[Implementation of non invasive ventilation in respiratory ward in patients with exacerbations of chronic obstructive pulmonary disease].
BACKGROUND
Non Invasive Ventilation (NIV) has been shown to lower the mortality rate from 22% to 9% when given as an additional treatment to selected chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure and hypercapnia. Risk of intubation has been shown to fall from 33% to 14%. In February 2004 NIV was added as a treatment modality in a respiratory ward to patients with exacerbation of COPD after initial stabilization with standard treatment: oxygen, bronchodilators, systemic steroids and, if indicated, antibiotics. We present the results of NIV treatment.


METHODS
Over a period of one year there were 906 admissions (555 patients) registered with COPD when discharged from the respiratory department, and 80 NIV patient courses (71 patients; two patients received NIV three times and five patients twice) were registered. Failure of the treatment was defined as reference to the Intensive Care Unit (ICU) for further treatment or death.


RESULTS
Three patients did not have COPD. A group of patients (13) were admitted directly to the ICU and received NIV in the respiratory ward after discharge from the ICU. A total of 19 patients receiving NIV were not evaluated as ICU candidates. There were 45 patients (ICU candidates) receiving NIV, 36 of which (80%) were treated successfully. Six patients were referred to the ICU (13.3%). Two patients died in the ICU and a third patient died in the ward (6.7%). In all, 11 patients died.


CONCLUSIONS
In selected COPD patients with acute respiratory failure and hypercapnia NIV is a safe and life-saving treatment applicable to the respiratory ward.
Titlestad
Ingrid Louise
IL
Odense Universitetshospital, Afdeling C, Lungemedicinsk Afsnit. it@dadlnet.dk
Madsen
Helle Dall
HD
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome