Initiation of Noninvasive Ventilation for Acute Respiratory Failure in a Pediatric Intermediate Care Unit
| Autor: | Daniel P. Kelly, Alla Smith, Christiana M. Russ, Julie Hurlbut, Patrice Melvin |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Critical Care medicine.medical_treatment Guidelines as Topic Pediatrics 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Humans Medicine Intubation Acute respiratory failure 030212 general & internal medicine Child Mechanical ventilation Respiratory Distress Syndrome Noninvasive Ventilation business.industry Critically ill General Medicine Guideline Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Resource use Female Noninvasive ventilation Intermediate Care Facilities business Intermediate care |
| Zdroj: | Hospital Pediatrics. 9:538-544 |
| ISSN: | 2154-1671 2154-1663 |
| DOI: | 10.1542/hpeds.2019-0034 |
| Popis: | BACKGROUND: Noninvasive ventilation (NIV) is increasingly used to manage acute respiratory failure in children, decreasing the need for mechanical ventilation. Safely managing these patients outside of the ICU improves ICU resource use. We measured the impact of a guideline permitting initiation of NIV in an intermediate care unit (IMCU) on ICU bed use. METHODS: A guideline for an NIV trial for acute respiratory failure was implemented in a 10-bed IMCU. The guideline stipulated criteria for initiation and maintenance of NIV. There were 4.5 years of intervention data collected. Baseline data were gathered for patients with acute respiratory failure who were transferred from the IMCU to the ICU for NIV initiation in the 3.25 years before guideline implementation. RESULTS: Three hundred eight patients were included: 101 in the baseline group and 207 in the intervention group. In the intervention group, 143 patients (69%) remained in the IMCU after NIV initiation, and 64 (31%) transferred to the ICU. A total of 656.4 ICU bed-days were saved in the intervention period (3.3 days per patient initiated on NIV in the IMCU). There was a significant decrease in the rate of intubation in the IMCU for patients awaiting ICU transfer (3 patients in the baseline group versus 0 patients in the intervention group; P = .035). CONCLUSIONS: The initiation of NIV in the IMCU for pediatric patients with acute respiratory failure saved ICU bed-days without increasing intubation in the IMCU for patients awaiting transfer. Close monitoring of these critically ill patients is a key component of their safe care. |
| Databáze: | OpenAIRE |
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