Non-invasive ventilation, ordinary wards and medical emergency team: maximizing effectiveness while preserving safety.

摘要

We read we great interest the paper by Schneider et al. on non-invasive ventilation (NIV) use in medical emergency team (MET) calls. The paper offers a precious insight into real-life MET interventions for patients suffering from acute respiratory failure (ARF), showing that NIV is a common MET-delivered treatment. In our opinion, two further considerations are required to better define the role of NIV in this context. First, NIV effectiveness is considered to be maximal when applied at an early stage of ARF. Unfortunately, the Authors did not report data (like arterial blood gas values) on the severity of treated patients, but given their strict MET criteria, likely patients suffered from moderate-to-severe ARF. This could explain the high rate of immediate admission to ICU/HDU and the high mortality rate in the study. If NIV is to be applied at an earlier stage to avoid patient deterioration (that is the fundamental aim of the MET), a larger number of patients would be treated. The shortage of ICU beds is a worldwide problem, so an increase in the number of treatments forces NIV application on ordinary wards: quoting the British Thoracic Society Guidelines for Non-invasive Ventilation,".. .If an acute NIV service is not provided, the shortage of ICU beds means that some patients will die". As a matter of fact, NIV use for ARF on ordinary ward has been reported from many Countries.5 Cost-effectiveness is also improved when patients are treated on ordinary wards.