Impact of noninvasive ventilation at a municipal emergency department on ICU admissions

BACKGROUND: In 2015, the emergency department of a municipal hospital in Vienna began to perform noninvasive ventilation (NIV) on patients admitted for acute respiratory failure, given no intubation criteria were met. The intention of this study was to show to which type of hospital unit patients were transferred after undergoing NIV in the emergency department. Additionally, the impact of the underlying disease, a patient’s sex and age and the year of intervention were analyzed. METHODS: A single-center retrospective exploratory study was performed on 371 patients. All patients with acute respiratory failure who were noninvasively ventilated at the study center emergency department from 2015 to 2018 were eligible. Relevant data were extracted from the patient’s medical records. RESULTS: A total of 43.7% (95% confidence interval, CI 38.8–48.5%) of patients were successfully stabilized in the emergency department through NIV and subsequently transferred to a normal care unit or discharged. This nonintensive care admission rate was significantly associated with certain underlying medical conditions, age and year of intervention. A further 19.7% (95% CI 15.6–23.7%) of patients were transferred to an intermediate care unit instead of an intensive care unit. CONCLUSION: These findings emphasize the importance of noninvasive ventilation at the emergency department in reducing load on intensive care units and ensuring an efficient hospital workflow. Nonintensive care admission rate appears to be the highest in patients with pulmonary edema, especially in the higher age range and is also associated with the level of staff training. Prospective trials are needed to accurately confirm these correlations.