Missed opportunities for noninvasive positive pressure ventilation: a utilization review.
BACKGROUND
Although noninvasive positive pressure ventilation (NPPV) improves outcomes in patients who have acute respiratory failure due to chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), it may be underutilized outside the controlled trial setting.


OBJECTIVE
The purpose of this study is to determine the proportion of patients who met criteria for a trial of NPPV but were emergently intubated and mechanically ventilated without receiving a trial of NPPV.


METHODS
We retrospectively reviewed charts of patients who were intubated and ventilated or who received NPPV on admission to one intensive care unit and who had an intensive care unit admitting diagnosis of either exacerbation of COPD or CHF during the period from November 1998 to July 2003.


RESULTS
Of the 243 patients who had an admitting diagnosis of COPD or CHF, 59 (24.3%) met explicit criteria for a trial of NPPV. Only 20 (33.9%) of 59 had a trial of NPPV. The remaining 39 (66%) of 59 did not receive a trial of NPPV and were intubated.


CONCLUSIONS
Nearly two thirds of patients who appeared to meet criteria for NPPV did not receive a trial of this intervention. There is an opportunity to improve the use of NPPV in these patients. Systematic knowledge translation strategies such as guideline implementation and interactive educational interventions may optimize the appropriate use of NPPV.
Sweet
David D
DD
Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6.
Naismith
Angela
A
Keenan
Sean P
SP
Sinuff
Tasnim
T
Dodek
Peter M
PM
D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012189:Retrospective Studies; D014600:Utilization Review