Comprehensive NIV guidance
One of the most comprehensive articles on non-invasive ventilation (NIV) has been published this September. Specialists can access this online
(e-medicine.medscape.com/article/304235-overview).
The author is Guy W Soo Hoo MD MPH, Clinical Professor of Medicine at Geffen School of Medicine at the University of California at Los Angeles; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Centre, Veteran Affairs Greater Los Angeles Healthcare System.
Dr Soo Hoo presents the history of NIV, methods of delivery, applications, general considerations (e.g. absolute contra-indications), patient inclusion criteria, types of ventilators and applications, non-invasive ventilation in COPD, cardiogenic pulmonary oedema and other conditions, procedures after extubation, and potential NIV complications.
His final cost-analysis indicates that NIV is cost-effective in patient management (savings of over Canadian $3000, and even more if patients are managed in a ward setting). It avoids costs of endotracheal intubation and mechanical ventilation, results in shorter ICU and hospital stays, he points out, adding most importantly that NIV also eliminates costs associated with infection complications -- episodes of ventilator-associated pneumonia can be reduced by 50% or more.
18.11.2009