title: Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations.
abstract: BACKGROUND
  Compared with usual care, noninvasive ventilation (NIV) lowers the risk of intubation and death for subjects with respiratory failure secondary to COPD exacerbations, but whether administration of NIV by a specialized, dedicated team improves its efficiency remains uncertain. Our aim was to test whether a dedicated team of respiratory therapists applying all acute NIV treatments would reduce the risk of intubation or death for subjects with COPD admitted for respiratory failure.
  
  
  METHODS
  We carried out a retrospective study comparing subjects with COPD admitted to the ICU before (2001-2003) and after (2010-2012) the creation of a dedicated NIV team in a regional acute care hospital. The primary outcome was the risk of intubation or death. The secondary outcomes were the individual components of the primary outcome and ICU/hospital stay.
  
  
  RESULTS
  A total of 126 subjects were included: 53 in the first cohort and 73 in the second. There was no significant difference in the demographic characteristics and severity of respiratory failure. Fifteen subjects (28.3%) died or had to undergo tracheal intubation in the first cohort, and only 10 subjects (13.7%) in the second cohort (odds ratio 0.40, 95% CI 0.16-0.99, P = .04). In-hospital mortality (15.1% vs 4.1%, P = .03) and median stay (ICU: 3.1 vs 1.9 d, P = .04; hospital: 11.5 vs 9.6 d, P = .04) were significantly lower in the second cohort, and a trend for a lower intubation risk was observed (20.8% vs 11% P = .13).
  
  
  CONCLUSIONS
  The delivery of NIV by a dedicated team was associated with a lower risk of death or intubation in subjects with respiratory failure secondary to COPD exacerbations. Therefore, the implementation of a team administering all NIV treatments on a 24-h basis should be considered in institutions admitting subjects with COPD exacerbations.
authors.affiliation: Department of Physiotherapy stephanie.vaudan@hopitalrivierachablais.ch.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Vaudan
authors.affiliation: Department of Intensive Care, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Damian
authors.initials: D
authors.lastname: Ratano
authors.affiliation: Department of Intensive Care.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beuret
authors.affiliation: Department of Physiotherapy.
authors.forename: John
authors.initials: J
authors.lastname: Hauptmann
authors.affiliation: University of Health Sciences (HESAV) and University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Contal
authors.affiliation: Department of Medicine, Hospital Riviera-Chablais, Monthey, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods / Q000401:mortality*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: COPD; ICU; acute respiratory failure; chronic obstructive pulmonary disease; intubation rate; mortality rate; noninvasive ventilation; respiratory therapist; stay