HM11 BREAKOUT SESSIONS OVERVIEW

The How, When, and Why of Noninvasive Ventilation

SPEAKER: Eric Siegal, MD, SFHM, critical care fellow, University of Wisconsin School of Medicine, Madison

Dr. Siegal’s review of literature in front of a packed crowd provided a road map to Noninvasive Positive Pressure Ventilation (NPPV) usage. In the end, NPPV should be a hospitalist’s first choice for patients with hypercarbic COPD exacerbations, and likely in patients with acute cardiogenic pulmonary edema, hypoxemic respiratory failure, immunocompromised patients, and pre-intubation patients.

Dr. Siegal stressed the use of NPPV in COPD, which has been studied thoroughly and “held up to repeated scrutiny.”

“If you put people on NPPV instead of intubating them … mortality is halved, intubation rate is less than half, treatment failure is much lower, you have a third of the complications, and huge reductions in length of stay,” Dr. Siegal said.

In the absence of contraindications, he stressed, NPPV should be the first line of therapy for patients with hypercarbic COPD exacerbations. “In fact, I would argue that you really should be asking yourself, ‘Why can’t I put these patients on NPPV?’ ” he asked, “because this has really shown to be life-saving.”

Dr. Siegal also explored recent findings on NPPV in acute cardiogenic pulmonary edema patients, which surprisingly showed “no better than supplemental oxygen.” He concluded that if your patient is not hypercarbic, “there is no advantage to adding pressure support.” He also said the benefit is more robust in ACPE patients who have acute coronary syndrome.

Dr. Siegal advised hospitalists to pick the right patients, start NPPV therapy early, and if the patient doesn’t improve within one or two hours, “it’s time to move on.”