bragagni, Gianpaolo AU - Giostra, Fabrizio AU - Ferrari, Rodolfo AU - Di Battista, Nicola PY - 2008/10/01/ UR - http://meeting.chestjournal.org/cgi/content/abstract/134/4/p123001 ER -