Management and Follow Up of Noninvasive Ventilation in a Third Level Hospital: A Descriptive Study

Abstract

PURPOSE: Emphasize the importance of proper monitoring of the non-invasive ventilation (NIV) to asssure the compliance of the therapeutic objectives. METHODS: A descriptive, retrospective and longitudinal study during 2012-2013 was completed. Three hundred patients with NIV criteria were evaluated by assessment of patient comfort, respiratory rate, cardiac rate, oxygen saturation, chest wall motion, accessory muscle recruitment, coordination of respiratory effort with the ventilator, conscious level, and arterial blood gas tensions (pH, pCO2) in the first hour, second hour if needed, 6 hours and 24 hours. RESULTS: Three hundred patients were analyzed, 182 (60.6 %) men and 118 (39.3 %) women, in which 193 (64.3 %) presented respiratory acidosis, 56 (18 %) presented acute cardiogenic pulmonary edema, and 53 (17.6 %) were postoperative patients, bronchoscopy, and weaning complicated in intubated patients. The principal diagnoses were COPD 136 (45.3 %), chronic cardiac failure 54 (18 %), obstructive sleep apnea- hypopnea syndrome (OSAHS) 38 (12.67 %), restrictive pulmonary disease 22 (7.3 %), neuromuscular diseases 16 (5.4 %), and others 34 (11.3 %). Out of the 300 cases, 219 (73 %) had improvement in the arterial blood gas tensions (pH> 7.35) in the first 24hrs, 108 (36 %) presented therapeutic failure, in which 3 (1%) were considered for invasive ventilation, 42 (14 %) were due to intolerance to the NIV, and 36 (12%) %) died. CONCLUSIONS: It is vitally important to recognize the need for suitable management and a close follow-up of the patient with indication for NIV. We have to consider a complete clinical evaluation combined with a continual assessment of the ventilatory parameters, arterial blood gas tension, and the pulmonary mechanics for at least 24 hours after initiating NIV, to verify the successful outcome from NIV, and to detect complications and therapeutic failure that could determine the discontinuation of NIV or to consider invasive ventilation.