Non-invasive mechanical ventilation in internal medicine departments: a pilot study

Abstract

Non-invasive mechanical ventilation (NIMV) has been shown to be an effective treatment in chronic and acute lung failure. Until a few years ago, all the different forms of mechanical ventilation were managed exclusively in intensive care units (ICU). However, the reduction in the number of ICU beds available and the high costs involved in running such units, together with the aging of the general population and the co-morbidities associated with this have meant that forms of mechanical ventilation are also used outside ICUs. In addition to emergency physicians and pneumologists, also internists have started to use NIMV on their wards in order to start treatment as early as possible and reduce costs. This is a preliminary study to explore the effectiveness, safety and feasibility of NIMV on a medical ward. The overall success rate was 68.8%; the likelihood of success was higher in patients who started NIMV earlier. The success rate was quite high (62%) also among do-not-intubate patients, despite their poorer clinical condition. Few complications were reported and there was no increase in staff workload. No significant differences were found in in-hospital mortality between hypercapnic patients with chronic obstructive pulmonary disease (COPD) exacerbation and hypercapnic patients with COPD plus pneumonia (27% vs 25%) or between patients with pneumonia and patients with COPD plus pneumonia (26% vs 25%). These results are encouraging for the successful use of NIMV on medical wards. A careful selection of patients, educating and motivating staff in NIMV use, and close collaboration with resuscitators are all essential for this to be achieved.