240
Correspondence
Correspondence European Journal of Emergency Medicine 2014, 21:240–241
Noninvasive ventilation in the emergency department: are protocols the key? Antonio M. Esquinasa, Paolo Groffb and Roberto Cosentinic, aIntensive Care Unit, Hospital Morales Meseguer, Murcia, Spain, bEmergency Department, Hospital Civile Madonna del Soccorso, San Benedetto Tronto and cNoninvasive Ventilation UO Emergency Medicine, Fondazione Ca’ Granda IRRCS Policlinico Milano, Milan, Italy
NIV in an equal manner [4], but further clinical trials are consolidated to global hospital application of NIV protocols and training is still the key for a successful NIV in the ED [2,3].
Acknowledgements
Correspondence to Antonio M. Esquinas, PhD, MD, FCCP, Avenida Marques Velez s/n, Murcia 30008, Spain Tel: + 34 609 321 966; fax: + 34 968 232 484; e-mail: [email protected]
Conflicts of interest
Received 10 December 2012 Accepted 18 February 2014
References
There are no conflicts of interest.
1
Noninvasive ventilation (NIV) is one of the greatest advances more commonly used in emergency departments (EDs) in the last decade [1]. Global results are influenced by complex relationships between severity of acute respiratory failure, appropriate skills and team experience, and well-organized healthcare resources and hospital policies [1,2]. However, still, the lack of homogeneity in NIV protocols and training programs is a key determinant factor [3]. We read with interest the work published by El-Khatib and colleagues and believe that this study consolidates information on how NIV is being developed in ED outside Europe or North America. Result turn opens a major ‘gap’ about issues of need for protocols and appropriate training [4]. However, we would like to add some comments that we believe are relevant in this study. First, the absence of NIV protocolization in ED could be associated with three major aspects that need to be taken into account for clarification: (a) information on the structural aspect of ED, (b) healthcare resources available (beds, monitoring, nurse : patient ratios), and (c) know that private or public hospital are lacking. Currently, there are no international regulations or policies on how NIV must be organized outside the ICU; even scientific societies have still not carried out studies on this subject [2]. Second, information on (a) indications of NIV, (b) etiology of acute respiratory failure, (c) equipment used (mechanical ventilators, interfaces), and (d) whether there is clear evidence of the training and skills necessary for successful application of NIV is necessary. This information was not provided by authors. In summary, we agree that the Lebanese experience is discovering new possibilities in this field, given that emergency, pulmonary, and intensivists seem to apply c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0969-9546
2 3 4
Bolton R, Bleetman A. Non-invasive ventilation and continuous positive pressure ventilation in emergency departments: where are we now? Emerg Med J 2008; 25:190–194. Hill NS. Where should noninvasive ventilation be delivered? Respir Care 2009; 54:62–70. Davies JD, Gentile MA. What does it take to have a successful noninvasive ventilation program? Respir Care 2009; 54:53–61. El-Khatib MF, Kazzi AN, Zeinelddine SM, Bou-Khalil PK, Ayoub CM, Kanazi GE. Use of noninvasive positive pressure ventilation in emergency departments of public and private hospitals in Lebanon. Eur J Emerg Med 2012 [Epub ahead of print].
Protocols for and training on noninvasive positive pressure ventilation in emergency departments Mohamad F. El-Khatiba, Amin N. Kazzib, Salah M. Zeinelddinec, Pierre K. Bou-Khalilc, Chakib M. Ayouba and Ghassan E. Kanazia, Departments of aAnesthesiology, bEmergency Medicine and cInternal Medicine, American University of Beirut, Beirut, Lebanon Correspondence to Ghassan E. Kanazi, MD, Department of Anesthesiology, American University of Beirut, PO Box 11-0236, 1107 2020 Beirut, Lebanon Tel: + 961 1 350000 x6380; fax: + 961 1 745249; e-mail: [email protected] Received 11 January 2013 Accepted 4 February 2013
During the early phases of its implementation and evaluation, the use of noninvasive positive pressure ventilation (NIPPV) was mainly restricted to ICUs and/or closely monitored patient areas. However, during the past decade convincing evidence has suggested that NIPPV can play an important role in emergency departments (EDs), where the first delivery of care is administered to patients during the acute and stressful period of their illnesses. When used early in EDs, NIPPV can lead to significant improvement in respiratory distress and metabolic disturbance. However, its impact on patient outcomes and survivals has been controversial. Early use of noninvasive ventilation in the ED was shown to be associated with mortality and ICU admissions for COPD patients [1]. However, in patients with acute cardiogenic pulmonary DOI: 10.1097/MEJ.0000000000000143
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Correspondence
Correspondence European Journal of Emergency Medicine 2014, 21:240–241
Noninvasive ventilation in the emergency department: are protocols the key? Antonio M. Esquinasa, Paolo Groffb and Roberto Cosentinic, aIntensive Care Unit, Hospital Morales Meseguer, Murcia, Spain, bEmergency Department, Hospital Civile Madonna del Soccorso, San Benedetto Tronto and cNoninvasive Ventilation UO Emergency Medicine, Fondazione Ca’ Granda IRRCS Policlinico Milano, Milan, Italy
NIV in an equal manner [4], but further clinical trials are consolidated to global hospital application of NIV protocols and training is still the key for a successful NIV in the ED [2,3].
Acknowledgements
Correspondence to Antonio M. Esquinas, PhD, MD, FCCP, Avenida Marques Velez s/n, Murcia 30008, Spain Tel: + 34 609 321 966; fax: + 34 968 232 484; e-mail: [email protected]
Conflicts of interest
Received 10 December 2012 Accepted 18 February 2014
References
There are no conflicts of interest.
1
Noninvasive ventilation (NIV) is one of the greatest advances more commonly used in emergency departments (EDs) in the last decade [1]. Global results are influenced by complex relationships between severity of acute respiratory failure, appropriate skills and team experience, and well-organized healthcare resources and hospital policies [1,2]. However, still, the lack of homogeneity in NIV protocols and training programs is a key determinant factor [3]. We read with interest the work published by El-Khatib and colleagues and believe that this study consolidates information on how NIV is being developed in ED outside Europe or North America. Result turn opens a major ‘gap’ about issues of need for protocols and appropriate training [4]. However, we would like to add some comments that we believe are relevant in this study. First, the absence of NIV protocolization in ED could be associated with three major aspects that need to be taken into account for clarification: (a) information on the structural aspect of ED, (b) healthcare resources available (beds, monitoring, nurse : patient ratios), and (c) know that private or public hospital are lacking. Currently, there are no international regulations or policies on how NIV must be organized outside the ICU; even scientific societies have still not carried out studies on this subject [2]. Second, information on (a) indications of NIV, (b) etiology of acute respiratory failure, (c) equipment used (mechanical ventilators, interfaces), and (d) whether there is clear evidence of the training and skills necessary for successful application of NIV is necessary. This information was not provided by authors. In summary, we agree that the Lebanese experience is discovering new possibilities in this field, given that emergency, pulmonary, and intensivists seem to apply c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 0969-9546
2 3 4
Bolton R, Bleetman A. Non-invasive ventilation and continuous positive pressure ventilation in emergency departments: where are we now? Emerg Med J 2008; 25:190–194. Hill NS. Where should noninvasive ventilation be delivered? Respir Care 2009; 54:62–70. Davies JD, Gentile MA. What does it take to have a successful noninvasive ventilation program? Respir Care 2009; 54:53–61. El-Khatib MF, Kazzi AN, Zeinelddine SM, Bou-Khalil PK, Ayoub CM, Kanazi GE. Use of noninvasive positive pressure ventilation in emergency departments of public and private hospitals in Lebanon. Eur J Emerg Med 2012 [Epub ahead of print].
Protocols for and training on noninvasive positive pressure ventilation in emergency departments Mohamad F. El-Khatiba, Amin N. Kazzib, Salah M. Zeinelddinec, Pierre K. Bou-Khalilc, Chakib M. Ayouba and Ghassan E. Kanazia, Departments of aAnesthesiology, bEmergency Medicine and cInternal Medicine, American University of Beirut, Beirut, Lebanon Correspondence to Ghassan E. Kanazi, MD, Department of Anesthesiology, American University of Beirut, PO Box 11-0236, 1107 2020 Beirut, Lebanon Tel: + 961 1 350000 x6380; fax: + 961 1 745249; e-mail: [email protected] Received 11 January 2013 Accepted 4 February 2013
During the early phases of its implementation and evaluation, the use of noninvasive positive pressure ventilation (NIPPV) was mainly restricted to ICUs and/or closely monitored patient areas. However, during the past decade convincing evidence has suggested that NIPPV can play an important role in emergency departments (EDs), where the first delivery of care is administered to patients during the acute and stressful period of their illnesses. When used early in EDs, NIPPV can lead to significant improvement in respiratory distress and metabolic disturbance. However, its impact on patient outcomes and survivals has been controversial. Early use of noninvasive ventilation in the ED was shown to be associated with mortality and ICU admissions for COPD patients [1]. However, in patients with acute cardiogenic pulmonary DOI: 10.1097/MEJ.0000000000000143
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
