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


METHODS
Observational study; prospectively collected data over a 6-month period in a single centre.


METHODS
Non-intensive wards in a University Hospital with 1,100 beds.


METHODS
Consecutive patients with ARF for whom a ventilatory support was indicated but tracheal intubation was not appropriated or immediately needed.


METHODS
None.


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.
Cabrini
Luca
L
Anesthesia and Intensive Care, San Raffaele Hospital and Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Idone
Cristina
C
Colombo
Sergio
S
Monti
Giacomo
G
Bergonzi
Pier Carlo
PC
Landoni
Giovanni
G
Salaris
Davide
D
Leggieri
Carlo
C
Torri
Giorgio
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004489:Edema, Cardiac / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D011654:Pulmonary Edema / Q000453:epidemiology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy*; D000078329:Workforce