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

• Published in: Respiratory care Vol. 60; no. 10; p. 1404
• Main Authors: Vaudan, Stéphanie, Ratano, Damian, Beuret, Philippe, Hauptmann, John, Contal, Olivier, Garin, Nicolas
• Format: Journal Article
• Language: English
• Published: United States 01.10.2015
• Subjects: 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; Pulmonary Disease, Chronic Obstructive - therapy; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Retrospective Studies; Treatment Outcome; acute respiratory failure; noninvasive ventilation; ICU; respiratory therapist; intubation rate; COPD; chronic obstructive pulmonary disease; mortality rate; stay
• ISSN: 1943-3654
• DOI: 10.4187/respcare.03844

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. 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. 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). 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.