Surveillance of the use of Non-invasive positive pressure ventilation (NIPPV) in general medical ward

MAN, Yu Hon; AU, Lik Hang; WONG, Tsz Lun; HO, Sheng Sheng Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Taipo, New Territories, Hong Kong

Introduction
Non-invasive positive pressure ventilation (NIPPV) has become the standard of treatment in acute hypercapnic respiratory failure due to COPD exacerbations. COPD patients requiring NIPPV support are nursed in various units in different hospitals in Hong Kong.

In 2007, daily surveillance of NIPPV cases was conducted by the ward clerk and was reported to the respiratory team. Cases were then screened by respiratory physicians to facilitate weaning.
The duration of NIPPV use and the in-patient bed-days were compared using paired student t test.

Table 1 Baseline characteristics of patients requiring NIPPV in 2002 and 2007

Discussion
Patients with acute respiratory failure using NIPPV account for significant workload in general medical wards. Methods in alleviating workload without compromising patient quality of care are of paramount importance. This study showed the surveillance of the use of NIPPV significantly reduces the length of inpatient beddays and number of days using NIPPV. Non-respiratory physicians may be unfamiliar with NIPPV, thus reluctant to wean NIPPV. This, in turn, creates unnecessary workload and prolongs patients discomfort.

2002 (n=91) 2007 (n=76) Age (mean (SE)) 76.3 (1.0) Male/Female (n) 59/32 COAD (%) 74 (81.3) Cardiac 17 (18.7) Disease (%) 76.0 (1.1) 50/26 45 (59.2) 27 (35.5)

Cardiac Disease includes AF, CHB, CHF or IHD

Results Aim
We aimed to study whether surveillance of the use of NIPV by respiratory physicians can reduce the duration of NIPPV use and inpatient bed-days in a regional hospital where patients on NIPV support was managed in general wards by non-respiratory physicians. A total of 91 and 76 patients requiring NIPPV were identified in 2002 and 2007 respectively. The demographic characteristics were similar between the two groups (Table 1). The duration of NIPPV use in 2007 was 4.36+/-0.32 days while that of 2002 was 6.86+/-0.50 days. The reduction was statistically significant (p<0.03). There was also a significant decrease in inpatient bed-days in 2007 when compared with that of 2002 (10.59+/-1.0 days Vs 15.09+/1.54 days, p<0.03) (Table 2).

Table 2 Duration of NIPPV use and in patient beddays in 2002 and 2007

2002 Duration of NIPPV use (days) Inpatient beddays

Data are n(SE).

2007 4.36 p<0.03 (0.32) 10.59 p<0.03 (1.0)

6.86 (0.50) 15.09 (1.54)

Duration of NIPPV use

10 8

Days

6 4 2 0

6.86 4.36

Conclusion
NIPPV can be successfully implemented in general ward setting in a regional hospital, where high dependency units are not available, by active liaisons between case physicians and the respiratory team.

Methods
All patients admitted to the general medical wards of Alice Ho Miu Ling Nethersole Hospital requiring NIPPV in the years of 2002 and 2007 were retrospectively reviewed.

2002

2007

Inpatient bed days

20

Bed days

15 10 5 0

15.09 10.59

2002
TEMPLATE DESIGN 2008

2007

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