title: A protocol for initiation of nasal positive pressure ventilation.
abstract: BACKGROUND
  Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting.
  
  
  METHODS
  Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives.
  
  
  RESULTS
  Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.
authors.affiliation: Respiratory and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110.
authors.forename: C K
authors.initials: CK
authors.lastname: Spessert
authors.forename: P B
authors.initials: PB
authors.lastname: Weilitz
authors.forename: D M
authors.initials: DM
authors.lastname: Goodenberger
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis; D015400:Clinical Nursing Research; D002985:Clinical Protocols; D003422:Critical Care; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005249:Fees and Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008176:Lung Volume Measurements; D008397:Masks / Q000009:adverse effects / Q000191:economics; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D009666:Nose; D010347:Patient Care Planning; D010349:Patient Compliance; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000379:methods / Q000451:nursing*; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome