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1. Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure.

Author

Cabrini L, Idone C, Colombo S, Monti G, Bergonzi PC, Landoni G, Salaris D, Leggieri C, and Torri G

Subjects
Acute Disease, Aged, Aged, 80 and over, Edema, Cardiac epidemiology, Edema, Cardiac therapy, Female, Hospitals, University, Humans, Male, Middle Aged, Pneumonia epidemiology, Pneumonia therapy, Prospective Studies, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive therapy, Pulmonary Edema epidemiology, Pulmonary Edema therapy, Workforce, Emergency Medical Services statistics & numerical data, Intensive Care Units, Patient Care Team, Patients' Rooms statistics & numerical data, Positive-Pressure Respiration statistics & numerical data, Respiratory Insufficiency therapy
Abstract

Objective: To report data about "real-life" treatments with non-invasive ventilation for acute respiratory failure (ARF), managed outside intensive care units by anaesthesiologists acting as a medical emergency team., Design: Observational study; prospectively collected data over a 6-month period in a single centre., Setting: Non-intensive wards in a University Hospital with 1,100 beds., Patients: Consecutive patients with ARF for whom a ventilatory support was indicated but tracheal intubation was not appropriated or immediately needed., Interventions: None., Measurements and Results: Patient's characteristics, safety data, short-term outcome and organizational aspects of 129 consecutive treatments were collected. The overall success rate was 77.5%, while 10.1% were intubated and 12.4% died (all of them were "do not attempt resuscitation" patients). The incidence of treatment failure varied greatly among different diseases. Complications were limited to nasal decubitus (5%), failure to accomplish the prescribed ventilatory program (12%), malfunction of the ventilator (2%) and excessive air leaks from face mask (2%) with no consequences for patients. Three patients became intolerant to NIV. The work-load for the MET was high but sustainable: on average NIV was applied to a new case every 34 h and more than three patients were simultaneously treated., Conclusions: Under the supervision of a MET, in our institution NIV could be applied in a wide variety of settings, outside the ICU, with a high success rate and with few complications.

Published
2009
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2. Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure

Author

G. Torri, Cristina Idone, Carlo Leggieri, Sergio Colombo, P. C. Bergonzi, Giacomo Monti, Davide Salaris, Giovanni Landoni, Luca Cabrini, Cabrini, L, Idone, C, Colombo, S, Monti, G, Bergonzi, P, Landoni, Giovanni, Salaris, D, Leggieri, C, and Torri, G.

Subjects
Male, Emergency Medical Services, medicine.medical_specialty, Resuscitation, medicine.medical_treatment, Pulmonary Edema, Critical Care and Intensive Care Medicine, Hospitals, University, Positive-Pressure Respiration, Pulmonary Disease, Chronic Obstructive, Intensive care, Anesthesiology, Patients' Rooms, Humans, Medicine, Prospective Studies, Intensive care medicine, Aged, Aged, 80 and over, Patient Care Team, Edema, Cardiac, business.industry, Incidence (epidemiology), Tracheal intubation, Pneumonia, Middle Aged, medicine.disease, Intensive Care Units, Acute Disease, Workforce, Breathing, Female, Observational study, Medical emergency, Respiratory Insufficiency, business
Abstract

To report data about “real-life” treatments with non-invasive ventilation for acute respiratory failure (ARF), managed outside intensive care units by anaesthesiologists acting as a medical emergency team. Observational study; prospectively collected data over a 6-month period in a single centre. Non-intensive wards in a University Hospital with 1,100 beds. Consecutive patients with ARF for whom a ventilatory support was indicated but tracheal intubation was not appropriated or immediately needed. None. Patient’s characteristics, safety data, short-term outcome and organizational aspects of 129 consecutive treatments were collected. The overall success rate was 77.5%, while 10.1% were intubated and 12.4% died (all of them were “do not attempt resuscitation” patients). The incidence of treatment failure varied greatly among different diseases. Complications were limited to nasal decubitus (5%), failure to accomplish the prescribed ventilatory program (12%), malfunction of the ventilator (2%) and excessive air leaks from face mask (2%) with no consequences for patients. Three patients became intolerant to NIV. The work-load for the MET was high but sustainable: on average NIV was applied to a new case every 34 h and more than three patients were simultaneously treated. Under the supervision of a MET, in our institution NIV could be applied in a wide variety of settings, outside the ICU, with a high success rate and with few complications.

Published
2009

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