P201 A remote pathway for inpatient home non-invasive ventilation set-up
| Autor: | Hina Pattani, ES Suh, M Ramsay, Hamid Aminy-Raouf, Joerg Steier, P Marino, Burhan Khan, R Bhalla, S Dixon, L Flight, Nicholas Hart, Patrick B. Murphy |
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| Rok vydání: | 2018 |
| Předmět: |
Mechanical ventilation
COPD medicine.medical_specialty Acute hypercapnic respiratory failure Neuromuscular disease Referral business.industry medicine.medical_treatment medicine.disease law.invention Respiratory failure law Emergency medicine Ventilation (architecture) medicine Non-invasive ventilation business |
| Zdroj: | Ventilatory support from hospital to home. |
| DOI: | 10.1136/thorax-2018-212555.358 |
| Popis: | Background Patients with acute hypercapnic respiratory failure (AHRF) due to chronic obstructive pulmonary disease (COPD), obesity-related respiratory failure (ORRF) and neuromuscular disease (NMD) may require home non-invasive ventilation (NIV) prior to discharge from hospital. However, many Trusts do not have access to local home NIV services and such patients require referral to tertiary ventilation centres for inpatient transfer, which is limited by long waiting times. We aimed to develop a pathway to set up inpatients at suburban district general hospital (DGH), on home NIV prior to discharge, using equipment from a metropolitan tertiary centre (TC) for home mechanical ventilation. Methods Patients referred for inpatient transfer to initiate home NIV from the DGH were screened by the oncall consultant at the TC for suitability for remote set-up at the DGH, following review of ventilatory parameters and overnight oximetry. A ventilator, circuit and interface were then sent to DVH within 48 hours, and the patient established on home NIV by the DGH respiratory nurse specialist. After discharge from the DGH, elective admission to the TC was arranged within 12 weeks to optimise NIV settings and subsequent outpatient follow-up provided by the TC. Results Between August 2015 and July 2016, 35 patients were accepted for the remote NIV set-up pathway (age 68±13 years, 17 (49%) male, 13 (37%) COPD, 16 (46%) ORRF and 6 (17%) NMD). Median time to discharge from point of referral was 8 (IQR 7–23) days. 25 (71%) patients were alive at 12 months, in keeping with existing data, and 20 (80%) of these were using NIV at the time of admission for inpatient optimisation (See table 1). Median time to admission for inpatient optimisation was 89 (IQR 37–149) days and all but one patient (24 of 25, 96%) attended for inpatient optimisation at the TC. Conclusion This remote pathway for home NIV set-up allows rapid and safe set-up of home NIV at Trusts without a local ventilation service. Length of hospital stay may be shortened through abolition of the waiting time for inpatient transfer to a tertiary ventilation service. |
| Databáze: | OpenAIRE |
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