An audit of the first non-invasive ventilation service in Malta compared to British Thoracic Society recommendations

M. La Ferla (Msida, Malta), L. Borg (Msida, Malta), K. Bartolo (Msida, Malta), J. Gauci (Msida, Malta), J. Micallef (Msida, Malta)

Source: Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome

Session: Long-term noninvasive ventilation: Outcome
Session type: Oral poster discussion
Number: 128

Abstract

Background

The first Non-Invasive Ventilation (NIV) unit in Malta was set up in 2020 at Mater Dei Hospital, which is the only general hospital in Malta.

Aims

This audit aimed to assess the current acute NIV practices in our Emergency department (ED) and NIV unit, when compared to the gold standard British Thoracic Society (BTS) recommendations outlined in the BTS National Adult NIV Audit 2019.

Methods

Data was collected prospectively over two consecutive months of January and February 2022, from the medical notes of all adult patients started acutely on Bilevel Positive Airway Pressure (BiPAP) at the local ED and subsequently transferred to the NIV unit. The following recommendations were audited: respiratory acidosis as an indication for BiPAP, time to initiation of BiPAP therapy, time to repeat arterial blood gas sampling and time to senior medical doctor review.

Results

Out of 48 patients, 89.6% (n=43) showed respiratory acidosis and 58.3% (n=28) had a clearly documented time of BiPAP initiation. In the acidotic patients, NIV was started within 1 hour (‘acidosis to mask time’) in 48.1% (n=13), and within 2 hours from hospital contact at the ED (‘door to mask time’) in 50.0% (n=9). An arterial blood gas within 2 hours of starting NIV was repeated in 71.8% (n=28). A medical senior review within 4 hours of starting NIV was documented in 60.9% (n=28). Failure of improvement in acidosis triggered medical senior review within 30 minutes in 20.0% (n=6).

Conclusions

The local NIV service should work on shortening the time to starting BiPAP therapy, as well as early senior review especially in cases of failure of improvement in respiratory acidosis.

Rating:

You must login to grade this presentation.

Share or cite this content

Citations should be made in the following way:
M. La Ferla (Msida, Malta), L. Borg (Msida, Malta), K. Bartolo (Msida, Malta), J. Gauci (Msida, Malta), J. Micallef (Msida, Malta). An audit of the first non-invasive ventilation service in Malta compared to British Thoracic Society recommendations. Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome

You must login to share this Presentation/Article on Twitter, Facebook, LinkedIn or by email.

Member's Comments

No comment yet.

You must Login to comment this presentation.