Non-invasive Ventilation Guidelines for Adult Patients with Acute Respiratory Failure David Sanchez, Kaye Rolls, Janet Masters, Dr Gilly Smith, Dr Amanda Piper, Karen Chronister, Sharon Shunker
TECHNICAL REPORT
ABSTRACT
Evidence review
Introduction: Over the past three decades, non-invasive ventilation (NIV) has emerged as a core therapy in the management of acute respiratory failure both inside and outside intensive care. The aim of this study was develop a guideline for inpatient adults in public hospitals.
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Aim: The aim of the guideline group was to develop a list of recommendations to guide clinicians across NSW in the management of adult patients requiring NiPPV in various units including Intensive Care (ICU), High Dependency (HDU) and Specialised Respiratory Units. Method: A group of clinical experts based in ICU, HDU and specialised respiratory units from across NSW formed a guideline development group along with representatives from ICCMU and ACI. An extensive literature search/review, along with a clinical practise survey at 39 sites (incorporating current practice, policy, guidelines and work instructions) was conducted. A total of thirteen (13) recommendation statements focused on Indications/Contraindications, Assessment, Interface (mask) selection, Initiation and Titration of therapy, Humidification, Patient comfort and Compliance, Escalation of Therapy, Palliation, Nursing Care, Nutrition and Hydration, Infection Prevention, Environment and location of care and Staffing Ratios were considered. Results: The last group meeting was completed in June 2013 resulting in group consensus and development of 45 recommendations related to the care of the adult patient in acute respiratory respiratory failure requiring NiPPV.
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Location of Care & Staffing Ratios
Indications Contraindicati ons
Practice Survey • Assessment
Environment
Initiation & titration
Nutrition & Hydration
Humidification
Nursing Care
Escalation Palliation
Evidence suggests the use of NIV in the management of acute respiratory failure may: •Reduce the need for invasive ventilation • Decrease the need for prolonged mechanical ventilation • Improve patient outcomes • Reduce hospital and ICU length of stay • Reduce mortality and morbidity in those with acute on chronic respiratory failure
CPG DEVELOPMENT HISTORY •
This guideline has been developed for all healthcare professionals who provide care for patients with acute respiratory failure who are treated with NIV including nurses, doctors, physiotherapists and other allied health professionals.
Guidelines were gathered from across Australia These were compared across standard practice areas
Summary
In NSW there is considerable clinical variation between facilities and within facilities for utilisation of NIV and patient outcomes
The scope of this guideline is for critically ill adult patients who following medical assessment require non-invasive positive pressure ventilation as an adjunct to standard medical therapy.
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Interface
BACKGROUND
The purpose of this guideline is to provide a consistent level of support and guidance to clinicians in adult critical care areas and specialist respiratory care units, about the care required for patients receiving NIV.
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Survey tool was emailed to senior nursing staff of 39 NSW units Elements included: 1) demographics & equipment; 2) clinical staff including medial & nursing staff; and 3) clinical practices including interface, humidification, titration of therapy, default settings
CPG Audit
Infection Prevention
Conclusion: The GDN for NiPPV aim to have the guidelines released for clinician use by the end of 2013.
A specific clinical question not formulated due to complexity of CPG Databases: Pubmed; Cochrane; CINAHL; Scholar google Keywords: non-invasive positive pressure ventilation; non-invasive ventilation; CPAP ;BPAP (biphasic/bilevel); care of; assessment of; indications for; contraindications for; complications of Limits: All peer-reviewed papers in English published in last 10 years Review Method: All articles reviewed by two GDN members traction tools incorporating SIGN quality
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April 2012 –GDN executive formed; Guideline scope and systematic review process formulated May 2012 – Team building; Finalisation of guideline scope and CPG workplan; evidence-based practice education; Team plan May-November 2012 – Evidence review , practice review & local guideline evaluation undertaken culminating in development of technical report December 2012 – Consensus development meeting with recommendation development December 2012-June 2012 – Guideline writing June 2013 – Internal consensus & development of implementation tools July 2013 – External Validation August 2013 – Organisation consultation via ACI networks
CONTACT Name: Email:
• Across the areas of practice the evidence base for NIV is limited • While the practice survey showed commonalties the CPGs were of poor quality
GUIDELINE DEVELOPMENT NETWORK Guideline Management Team Dr Gilly Smith Senior Lecturer School of Nursing and Midwifery Edith Cowan University David Sanchez CNC - Intensive Care Campbelltown Camden Hospitals Karen Chronister Rural Critical Care CNC(ICU/HDU) HNE LHD Sharon-Anne CNC ICU, Liverpool Hospital. Shunker Dr. Amanda Piper Senior Physiotherapist, RPA Members Karla Lopez CNE ICU Liverpool Phillip Marshall NE -ICU Sutherland Hospital Karlee McCann St Vincent’s Hospital ICU Wanda McDermott Clinical Skills Educator, Sydney Adventist Hospital Clinical School Simone Moran RN St George Hospital ICU Patrick Regan NUM ICU Port Macquarie Base Hospital Richard Walker CNC - Critical Care Far West LHD Natalie Wright RN Shoalhaven District Memorial Hospital. Cecily Barrack Respiratory Network Manager ACI Mary Dunford CNC Respiratory St George Hospital Darrin Penola CNC Respiratory Medicine SVH Project Team Kaye Rolls ACI – ICCMU – Project Manager Janet Masters NaMO – Project Officer
Kaye Rolls Clinical Project Officer
[email protected]
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