Structured practices increasing patient compliance to noninvasive mechanical ventilation therapy: example of best practice

Year 2022, Volume: 4 Issue: 2, 126 - 132, 29.03.2022

Murat Yıldız Deniz Çelik Figen Akoğlan Yeşim Güllü Coşkun Hatice Baldede

https://doi.org/10.38053/acmj.1032396

Abstract

Aim: The initiation of non-invasive mechanical ventilation (NIV) therapy, mask choice, device settings, and patient follow-up are carried out jointly by physicians and nurses. The physician and the nurses should have knowledge and experience. A checklist for the patient follow-up may increase identifying and preventing problems that may occur. Our study aims to share our data and experiences by documenting the NIV implementation success of our pulmonary intensive care unit (PICU) as an example of best practice.
Material and Method: Patients with respiratory failure who had an indication for NIV therapy between 01.01.2021 and 15.09.2021 were included in the study. Patient data were obtained retrospectively. With the NIV therapy application checklist, what should be done in the preparations, initiation, and follow-up steps of the therapy are standardized. All checkpoints and the outcome of the checklist were recorded routinely.
Results: One hundred one patients with the diagnosis of hypercapnic respiratory failure treated by NIV therapy in PICU were included in the study. There was a significant difference between NIV compliant and NIV noncompliant patients in terms of PaCO2 in arterial blood gas analysis (p=0.009). PaCO2 was significantly lower in patients who were noncompliant to treatment than those who were compliant with treatment (p<0.05). In all of the patients who were noncompliant with NIV treatment, the problem was detected, the training and the motivation were repeated, and the noncompliance was resolved in 52.6%. For the non-compliant patients who were not resolved, the need for restriction (21.1%) and/or the need for sedation (21.1%) were observed.
Conclusion: Structured checklist is useful in common problems in the implementation and follow-up of the NIV therapy. Increased compliance with NIV therapy reduces the length of stay in the hospital and intensive care unit and decreases the rates of mortality and morbidity.

Keywords

Noninvasive mechanical ventilation, pulmonary intensive care, respiratory failure

Project Number

yok

References

• Saltürk C, Kargın F, Berk Takır H, et al. Yoğun bakım ünitesinde gece noninvaziv mekanik ventilasyon maske uygulama sıklığı. Göztepe Tıp Dergisi 2012; 27: 90-3
• Rochwerg B, Brochard L, Elliott MW, et al. Members of the Steering Committee, Antonelli M, Brozek J, Conti G, et al., Members of the Task Force. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50: 1602426.
• Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013; 110: 896-914.
• Hill NS. Where should noninvasive ventilation be delivered?. Respir Care. 2009;54(1):62-70.
• Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis 2014; 9: 837-52.
• Raurell-Torredà M, Argilaga-Molero E, Colomer-Plana M, Ródenas-Francisco A, Garcia-Olm M. Nurses’ and physicians’ knowledge and skills in non-invasive ventilation: Equipment and contextual influences. Conocimiento y habilidades de enfermeras y médicos en ventilación mecánica no invasiva: equipamiento e influencias contextuales. Enfermeria Intensiva 2019; 30: 21–32.
• Scala R, Windisch W, Köhnlein T, Cuvelier A, Navalesi P, Pelosi P. European Respiratory Society Respiratory Intensive Care Assembly Targeting European Respiratory Society Group activities: a survey of the Noninvasive Ventilatory Support Group. Eur Respir Rev 2014; 23: 258-60.
• Tarhan M, Hançer H, Polat F, Akbaş Gökduman S, Dalar L. Noninvasive mechanical ventilation knowledge level of the nurses: a questionnaire survey in a tertiary care training and research hospital. Eurasian J Pulmonol 2015; 17: 163-70.
• Montravers P, Le Comité réanimation de la Sfar, Ichai C, et al. Organization of mechanical ventilation in French Intensive care units. Ann Fr Anesth Reanim 2013; 32: 736-41.
• Chandra D, Stamm JA, Taylor B, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008. Am J Respir Crit Care Med 2012; 185: 152-9.
• Sørensen D, Frederiksen K, Grøfte T, Lomborg K. Practical wisdom: a qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses. Intensive Crit Care Nurs 2013; 29: 174-81.
• Elliott MW, Confalonieri M, Nava S. Where to perform noninvasive ventilation? Eur Respir J 2002; 19: 1159-66
• Shee CD, Green M. Non-invasive ventilation and palliation: experience in a district general hospital and a review. Palliative Medicine 2003; 17: 21–6.
• Hill NS. Noninvasive ventilation for chronic obstructive pulmonary disease. Respiratory Care 2004; 49: 72–89.
• Masip J, Páez J, Merino M, et al. Risk factors for intubation as a guide for noninvasive ventilation in patients with severe acute cardiogenic pulmonary edema. Intensive Care Med 2003; 29: 1921-8.
• Burk RS, Grap MJ, Munro CL, Schubert CM, Sessler CN. Predictors of agitation in critically ill adults. Am J Crit Care 2014; 23: 414-23
• Tully V. Non-invasive ventilation: a guide for nursing staff. Nursing in Critical Care 2002; 7: 296-9.