The Use of Bi-level Positive Airway Pressure in Patients Presenting to the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/162994
Type:
Presentation
Title:
The Use of Bi-level Positive Airway Pressure in Patients Presenting to the Emergency Department
Abstract:
The Use of Bi-level Positive Airway Pressure in Patients Presenting to the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Meredith, Rebecca L., BS, RRT
P.I. Institution Name:The Cleveland Clinic Foundation
Title:Supervisor, Respiratory Therapy, Emergency Services
Contact Address:9500 Euclid Avenue, E19, Cleveland, OH, 44195, USA
Contact Telephone:(216) 445-4554
Clinical Topic: The use of noninvasive ventilatory support has gained popularity over the last decade. The technique has been shown to decrease work of breathing and increase the functional residual capacity of patients in acute respiratory distress (ARD) of cardiac, pulmonary, or neurologic origin. This study addressed the use of Bi-Level Positive Airway Pressure (PAP) in emergency department (ED) patients presenting with a primary diagnosis of heart failure (HF) or chronic obstructive pulmonary disease (COPD) resulting in ARD. The aim was to evaluate the impact of Bi-Level PAP on: (1) Arterial blood gases (ABG); (2) Oxygen requirements; (3) Avoidance of intubation; and (4) Hospital admission to a regular nursing floor (RNF) versus intensive care unit (ICU). Implementation: The sample included 29 patients (12 with HF and 17 with COPD). Patients were assessed and rated on their intensity of sensation using a modified Borg Dyspnea Category Scale (0 = nothing, 10 = maximal). An emergency physician, an ED respiratory therapist, and an RN managed patient care and adjusted Bi-Level PAP settings to patient tolerance. Inspiratory Positive Airway Pressure/Expiratory Positive Airway Pressure (IPAP/EPAP) was set for patient comfort, ABG/saturation, and control of ventilation. All patients had continuous ECG and pulse oximetry monitoring. Outcomes: Results of the study indicated improvement in ABGs after the initiation of Bi-Level PAP. The mean dyspnea index decreased from 7 to 3 in both patient groups. Intubation was required in only 7% of the patients, thus avoiding complications, such as airway trauma, nosocomial infection, and death. The remaining 93% were successfully managed throughout their hospital stays with Bi-Level PAP. Seven patients were admitted to ICU, and 20 went to an RNF. Recommendations: Bi-Level PAP decreased work of breathing, improved ventilation, reduced level of discomfort, and improved sensation of dyspnea. Utilization of this technology requires availability of equipment and staff specifically trained in its use and application. This emergency department has a respiratory therapy staff that is decentralized under nursing to provide 24-hour bedside coverage. Therefore, patients presenting with ARD are assessed immediately by qualified personnel, eliminating delay to therapeutic intervention. Having respiratory therapy immediately available at the bedside enables the nurse to provide effective, efficient patient care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Use of Bi-level Positive Airway Pressure in Patients Presenting to the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162994-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Use of Bi-level Positive Airway Pressure in Patients Presenting to the Emergency Department</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Meredith, Rebecca L., BS, RRT</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Cleveland Clinic Foundation</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Supervisor, Respiratory Therapy, Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9500 Euclid Avenue, E19, Cleveland, OH, 44195, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(216) 445-4554</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">meredir@ccf.org</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: The use of noninvasive ventilatory support has gained popularity over the last decade. The technique has been shown to decrease work of breathing and increase the functional residual capacity of patients in acute respiratory distress (ARD) of cardiac, pulmonary, or neurologic origin. This study addressed the use of Bi-Level Positive Airway Pressure (PAP) in emergency department (ED) patients presenting with a primary diagnosis of heart failure (HF) or chronic obstructive pulmonary disease (COPD) resulting in ARD. The aim was to evaluate the impact of Bi-Level PAP on: (1) Arterial blood gases (ABG); (2) Oxygen requirements; (3) Avoidance of intubation; and (4) Hospital admission to a regular nursing floor (RNF) versus intensive care unit (ICU). Implementation: The sample included 29 patients (12 with HF and 17 with COPD). Patients were assessed and rated on their intensity of sensation using a modified Borg Dyspnea Category Scale (0 = nothing, 10 = maximal). An emergency physician, an ED respiratory therapist, and an RN managed patient care and adjusted Bi-Level PAP settings to patient tolerance. Inspiratory Positive Airway Pressure/Expiratory Positive Airway Pressure (IPAP/EPAP) was set for patient comfort, ABG/saturation, and control of ventilation. All patients had continuous ECG and pulse oximetry monitoring. Outcomes: Results of the study indicated improvement in ABGs after the initiation of Bi-Level PAP. The mean dyspnea index decreased from 7 to 3 in both patient groups. Intubation was required in only 7% of the patients, thus avoiding complications, such as airway trauma, nosocomial infection, and death. The remaining 93% were successfully managed throughout their hospital stays with Bi-Level PAP. Seven patients were admitted to ICU, and 20 went to an RNF. Recommendations: Bi-Level PAP decreased work of breathing, improved ventilation, reduced level of discomfort, and improved sensation of dyspnea. Utilization of this technology requires availability of equipment and staff specifically trained in its use and application. This emergency department has a respiratory therapy staff that is decentralized under nursing to provide 24-hour bedside coverage. Therefore, patients presenting with ARD are assessed immediately by qualified personnel, eliminating delay to therapeutic intervention. Having respiratory therapy immediately available at the bedside enables the nurse to provide effective, efficient patient care.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:43Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:43Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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