A NOCTURNAL AVAPS PROGRAM DECREASES READMISSIONS OF HYPERCAPNIC PATIENTS

Abstract

SESSION TITLE: Call an RT! Novel Studies in Respiratory Care SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: Patients with hypercapnic respiratory failure are high users of health care services with frequent readmissions, high needs, and associated high costs. We noted that nocturnal AVAPS delivered to in-patients could be combined with home nocturnal AVAPS serviced by a home care respiratory provider. We initiated a combined in-and out-patient nocturnal AVAPS program with the hypothesis that the combination of in-patient and out-patient AVAPS would decrease readmissions of hypercapnic respiratory failure patients. METHODS: Charts of patients with paCO2 greater than 55 torr were reviewed. These patients had been evaluated in the ED and trialed on sequential therapies: simple nasal cannula, if failed then high flow nasal cannula, if failed then non-invasive ventilation (NIV) in the BiPAP mode, if failed then NIV in the AVAPS mode. If NIV was initiated, patients required admission to the ICU. Sequential patients receiving AVAPS were referred to the home care respiratory provider with a letter of medical necessity, AVAPS prescription for tidal volume, maximum inspiratory pressure, minimum inspiratory pressure, maximum expiratory pressure, minimum expiratory pressure, rate, and FiO2,%.. In-patient AVAPS was delivered by the Philips V-60; out-patient by the Philips Trilogy 200. The home care respiratory provider demonstrated the Trilogy 200 prior to discharge, met the patient at home on the day of discharge, visited each day at home for 1 week, then once weekly at home x 4 weeks, then made regular monthly home visits. Patients were scheduled for out-patient pulmonary office follow-up. Data collected included: age, gender, body mass index (BMI, kg/m2) >,= 30 (OHS group), or < 30 (COPD group), ABG pH, pCO2, out-patient months of follow up, and number of readmissions. This was a multicenter retrospective quality improvement project. RESULTS: Fifteen patients were enrolled, 10 OHS and 5 COPD. The average age, gender, average BMI, average pH, average pCO2, total months follow up, number of readmissions for each group were as follows: OHS group: 63.7 years, 4M & 6F, 47.4 kg/m2, 7.32, 71.5 torr, 161 months, 6 patients with no readmissions. COPD group: 64.2 years, 3M & 2F, 24.1 kg/m2, 7.26, 73.4 torr, 69 months, 3 patients with no readmissions. CONCLUSIONS: Our nocturnal AVAPS program, initiated for in-patients and combined with a home care respiratory provider and pulmonary office visits when they transitioned to out-patients, decreased readmissions. Our hypothesis was supported. CLINICAL IMPLICATIONS: The home care respiratory service provider adopted the unique role as a patient navigator. Expanded studies are needed to discern the role of the AVAPS mode itself versus the education by the home care service provider, versus the pulmonary office staff support. DISCLOSURES: Speaker/Speaker's Bureau relationship with AstraZeneca Please note: $1001 - $5000 Added 03/07/2018 by Gary Aaronson, source=Web Response, value=Honoraria Employee relationship with Brotherston Homecare Please note: $20001 - $100000 Added 03/04/2018 by Thomas Buchanan, source=Web Response, value=Salary No relevant relationships by Ashleigh Frank, source=Web Response No relevant relationships by Justin Grammy, source=Web Response No relevant relationships by Jim Long, source=Web Response No relevant relationships by Herbert Patrick, source=Web Response No relevant relationships by Dianna Whartenby, source=Web Response