With its monitoring facilities, 24 hour staff availability, and trained care givers, the intensive care unit (ICU) provides the setting for successful NIV. In the ICU, there is much interest in NIV to prevent intubation and ventilator-associated pneumonia.
Most study settings around the benefits of NIV have been performed on the ICU or a high acuity setting. The ICU with its monitoring capabilities, 24 hour staff availability, trained care givers as well as the possibility for quick intubation in case of NIV failure offer without any doubt a good setting for successful NIV.
Some hospitals report using more NIV than invasive ventilation in acute respiratory failure (ARF) leading them to rethink the optimal utilization of the ICU. Other hospitals worldwide are reporting that their ICU’s are chronically full and with increased pressure to move patients out of the emergency department, many hospitals actively seek alternate areas to perform NIV in certain categories of ARF.
A general concern when it comes to NIV either inside or outside the ICU is the additional workload which has been suggested in early studies. The International Consensus states that NIV therapy doesn’t appear to increase nursing or respiratory therapist workload.¹
It is relevant to note that staff training and experience is more important than the actual location where NIV is being performed in the hospital as stated by Elliott et al.²
One major challenge in the ICU is VAP (ventilator-associated pneumonia). Between 10 and 20 percent of patients receiving >48 hours of mechanical ventilation will develop VAP.Patients who have developed VAP are twice as likely to die compared to similar patients without VAP and as a result have significantly longer stays in the ICU.³
Therefore, there is much interest in avoiding intubation and using NIV treatment instead. Strong evidence suggests that patients who are appropriate candidates for NPPV can benefit from such treatment by showing lower rates of pneumonia infections, intubations and also mortality.⁴
Read more about how NIV can help to prevent intubation here.