title: Non-invasive ventilation in the emergency department for patients in type II respiratory failure due to COPD exacerbations.
abstract: BACKGROUND
  Acute chronic obstructive pulmonary disease (COPD) exacerbations can cause respiratory failure and may require non-invasive ventilation (NIV). There is a paucity of studies examining their NIV implementation within the emergency department (ED).
  
  
  OBJECTIVE
  The aims were (i) to establish whether NIV was beneficial for patients using arterial blood gas analysis (ABG), (ii) to observe whether current ED practice met the guidelines of obtaining ABG measurements within 15 minutes of arrival and commencement of NIV within 1 hour of clinical indication and (iii) to examine which healthcare professionals (HCPs) initiated NIV.
  
  
  METHODS
  A retrospective observational study reviewing all patients commenced on NIV in the ED due to COPD exacerbations was undertaken.
  
  
  RESULTS
  A total of 48 patients were included and the majority received NIV within 1 hour (n =  6, 75%) as recommended by the guidelines. Over 50% of the patients in the study had ABG analysis within 15 minutes and 89% (n = 43) within 30 minutes and statistically significant improvements were noted in respiratory rate, oxygen saturation and ABGs from baseline to repeat measurements undertaken 58 minutes post NIV initiation (p < 0.001). The largest healthcare group to initiate NIV was the nursing team (50% n = 24) with the majority of emergency nurses being experienced nurses [band 6 (n = 17)].
  
  
  CONCLUSIONS
  From this small single centre study, early ABG analyses and NIV initiation were beneficial to COPD patients presenting in respiratory failure with the majority receiving treatment within the recommended guidelines.
authors: Abigail
authors: A
authors: Moxon
authors: Geraldine
authors: G
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D018450:Disease Progression; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000451:nursing*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000451:nursing*; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Arterial blood gas; Chronic obstructive pulmonary disease; Non-invasive ventilation; Type II respiratory failure