title: Does noninvasive ventilation delivery in the ward provide early effective ventilation?
abstract: BACKGROUND
  Although noninvasive ventilation (NIV) is increasingly used in general wards, limited information exists about its ability to provide effective ventilation in this setting. We aim to evaluate NIV delivered in the ward by assessing (1) overall time of application and occurrence of adverse events and (2) differences between daytime and nighttime NIV application.
  
  
  METHODS
  We studied subjects with hypercapnic acute hypercapnic respiratory failure not fulfilling strict criteria for ICU admission, and excluded those who interrupted NIV prior to 48 h. Time spent on NIV, presence and extent of air leaks, and occurrence of desaturations were assessed for the overall study period, and compared between daytime and nighttime.
  
  
  RESULTS
  We enrolled 42 subjects, 25 of whom received NIV for at least 48 h and were included in the data analysis. NIV was successful for 20 subjects, who did not reach criteria for ICU admission. Both PaCO2 and pH significantly improved on average after 2 h and at the end of the study period. NIV was applied for 64.5% of the overall study period and had absent or compensated air leaks for 62.3% of the overall 48-h period. NIV was applied for 55.8% of daytime and for 79.3% of nighttime (P < .01). Effective NIV application was significantly longer overnight (76.9%) than during daytime (53.2%) (P < .01).
  
  
  CONCLUSIONS
  In selected subjects with hypercapnic acute respiratory failure not fulfilling criteria for ICU admission, the application of NIV in the ward is feasible; in addition, NIV can be safely administered overnight.
authors.affiliation: Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara.
authors.forename: Carlo
authors.initials: C
authors.lastname: Olivieri
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara.
authors.forename: Luca
authors.initials: L
authors.lastname: Carenzo
authors.affiliation: Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Vignazia
authors.affiliation: Internal Medicine, Maggiore della Carità University Hospital, Novara.
authors.forename: Mauro
authors.initials: M
authors.lastname: Campanini
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara Internal Medicine, Maggiore della Carità University Hospital, Novara.
authors.forename: Mario
authors.initials: M
authors.lastname: Pirisi
authors.affiliation: Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara.
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Corte
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara Anesthesia and Intensive Care, Sant'Andrea Hospital, Vercelli; and with CRRF Mons. L. Novarese, Moncrivello, Vercelli, Italy. paolo.navalesi@med.unipmn.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000628:therapy*; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000379:methods; D010313:Partial Pressure; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: acute respiratory failure; air-leaks; chronic obstructive pulmonary disease; exacerbation; general ward; intensive care unit; noninvasive ventilation