Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure

Background. Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. Methods. A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. Results. Fifteen patients were included in the study: 10 males, mean age 68 ± 12. APACHE-II score was 17.6 ± 6.5. pH and pCO2 before NIV were 7.22 ± 0.11 and 110 ± 72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. Conclusions. NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.