The use of noninvasive mechanical ventilation for the treatment of acute exacerbations of chronic obstructive pulmonary disease in Canada.
ABSTRACT Noninvasive mechanical ventilation (NIMV) is accepted as a life-saving treatment for patients presenting to the emergency department and other acute care settings with severe exacerbations of chronic obstructive pulmonary disease (COPD).
It was hypothesized that there is marked national variability in the use of NIMV. Therefore, the use of NIMV for COPD exacerbations in urban centres across Canada was evaluated.
All Canadian hospitals affiliated with a university training program were surveyed, and a request for involvement in this survey was posted on the Canadian Society of Respiratory Therapy professional practice listserv. Survey information was received from all 33 sites (100%) that were contacted.
Marked differences in the application of NIMV were identified across all regions in Canada, ranging from requiring extensive monitoring in the intensive care unit to application on a general internal medical unit with intermittent noninvasive blood pressure monitoring. There were sites that rarely used NIMV for COPD exacerbations and others where it was routine practice.
NIMV is a life-saving treatment for acute exacerbations of COPD. Despite clear clinical evidence, its use has not penetrated throughout all the larger urban hospitals in Canada. This may be more problematic in sites without 24 h respiratory therapy support. There are barriers to the routine application of NIMV that can be overcome using established guidelines and available evidence.
- SourceAvailable from: João Carlos WinckMinerva anestesiologica 03/2011; 77(3):263-5. · 2.82 Impact Factor
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ABSTRACT: Although noninvasive ventilation (NIV) was first used to treat patients with acute respiratory failure in the 1940s, the history of this mainstay of today's respiratory care armamentarium has mainly been written in the last 20 years. There is now a robust evidence base documenting the efficacy of NIV in exacerbations of chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and acute respiratory failure in immunocompromised patients, and evidence in support of NIV in other settings, such as hypoxemic acute respiratory failure and the management of patients who decline endotracheal intubation, is accumulating rapidly. Efficacy as demonstrated in clinical trials does not necessarily translate to clinical effectiveness in practice, however, and important barriers need to be overcome if NIV is to realize for the average patient the potential it has shown in research studies. However, although the expansion of its use in everyday patient care has lagged behind the growth of its evidence base, an increasing number of studies document the steadily expanding use of NIV in the acute-care setting. This article reviews the history of NIV as applied in acutely ill patients and summarizes the studies of NIV outside the research setting during the last decade.Respiratory care 02/2009; 54(1):40-52. · 2.03 Impact Factor
- 04/2012; 9(1):1-5.