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

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.