Missed opportunities for noninvasive positive pressure ventilation: A utilization review☆
published online 05 July 2007.
Abstract
Background
Although noninvasive positive pressure ventilation (NPPV) improves outcomes in patients who have acute respiratory failure due to chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), it may be underutilized outside the controlled trial setting.
Purpose
The purpose of this study is to determine the proportion of patients who met criteria for a trial of NPPV but were emergently intubated and mechanically ventilated without receiving a trial of NPPV.
Methods
We retrospectively reviewed charts of patients who were intubated and ventilated or who received NPPV on admission to one intensive care unit and who had an intensive care unit admitting diagnosis of either exacerbation of COPD or CHF during the period from November 1998 to July 2003.
Results
Of the 243 patients who had an admitting diagnosis of COPD or CHF, 59 (24.3%) met explicit criteria for a trial of NPPV. Only 20 (33.9%) of 59 had a trial of NPPV. The remaining 39 (66%) of 59 did not receive a trial of NPPV and were intubated.
Interpretation
Nearly two thirds of patients who appeared to meet criteria for NPPV did not receive a trial of this intervention. There is an opportunity to improve the use of NPPV in these patients. Systematic knowledge translation strategies such as guideline implementation and interactive educational interventions may optimize the appropriate use of NPPV.
Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6
Corresponding author. Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada V6Z 1Y6. Tel.: +1 604 806 9023; fax: +1 604 806 8674.
☆ This study was supported by St. Paul's Hospital and The Keenan Foundation; Dr Sinuff is supported by a Clinician Scientist award from the Canadian Institutes for Health Research.
1 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada (conception and design, acquisition of data, analysis and interpretation of data).
2 Department of Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, BC, Canada (conception and design, analysis and interpretation of data).
3 Department of Critical Care Medicine and Interdepartmental Division of Critical Care Sunnybrook and Women's College Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada (conception and design, analysis and interpretation of data).
4 Program of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada (conception and design, analysis and interpretation of data).
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