Non-invasive pressure support ventilation (NIPSV) is not very time-consuming for the nursing staff

Aims of the study

Methods of NIPSV are being proposed more and more for acute exacerbations of COPD (Brochard: N Engl J Med 1995, 333:817–822). Nevertheless, Chevrolet et al (Chest 1991, 100:775–782) found that this procedure was very time-consuming for nurses. Objective of our prospective study: to study the amount of nursing care required to treat respiratory failure with NIPSV.

Patients and methods

Forty COPD patients completed the study. Twenty patients had acute exacerbations of their lung disease, with pH = 7.29 ± 0.05. Twenty patients had suspected ventilatory muscle fatigue after weaning from mechanical ventilation. They presented, in 72 h post-extubation, a mark-up of PaCO₂ of at least 20% as compared to the value measured in post-extubation, and a respiratory rate > 25 per min. NIPSV (BiPAP^® – Respironics; Evita 2 – Dräger) was performed in a sequential mode. For each session of ventilation, it was taken notice of: duration of the session; duration of nursing care required; side-effects observed; improvement, acceptance by the patient.

Results

After a mean duration of sequential ventilatory assistance of 6 ± 3 days, NIPSV was successful in 75% of cases. During the first 24 h of the protocol: 8 ± 3 sessions of NIPSV were performed; the mean duration of a session of ventilation was 48 ± 14 min; the average minutes spent at the bedside directly administering care as estimated by nurses was 10 ± 7. There was a drop in the amount of time nurses spent at the bedside of patients, after the first 24 h of the study. NIPSV was well tolerated and accepted by the COPD patients.

Conclusion

NIPSV, performed with a sequential mode, may reduce the need for tracheal intubation in the failure of COPD patients, and is not very time-consuming for the nursing staff.