title: NIV by an interdisciplinary respiratory care team in severe respiratory failure in the emergency department limited to day time hours.
abstract: Non-invasive ventilatory support is frequently used in patients with severe respiratory failure (SRF), but is often limited to intensive care units (ICU). We hypothesized that an instantaneous short course of NIV (up to 2 h), limited to regular working hours as an additional therapy on the emergency department (ED) would be feasible and could improve patient´s dyspnoea measured by respiratory rate and Borg visual dyspnea scale. NIV was set up by an interdisciplinary respiratory care team. Outside these predefined hours NIV was performed in the ICU. This is an observational cohort study over 1 year in the ED in a non-university hospital. Fifty-one % of medical emergencies arrived during regular working hours (5475 of 10,718 patients). In total, 63 patients were treated with instantaneous NIV. Door to NIV in the ED was 56 (31-97) min, door to ICU outside regular working hours was 84 (57-166) min. Within 1 h of NIV, the respiratory rate decreased from 30/min (25-35) to 19/min (14-24, p < 0.001), the Borg dyspnoea scale improved from 7 (5-8) to 2 (0-3, p < 0.001). In hypercapnic patients, the blood-pH increased from 7.29 (7.24-7.33) to 7.35 (7.29-7.40) and the pCO2dropped from 8.82 (8.13-10.15) to 7.45 (6.60-8.75) kPa. In patients with SRF of varying origin, instantaneous NIV in the ED during regular working hours was feasible in a non-university hospital setting, and rapidly and significantly alleviated dyspnoea and reduced respiratory rate. This approach proved to be useful as a bridge to the ICU as well as an efficient palliative dyspnoea treatment.
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. christian.horvath@swissonline.ch.
authors.forename: Christian Michael
authors.initials: CM
authors.lastname: Horvath
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Martin Hugo
authors.initials: MH
authors.lastname: Brutsche
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Otto Dagobert
authors.initials: OD
authors.lastname: Schoch
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Bernarde
authors.initials: B
authors.lastname: Schillig
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Florent
authors.initials: F
authors.lastname: Baty
authors.affiliation: Emergency Department, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: vonOw
authors.affiliation: Pneumology and Sleep Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Jochen Julius
authors.initials: JJ
authors.lastname: Rüdiger
mesh_terms: D001784:Blood Gas Analysis; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000032:analysis; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000706:statistics & numerical data*; D010092:Oximetry / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000628:therapy*; D056152:Respiratory Rate; D013557:Switzerland; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide
keywords: Emergency department; Non-invasive ventilation; Severe respiratory failure