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

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

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