Feasibility of early noninvasive ventilation strategy for patients with acute onset shortness of breath in emergency department — A prospective interventional study

Abstract

Introduction: Noninvasive ventilation (NIV) has revolutionized the initial respiratory support provided to a patient in respiratory distress presenting to emergency department. Standardization of NIV practices and safety has always been a matter of concern and debate in emergency medicine. In this study, we tried to assess the clinical outcome of NIV in respiratory failures of varied etiologies. Materials and methods: This study was conducted from August 2017 to August 2018 at our emergency department which is a tertiary care teaching institute. All patients presenting to the ED with shortness of breath were screened for acute respiratory failure and enrolled after confirming the inclusion criteria. Results: Out of the 236 patients presenting with acute respiratory failure, 182 fulfilled the study criteria. However, 154 patients with a mean age of 55.19 + 16.73 years were enrolled in the study. Bilevel PAP was initiated in 103 patients whereas 51 patients received CPAP. 115 (74.67%) NIV trials were successful whereas 36 (23.37%) patients had to be intubated. 32 patients died among the study group among which 3 had not consented for intubation. The in-hospital mortality has been 20.77% whereas the percentage of NIV failure with consequent intubation was 25.32%. Conclusion: In conclusion, our study shows that NIV is not only safe and efficacious but also significantly brings down the requirement of endotracheal intubations and its complications provided proper patient selection and close monitoring is assured.