Non-invasive ventilation in the emergency department for patients in type II respiratory failure due to COPD exacerbations

Abstract

IntroductionAcute chronic obstructive pulmonary disease (COPD) exacerbations can cause respiratory failure and may require non-invasive ventilation (NIV). There is a paucity of studies examining their NIV implementation within the emergency department (ED). Aim of the studyThe aims were (i) to establish whether NIV was beneficial for patients using arterial blood gas analysis (ABG), (ii) to observe whether current ED practice met the guidelines of obtaining ABG measurements within 15 minutes of arrival and commencement of NIV within 1 hour of clinical indication and (iii) to examine which healthcare professionals (HCPs) initiated NIV. MethodsA retrospective observational study reviewing all patients commenced on NIV in the ED due to COPD exacerbations was undertaken. ResultsA total of 48 patients were included and the majority received NIV within 1 hour (n = 36, 75%) as recommended by the guidelines. Over 50% of the patients in the study had ABG analysis within 15 minutes and 89% (n = 43) within 30 minutes and statistically significant improvements were noted in respiratory rate, oxygen saturation and ABGs from baseline to repeat measurements undertaken 58 minutes post NIV initiation (p < 0.001). The largest healthcare group to initiate NIV was the nursing team (50% n = 24) with the majority of emergency nurses being experienced nurses [band 6 (n = 17)]. ConclusionFrom this small single centre study, early ABG analyses and NIV initiation were beneficial to COPD patients presenting in respiratory failure with the majority receiving treatment within the recommended guidelines.