NIV in the

emergency department

NIV in the emergency department (ED) should be considered to encourage early intervention and to avoid patient deterioration.

 

The emergency department in particular, should be considered for NIV programs as this is often the first point-of-care for a patient with acute respiratory failure. This is supported by the International Consensus stating that: “Potentially, NPPV can be administered in the emergency department, intermediate care unit, or general respiratory ward[…]“.¹

 

Thus, NIV in the ED should be considered to follow the approach of early intervention and avoid patient deterioration.

 

With regards to the actual usage of NIV in the emergency department, the 2009 study conducted by Hess et al. set out to determine the frequency of use of NIV for adult patients (acute asthma, COPD, CPE) in emergency departments in the US, but also researched possible barriers for usage.

 

In terms of usage the conclusion was that NIV is more common for acute COPD and CPE than for acute asthma. Here the main barrier is the lack of clinical evidence about therapeutic benefits. The main barriers to utilization of NIV were the familiarity with the NIV application, availability of a Respiratory Therapist and equipment in the ED, and time required for NIV.²

 

Knowing and overcoming these barriers can make a huge difference in implementing a successful NIV program outside the ICU and in the emergency department in particular.

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Side note

Early intervention

 

The importance of early NIV support cannot be stressed enough. If the patient could benefit from NIV as a first line therapy, this is strongly recommended. Studies have shown that the intubation rate is lower when CPAP is initiated by EMS services.

 

Does your facility have a rapid response team? Rapid response teams work together to provide the best care for the patient in the fastest time possible. The key is early intervention before patients deteriorate to a point where NIV might not be successful. Patients with a pH of less than 7.25 have a predicted risk of failure of > 70%.³

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thinkNIV

 

Despite its proven benefits to improve patient comfort and reduce mortality and also costs, noninvasive ventilation (NIV) is still underutilized at many hospitals. This website is designed to promote the usage of NIV by sharing the many situations in which NIV improves patients’ outcomes as well as to inform about the factors which are important in order to perform successful NIV.

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