Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure

Intensive Care Med. 2009 Feb;35(2):339-43. doi: 10.1007/s00134-008-1350-y. Epub 2008 Nov 19.


Objective: To report data about "real-life" treatments with non-invasive ventilation for acute respiratory failure (ARF), managed outside intensive care units by anaesthesiologists acting as a medical emergency team.

Design: Observational study; prospectively collected data over a 6-month period in a single centre.

Setting: Non-intensive wards in a University Hospital with 1,100 beds.

Patients: Consecutive patients with ARF for whom a ventilatory support was indicated but tracheal intubation was not appropriated or immediately needed.

Interventions: None.

Measurements and results: Patient's characteristics, safety data, short-term outcome and organizational aspects of 129 consecutive treatments were collected. The overall success rate was 77.5%, while 10.1% were intubated and 12.4% died (all of them were "do not attempt resuscitation" patients). The incidence of treatment failure varied greatly among different diseases. Complications were limited to nasal decubitus (5%), failure to accomplish the prescribed ventilatory program (12%), malfunction of the ventilator (2%) and excessive air leaks from face mask (2%) with no consequences for patients. Three patients became intolerant to NIV. The work-load for the MET was high but sustainable: on average NIV was applied to a new case every 34 h and more than three patients were simultaneously treated.

Conclusions: Under the supervision of a MET, in our institution NIV could be applied in a wide variety of settings, outside the ICU, with a high success rate and with few complications.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Edema, Cardiac / epidemiology
  • Edema, Cardiac / therapy
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Hospitals, University
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Patient Care Team*
  • Patients' Rooms / statistics & numerical data*
  • Pneumonia / epidemiology
  • Pneumonia / therapy
  • Positive-Pressure Respiration / statistics & numerical data*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Pulmonary Edema / epidemiology
  • Pulmonary Edema / therapy
  • Respiratory Insufficiency / therapy*
  • Workforce