Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations.

Details

Serval ID
serval:BIB_790A37D47BDF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations.
Journal
Respiratory Care
Author(s)
Vaudan S., Ratano D., Beuret P., Hauptmann J., Contal O., Garin N.
ISSN
1943-3654 (Electronic)
ISSN-L
0020-1324
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
60
Number
10
Pages
1404-1408
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
BACKGROUND: Compared with usual care, noninvasive ventilation (NIV) lowers the risk of intubation and death for subjects with respiratory failure secondary to COPD exacerbations, but whether administration of NIV by a specialized, dedicated team improves its efficiency remains uncertain. Our aim was to test whether a dedicated team of respiratory therapists applying all acute NIV treatments would reduce the risk of intubation or death for subjects with COPD admitted for respiratory failure.
METHODS: We carried out a retrospective study comparing subjects with COPD admitted to the ICU before (2001-2003) and after (2010-2012) the creation of a dedicated NIV team in a regional acute care hospital. The primary outcome was the risk of intubation or death. The secondary outcomes were the individual components of the primary outcome and ICU/hospital stay.
RESULTS: A total of 126 subjects were included: 53 in the first cohort and 73 in the second. There was no significant difference in the demographic characteristics and severity of respiratory failure. Fifteen subjects (28.3%) died or had to undergo tracheal intubation in the first cohort, and only 10 subjects (13.7%) in the second cohort (odds ratio 0.40, 95% CI 0.16-0.99, P = .04). In-hospital mortality (15.1% vs 4.1%, P = .03) and median stay (ICU: 3.1 vs 1.9 d, P = .04; hospital: 11.5 vs 9.6 d, P = .04) were significantly lower in the second cohort, and a trend for a lower intubation risk was observed (20.8% vs 11% P = .13).
CONCLUSIONS: The delivery of NIV by a dedicated team was associated with a lower risk of death or intubation in subjects with respiratory failure secondary to COPD exacerbations. Therefore, the implementation of a team administering all NIV treatments on a 24-h basis should be considered in institutions admitting subjects with COPD exacerbations.
Keywords
Aged, Disease Progression, Female, Hospital Mortality, Humans, Intensive Care Units/statistics & numerical data, Intubation, Intratracheal/statistics & numerical data, Length of Stay, Male, Middle Aged, Noninvasive Ventilation/methods, Noninvasive Ventilation/mortality, Patient Care Team/statistics & numerical data, Pulmonary Disease, Chronic Obstructive/complications, Pulmonary Disease, Chronic Obstructive/mortality, Respiratory Insufficiency/etiology, Respiratory Insufficiency/mortality, Retrospective Studies, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
27/10/2015 17:23
Last modification date
20/08/2019 14:35
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