Congress Abstracts 2006

138

INTENSIVE RESPIRATORY CARE AND NONINVASIVE POSITIVE PRESSURE VENTILATORY SUPPORT IN A NCI DESIGNATED CANCER CENTER: EVALUATION OF RECENT CLINICAL PRACTICE. Brenda Shelton, RN, MS, CCRN, AOCN^®, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Julie Jablonski, BSN, RN, York College Graduate School of Nursing, York, PA; and Marie Swisher, MSN, RN, and Cheri Wilson, MA, PhD(c), Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.

Mechanical ventilation (MV) in immunocompromised patients is associated with significant morbidity and mortality. Non-invasive ventilation (NIV) is a form of ventilatory support without the use of an endotracheal tube. A mask is applied and continuous positive pressure (CPAP) with or without inspiratory pressure support (BiPAP) can be provided. Recent research on the role of NIV in immunosuppressed patients is still limited. The use of NIV support allows for less patient sedation, more verbal communication, and expression of treatment wishes, along with a decreased risk for the development of ventilator associated pneumonia.

Clinicians at this NCI designated Comprehensive Cancer Center assessed the implementation of high flow oxygen masks and CPAP/ BiPAP as effective alternative respiratory support for patients with respiratory failure from January 2005 to present.

Charts of patients who received a 100% non-rebreather mask, CPAP/ BiPAP, and/or mechanical ventilation from January 2005 to present were reviewed. Data was collected on the number of hours from NIV to the point of endotracheal intubation, recovery, or death.

Data was assessed on the implementation of alternative respiratory support and its efficacy in 108 patients. In these data, 66 patients required MV. Approximately 52% of the total patients died, 16% lived to have respiratory care needs resolved, and 25% were discharged from the hospital. Data suggests that most patients, who progress to MV, do so within 48 hours of initiation of intensive support. NIV was implemented in 20 patients, effectively avoiding MV in seven patients, allowing time to obtain orders to limit resuscitation in two patients, and as abridge to assist post-MV in five patients. This data analysis was used to develop an evidence-based clinical pathway for identifying candidates for NIV.

Selected patients receiving CPAP/ BiPAP instead of MV may experience reduced complications of invasive ventilatory support, provide time to correct underlying respiratory compromise, and allow family and healthcare providers to interact with patients to address end of life wishes. Quality outcomes support consideration of NIV as an alternative to MV in patients with respiratory failure and cancer.