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Arranz M, Jacob J, Sancho-Ramoneda M, Lopez À, Navarro-Sáez MC, Cousiño-Chao JR, López-Altimiras X, López I Vengut F, García-Trallero O, German A, Farré-Cerdà J, Zorrilla J. Characteristics of prolonged noninvasive ventilation in emergency departments and impact upon effectiveness. Analysis of the VNICat registry. Med Intensiva 2021; 45:477-484. [PMID: 34475010 DOI: 10.1016/j.medine.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/08/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the characteristics and variables associated with prolonged noninvasive ventilation performed completely in Emergency Departments (NIV-ED) and its influence upon effectiveness. DESIGN A prospective, multicenter, observational multipurpose cohort study was carried out. SETTING VNICAT Registry. SUBJECTS Patients in which NIV-ED was performed in 11 Catalan hospitals in the months of February or March 2015. INTERVENTION No. VARIABLES The study variable was NIV-ED, which as a function of time was defined as prolonged or not prolonged. The efficacy variable was the success of the technique in terms of patient improvement. RESULTS A total of 125 patients were included, with a median NIV-ED duration of 12 h, which was the cut-off point for the comparator groups. In 60 cases (48%) NIV-ED was not prolonged (<12 h), while in 65 cases (52%) ventilation was prolonged (≥12 h). Non-prolonged NIV-ED was associated to the indication of acute heart failure and prolonged ventilation to the presence of diabetes. There were no differences between non-prolonged and prolonged NIV-ED in terms of efficacy, and the success rate in terms of improvement was 68.3% and 76.9%, respectively, with an adjusted odds ratio of 1.49 (95%CI 0.61-3.60). CONCLUSIONS Prolonged NIV-ED is a frequent situation, but few variables associated to it have been studied. The presence of prolonged ventilation did not influence the success rate of NIV.
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Affiliation(s)
- M Arranz
- Servicio de Urgencias, Hospital de Viladecans, Viladecans, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - M Sancho-Ramoneda
- Servicio de Urgencias, Hospital Universitari Josep Trueta, Girona, Spain
| | - À Lopez
- Sistema d'Emergències Mèdiques (SEM), Barcelona, Spain
| | - M C Navarro-Sáez
- Servicio de Urgencias, Coorporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - J R Cousiño-Chao
- Servicio de Urgencias, Hospital Sant Jaume de Calella, Calella, Barcelona, Spain
| | - X López-Altimiras
- Servicio de Urgencias, Hospital de Mollet, Mollet del Vallès, Barcelona, Spain
| | - F López I Vengut
- Servicio de Urgencias, Parc sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - O García-Trallero
- Servicio de Urgencias, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - A German
- Servicio de Urgencias, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - J Farré-Cerdà
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
| | - J Zorrilla
- Servicio de Urgencias, Xarxa Assistencial de Manresa, Fundació Althaia, Manresa, Barcelona, Spain
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Arranz M, Jacob J, Sancho-Ramoneda M, Lopez À, Navarro-Sáez MC, Cousiño-Chao JR, López-Altimiras X, López I Vengut F, García-Trallero O, German A, Farré-Cerdà J, Zorrilla J. Characteristics of prolonged noninvasive ventilation in emergency departments and impact upon effectiveness. Analysis of the VNICat registry. Med Intensiva 2020; 45:S0210-5691(20)30065-6. [PMID: 32303369 DOI: 10.1016/j.medin.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the characteristics and variables associated with prolonged noninvasive ventilation performed completely in Emergency Departments (NIV-ED) and its influence upon effectiveness. DESIGN A prospective, multicenter, observational multipurpose cohort study was carried out. SETTING VNICat Registry. SUBJECTS Patients in which NIV-ED was performed in 11 Catalan hospitals in the months of February or March 2015. INTERVENTION No. VARIABLES The study variable was NIV-ED, which as a function of time was defined as prolonged or not prolonged. The efficacy variable was the success of the technique in terms of patient improvement. RESULTS A total of 125 patients were included, with a median NIV-ED duration of 12hours, which was the cut-off point for the comparator groups. In 60 cases (48%) NIV-ED was not prolonged (<12hours), while in 65 cases (52%) ventilation was prolonged (≥12hours). Non-prolonged NIV-ED was associated to the indication of acute heart failure and prolonged ventilation to the presence of diabetes. There were no differences between non-prolonged and prolonged NIV-ED in terms of efficacy, and the success rate in terms of improvement was 68.3% and 76.9%, respectively, with an adjusted odds ratio of 1.49 (95%CI 0.61-3.60). CONCLUSIONS Prolonged NIV-ED is a frequent situation, but few variables associated to it have been studied. The presence of prolonged ventilation did not influence the success rate of NIV.
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Affiliation(s)
- M Arranz
- Servicio de Urgencias, Hospital de Viladecans, Viladecans, Barcelona, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - M Sancho-Ramoneda
- Servicio de Urgencias, Hospital Universitari Josep Trueta, Girona, España
| | - À Lopez
- Sistema d'Emergències Mèdiques (SEM), Barcelona, España
| | - M C Navarro-Sáez
- Servicio de Urgencias, Coorporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - J R Cousiño-Chao
- Servicio de Urgencias, Hospital Sant Jaume de Calella, Calella, Barcelona, España
| | - X López-Altimiras
- Servicio de Urgencias, Hospital de Mollet, Mollet del Vallès, Barcelona, España
| | - F López I Vengut
- Servicio de Urgencias, Parc sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | - O García-Trallero
- Servicio de Urgencias, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España
| | - A German
- Servicio de Urgencias, Hospital Universitari Mútua de Terrassa, Terrasa, Barcelona, España
| | - J Farré-Cerdà
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, España
| | - J Zorrilla
- Servicio de Urgencias, Xarxa Assistencial de Manresa, Fundació Althaia, Manresa, Barcelona, España
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Non-invasive ventilation in emergency departments in public hospitals in Catalonia. The VENUR-CAT study. Med Intensiva 2017. [PMID: 28625339 DOI: 10.1016/j.medin.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To know the implementation and characteristics of non-invasive ventilation (NIV) in the Emergency Departments (EDs) of public hospitals in Catalonia (Spain) and analyze possible differences based on the typology, degree of activity and the availability of an Intensive Care Unit (ICU) in the hospital. DESIGN A non-interventional, descriptive study was carried out, using a structured questionnaire divided into 3sections: 1) professional experience and training; 2) devices used; and 3) clinical scenarios and the use of NIV. SETTING Persons responsible for public EDs in Catalonia. RESULTS Fifty-two of the 54 public EDs in Catalonia responded (96.3%). Fifty-one perform NIV, which is mainly initiated by emergency care physicians (78.5%); 66.7% maintain the patient in the ED until discharge; and in 43.1% of the cases the length of stay is>24h. Of the EDs, 39.2% have their own protocol, 35.3% of which are established by consensus with other departments (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.014]), while 25.5% have no protocol, and 43.1% register the activity. Training represents the greatest difficulty for the implementation of NIV, but 19.6% do not provide specific training. When support is needed, the main physician of reference is the intensivist (35.3%) (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.002]). CONCLUSIONS In most EDs in Catalonia, NIV is performed by emergency care physicians. Areas needing improvement include drainage of patients once NIV has been started, the promotion of protocols, registry of activity, and training of the healthcare professionals.
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Jacob J, Miró Ò, Herrero P, Martín-Sánchez F, Gil V, Tost J, Aguirre A, Escoda R, Alquézar A, Andueza J, Llorens P. Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D. Med Intensiva 2016; 40:348-55. [DOI: 10.1016/j.medin.2015.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 02/01/2023]
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Ozsancak Ugurlu A, Sidhom SS, Khodabandeh A, Ieong M, Mohr C, Lin DY, Buchwald I, Bahhady I, Wengryn J, Maheshwari V, Hill NS. Where is Noninvasive Ventilation Actually Delivered for Acute Respiratory Failure? Lung 2015. [PMID: 26210474 DOI: 10.1007/s00408-015-9766-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Few studies have examined locations of noninvasive ventilation (NIV) application for acute respiratory failure (ARF). We aimed to track actual locations of NIV delivery and related outcomes. METHODS Observational cohort study based at 8 acute care hospitals in Massachusetts on adult patients admitted for ARF requiring ventilatory support during pre-determined time intervals. RESULTS Of 1225 ventilator starts, 499 were NIV; 209 (42%) in intensive care units (ICU), 185 (37%) in emergency departments (ED), 91 (18%) on general wards, and 14 (3%) in other units. Utilization (% of all ventilator starts) (1), success (2) and in-hospital mortality (3) rates for patients initiated on NIV in ICU, ED, and general and other wards were (1) 38, 36, 73, and 52%, (2) 60, 77, 68, and 93% and (3) 25, 12, 17, and 0%, respectively (p < 0.05 for all). Patients with acute-on-chronic lung disease (ACLD) and acute pulmonary edema (APE) were begun on NIV most often in EDs and patients with 'de novo' ARF and neurologic disorders most often in ICU's. Approximately 2/3 of patients begun on NIV outside of ICUs were transferred within 72 h to ICUs, wards or other units. CONCLUSIONS Most NIV starts occurred in ICUs and EDs but utilization rate was highest (>50%) on general wards where a fifth of NIV starts took place. Actual location depended on etiology of ARF as patients with ACLD and APE were started more often in EDs and "de novo" ARF in ICU. NIV failure and mortality rates were higher in ICUs related to the greater proportion of patients with "de novo" ARF.
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Affiliation(s)
- Aylin Ozsancak Ugurlu
- Department of Pulmonary Disease, Baskent University, Oymaci sok. No: 2, 34662, Altunizade/Istanbul, Turkey.
| | - Samy S Sidhom
- Pulmonary Department, Newton-Wellesley Hospital, Newton, MA, USA
| | | | | | | | | | | | | | | | | | - Nicholas S Hill
- Department of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
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Martín-González F, González-Robledo J, Sánchez-Hernández F, Moreno-García MN, Barreda-Mellado I. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure. Med Intensiva 2015; 40:9-17. [PMID: 25759114 DOI: 10.1016/j.medin.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/16/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effectiveness and identify predictors of failure of noninvasive ventilation. DESIGN A retrospective, longitudinal descriptive study was made. SETTING Adult patients with acute respiratory failure. PATIENTS A total of 410 consecutive patients with noninvasive ventilation treated in an Intensive Care Unit of a tertiary university hospital from 2006 to 2011. PROCEDURES Noninvasive ventilation. MAIN VARIABLES OF INTEREST Demographic variables and clinical and laboratory test parameters at the start and two hours after the start of noninvasive ventilation. Evolution during admission to the Unit and until hospital discharge. RESULTS The failure rate was 50%, with an overall mortality rate of 33%. A total of 156 patients had hypoxemic respiratory failure, 87 postextubation respiratory failure, 78 exacerbation of chronic obstructive pulmonary disease, 61 hypercapnic respiratory failure without chronic obstructive pulmonary disease, and 28 had acute pulmonary edema. The failure rates were 74%, 54%, 27%, 31% and 21%, respectively. The etiology of respiratory failure, serum bilirubin at the start, APACHEII score, radiological findings, the need for sedation to tolerate noninvasive ventilation, changes in level of consciousness, PaO2/FIO2 ratio, respiratory rate and heart rate from the start and two hours after the start of noninvasive ventilation were independently associated to failure. CONCLUSIONS The effectiveness of noninvasive ventilation varies according to the etiology of respiratory failure. Its use in hypoxemic respiratory failure and postextubation respiratory failure should be assessed individually. Predictors of failure could be useful to prevent delayed intubation.
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Affiliation(s)
- F Martín-González
- Unidad de Cuidados Intensivos, Hospital Universitario de Salamanca, Salamanca, España.
| | - J González-Robledo
- Unidad de Cuidados Intensivos, Hospital Universitario de Salamanca, Salamanca, España
| | - F Sánchez-Hernández
- Escuela de Enfermería y Fisioterapia, Universidad de Salamanca, Salamanca, España
| | - M N Moreno-García
- Departamento de Informática y Automática, Universidad de Salamanca, Salamanca, España
| | - I Barreda-Mellado
- Departamento de Estadística, Universidad de Salamanca, Salamanca, España
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