Carlo Olivieri1, Luca Carenzo2, Gian Luca Vignazia1, Mauro Campanini3, Mario Pirisi4, Francesco Della Corte5, Paolo Navalesi6. 1. Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara. 2. Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara. 3. Internal Medicine, Maggiore della Carità University Hospital, Novara. 4. Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara Internal Medicine, Maggiore della Carità University Hospital, Novara. 5. Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara. 6. Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara Anesthesia and Intensive Care, Sant'Andrea Hospital, Vercelli; and with CRRF Mons. L. Novarese, Moncrivello, Vercelli, Italy. paolo.navalesi@med.unipmn.it.
Abstract
BACKGROUND: Although noninvasive ventilation (NIV) is increasingly used in general wards, limited information exists about its ability to provide effective ventilation in this setting. We aim to evaluate NIV delivered in the ward by assessing (1) overall time of application and occurrence of adverse events and (2) differences between daytime and nighttime NIV application. METHODS: We studied subjects with hypercapnic acute hypercapnic respiratory failure not fulfilling strict criteria for ICU admission, and excluded those who interrupted NIV prior to 48 h. Time spent on NIV, presence and extent of air leaks, and occurrence of desaturations were assessed for the overall study period, and compared between daytime and nighttime. RESULTS: We enrolled 42 subjects, 25 of whom received NIV for at least 48 h and were included in the data analysis. NIV was successful for 20 subjects, who did not reach criteria for ICU admission. Both PaCO2 and pH significantly improved on average after 2 h and at the end of the study period. NIV was applied for 64.5% of the overall study period and had absent or compensated air leaks for 62.3% of the overall 48-h period. NIV was applied for 55.8% of daytime and for 79.3% of nighttime (P < .01). Effective NIV application was significantly longer overnight (76.9%) than during daytime (53.2%) (P < .01). CONCLUSIONS: In selected subjects with hypercapnic acute respiratory failure not fulfilling criteria for ICU admission, the application of NIV in the ward is feasible; in addition, NIV can be safely administered overnight.
BACKGROUND: Although noninvasive ventilation (NIV) is increasingly used in general wards, limited information exists about its ability to provide effective ventilation in this setting. We aim to evaluate NIV delivered in the ward by assessing (1) overall time of application and occurrence of adverse events and (2) differences between daytime and nighttime NIV application. METHODS: We studied subjects with hypercapnic acute hypercapnic respiratory failure not fulfilling strict criteria for ICU admission, and excluded those who interrupted NIV prior to 48 h. Time spent on NIV, presence and extent of air leaks, and occurrence of desaturations were assessed for the overall study period, and compared between daytime and nighttime. RESULTS: We enrolled 42 subjects, 25 of whom received NIV for at least 48 h and were included in the data analysis. NIV was successful for 20 subjects, who did not reach criteria for ICU admission. Both PaCO2 and pH significantly improved on average after 2 h and at the end of the study period. NIV was applied for 64.5% of the overall study period and had absent or compensated air leaks for 62.3% of the overall 48-h period. NIV was applied for 55.8% of daytime and for 79.3% of nighttime (P < .01). Effective NIV application was significantly longer overnight (76.9%) than during daytime (53.2%) (P < .01). CONCLUSIONS: In selected subjects with hypercapnic acute respiratory failure not fulfilling criteria for ICU admission, the application of NIV in the ward is feasible; in addition, NIV can be safely administered overnight.
Authors: Bandar M Faqihi; Dhruv Parekh; Samuel P Trethewey; Julien Morlet; Rahul Mukherjee; Alice M Turner Journal: Can Respir J Date: 2021-12-21 Impact factor: 2.409