Hong Kong Journal of Emergency Medicine

Volume 8 Number 3, July 2001

Noninvasive ventilatory support in emergency department: initial experience in Hong Kong

HM Tang, FL Lau

Background and Method: There is favourable evidence supporting the use of noninvasive ventilatory support (NIV) in Emergency Department (ED) in treating patients with non-traumatic acute respiratory distress (ARD). To determine the feasibility and potential uses of NIV in the ED of Hong Kong, a prospective study was done in the ED of a regional acute hospital. A convenience sample of patients with non-traumatic ARD was recruited within the first 3 months after the introduction of this modality of therapy. Haemodynamically unstable or uncooperative patients and those requiring immediate endotracheal intubaton (ETI) were excluded. Patients were placed on BiPAP noninvasive ventilator with face mask for at least 30 minutes in ED. Blood pressure, respiratory rate and arterial blood gases analysis were recorded before and after the therapy. Adverse effects of NIV in ED, necessity of ETI and hospital mortality were also recorded. Results: 28 patients were studied. The mean age was 76 years old (range 56-98). Causes of ARD included acute exacerbation of chronic obstructive airway disease (COAD, n=14), acute pulmonary oedema (APO, n=10) and bronchopneumonia (n=4). Patients were put on either Continuous Positive Airway Pressure (n=7) or Bilevel Positive Airway Pressure (n=21) modes of NIV. The COAD and APO groups responded favourably. The bronchopneumonia group showed only borderline or no improvement and 2 patients in this group needed ETI in ED, in contrast to only 1 patient in APO group and nil in COAD group. Only minor discomforts were felt by patients but no major adverse effect was observed. Two patients (2/4=50%) in bronchopneumonia group died from the disease. Conclusion: NIV delivered in ED is feasible and is likely to be beneficial to patients with ARD due to COAD or APO. Further randomised controlled trials should be conducted to explore its potential uses in ED. (Hong Kong j.emerg.med. 2001;8:140-145)

Keywords : Emergency department, Hong Kong, noninvasive ventilation

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