Optimising non-invasive mechanical ventilation: Which unit should care for these patients? A cohort study.
BACKGROUND
Use of noninvasive ventilation (NIV) has extended beyond intensive care units (ICUs), becoming usual practice in emergency departments (EDs) and general wards.


OBJECTIVE
To analyse the relationship between nursing care and NIV outcome in different hospital units.


METHODS
Three university hospitals and one community hospital participated in a prospective observational cohort study.


METHODS
Ten units participated: 4 ICUs (1 surgical, 3 medical-surgical), 3 recovery (1 postsurgical, 2 EDs, 3 general wards).


METHODS
Treatment success/failure, interface intolerance and complications were evaluated according to patient characteristics, nursing care provided, and procedures used. Complications analysed included bronchoaspiration, pneumothorax, skin lesions, inability to manage secretions, eye irritations, deteriorating level of consciousness, gastric distension, and excessive air losses around the mask.


RESULTS
Of 387 patients, 194 (50.1%) were treated in ICU, 121 (31.3%) in ED, 38 (9.8%) postsurgery, and 34 (8.8%) in general wards. Regression analysis, adjusted for APACHE score and NIV indication, showed 3.3 times greater risk of NIV failure (95% CI [1.2-9.2]) in a university-hospital ICU with <50 NIV cases/year, compared to a community hospital ICU. In ICUs and general wards, NIV was suspended in 12% of patients due to interface intolerance. Acute-on-chronic lung diseases (ACLD) had lower risk of NIV failure (OR 0.2 [95% CI 0.06-0.69]) and lack of humidification was not associated with treatment failure (OR 0.2 [95% CI 0.1-0.4]). Poor secretion management was linked to pneumonia (OR 2.5 [95% CI 1.1-5.9]) and early weaning/extubation (OR 3.3 [95% CI 1.2-8.9]). Interface intolerance was associated with conventional ICU ventilators (OR 4.4 [95% CI 2.1-9.2]) and nasal skin lesions with excessive air losses (OR 2.4 [95% CI 1.1-5.3]), especially with oronasal masks (OR 3.5 [95% CI 1.1-11.3]).


CONCLUSIONS
Acute respiratory failure patients with pneumonia admitted to general wards had increased interface intolerance and NIV failure. Rotating mask types could improve NIV success in any unit administering this therapy.
Nursing Department, University of Girona, C/Emili Grahit, 77, Girona, Girona Province 17071, Spain. Electronic address: martaraure@gmail.com.
Marta
M
Raurell-Torredà
University Hospital Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona Province 08907, Spain. Electronic address: eargilaga@gmail.com.
E
E
Argilaga-Molero
University Hospital Dr. Josep Trueta, Avinguda de França s/n, Girona, Girona Province 17007, Spain. Electronic address: maria.colomer@udg.edu.
M
M
Colomer-Plana
Community Hospital Consorci Hospitalari de Vic, Francesc Pla el Vigatà s/n, Vic, Barcelona Province 08500, Spain. Electronic address: angelsrodenas@gmail.com.
A
A
Ródenas-Fransico
University Hospital Clínic de Barcelona, Villaroel 170, Barcelona, Barcelona Province 08036, Spain. Electronic address: mtruizg08@hotmail.es.
M T
MT
Ruiz-Garcia
University Hospital Bellvitge-School of Nursing, University of Barcelona, Barcelona Province 08907, Spain. Electronic address: jaume.uya@gmail.com.
J
J
Uya Muntaña
D018806:APACHE; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000592:standards*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013030:Spain
Airway management; Critical care unit; Emergency; Masks; Noninvasive ventilation; Nursing care; Pressure ulcers; Respiratory insufficiency; Respiratory therapy; Skin lesions