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Bird DH, Beringer DC, Parris DP. The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa - assessing knowledge, attitudes and practices. Afr J Emerg Med 2023; 13:322-327. [PMID: 38021353 PMCID: PMC10665829 DOI: 10.1016/j.afjem.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Non-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.Emergency department doctors' knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors' use of NIV in the South African setting. Methods This was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description. Results The mean knowledge score of the participants was shown to increase with an increase in job designation (p < 0.001). The doctors' attitude towards NIV was more positive in those with higher knowledge scores (p < 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, p = 0.009) as was formal NIV training versus those without (77% vs. 69 %, p = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol. Conclusion Increased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.
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Affiliation(s)
- Dr Holly Bird
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Dr Craig Beringer
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Dr Pano Parris
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Jacob Rodríguez J, Arranz Betegón M, Zorrilla Riveiro J. Reply to Comments on «Characteristics of prolonged non-invasive ventilation in hospital emergency departments and their impact on efficacy. Analysis of the VNICat registry». Med Intensiva 2022; 46:659-660. [PMID: 36272900 DOI: 10.1016/j.medine.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 06/16/2023]
Affiliation(s)
- J Jacob Rodríguez
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - J Zorrilla Riveiro
- Servicio de Urgencias, Xarxa Assistencial de Manresa, Fundació Althaia, Manresa, Barcelona, Spain
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Workplace violence among workmates: What we do and the way we are. Eur J Emerg Med 2022; 29:86-88. [PMID: 35210371 DOI: 10.1097/mej.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jacob Rodríguez J, Arranz Betegón M, Zorrilla Riveiro J. Respuesta a puntualizaciones sobre «Características de la ventilación no invasiva prolongada en los servicios de urgencias hospitalarios y su impacto en la eficacia. Análisis del registro VNICat». Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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 and Prognosis of Patients Who Receive Noninvasive Ventilation and Present Limitation of Life Support Treatment: The LLST-NIVCat Multicenter Cohort Study. J Emerg Med 2020; 59:477-484. [PMID: 32684380 DOI: 10.1016/j.jemermed.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/16/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patients who receive noninvasive ventilation (NIV) in the emergency department (ED) sometimes have a limitation of life support treatment (LLST). The characteristics and prognosis in these patients may be worse, however, few studies have been carried out in this respect. OBJECTIVE Analyze the differences between patients receiving NIV in the ED with LLST (NIV-LLST) or without LLST (NIV-noLLST) and their impact on in-hospital mortality, as well as investigate in-hospital mortality in the NIV-LLST group. METHOD We performed a secondary analysis of data from the NIVCat registry. This was a prospective, multicenter, analytical cohort study with consecutive inclusion of patients receiving NIV from February to March 2015 in 11 hospital EDs in Spain. Data on the baseline characteristics, the acute episode, and final patient destination were collected. The dependent variable was all-cause in-hospital mortality. RESULTS We analyzed 152 cases receiving NIV, 66 (43.4%) of whom had NIV-LLTS. Age ≥ 75 years was associated with NIV-LLST. In-hospital mortality was higher in the NIV-LLST group, with an adjusted hazard ratio of 2.50 (95% confidence interval [CI] 1.03-6.06). Patients with NIV-LLST presenting an exacerbation of chronic obstructive pulmonary disease (COPD) presented the lowest mortality, with an odds ratio of 0.27 (95% confidence interval 0.08-0.93), compared with the remaining patients. CONCLUSION In our cohort of patients receiving NIV in the ED, the presence of LLST is frequent and is associated with high hospital mortality. The NIV-LLST patients with a COPD exacerbation have a better prognosis than NIV-LLST patients with other diseases.
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Affiliation(s)
- María Arranz
- Emergency Department, Hospital de Viladecans, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Àngels Lopez
- Sistema d'Emergències Mèdiques, Barcelona, Spain
| | | | | | | | - Francesc López I Vengut
- Emergency Department, Parc sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Antonio German
- Emergency Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Jaume Farré-Cerdà
- Emergency Department, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
| | - José Zorrilla
- Emergency Department, Xarxa Assistencial de Manresa, Fundació Althaia, 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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Gordo F, González del Castillo J. Ventilación mecánica sí, pero no de cualquier forma. Med Intensiva 2018. [DOI: 10.1016/j.medin.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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