Running head: NONINVASIVE POSITIVE PRESSURE VENTILATION
Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure
Heather E. Strickland
Methodist University BSN Program
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NONINVASIVE POSITIVE PRESSURE VENTILATION
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Noninvasive Positive Pressure Ventilation
in Acute Respiratory Failure
It is the duty of each employed nurse to remain knowledgeable and aware of the best
evidence-based practice currently available in the healthcare field. When a nurse remains
competent on the most effective ways to treat a patient, the nurse is able to advocate for the
patient and assure appropriate care is provided. Acute respiratory failure is a dangerous condition
which will lead to death if not treated promptly. In the past, it was common to perform an
endotracheal intubation or a tracheostomy to allow the patient to receive adequate oxygen or rid
his or her body of excess carbon dioxide. However, invasive procedures leave room for infection
and further complication. A successful alternative treatment is noninvasive positive pressure
ventilation (NPPV). It is important, as nurses, to work together and promote positive change in
patient care using the democratic form of leadership. The use of noninvasive positive pressure
ventilation has become the best evidence-based practice for acute respiratory failure because it
has a low incidence of mortality, reduces risk for infection, and is cost effective. Barriers that
could affect implementing NPPV into practice include lack of equipment, resistance to change,
and time consuming care.
Democratic Leadership
Nurses are leaders among the healthcare industry. As a leader, every nurse has a duty to
the patient to provide exceptional care. A large part in providing exceptional care involves
collaborating with other nurses and varying members of the interdisciplinary team. Democratic
leadership is the best leadership theory to use when working together with peers. Bessie Marquis
and Carol Huston (2012), authors of Leadership and Management Tools for the New Nurse,
describe democratic leadership when they state: “Democratic leadership, where there is less
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control and decision making involves others, is appropriate for groups who work together for
extended periods” (p. 11). Democratic leadership allows nurses to express their opinions about
an issue and work collaboratively towards the best solution. It is important to present facts when
proposing a new treatment method, but democratic leadership allows all nurses the opportunity
to discuss any concerns. This leadership style creates positive change by promoting team work
and allowing nurses the opportunity to participate in the decision making process.
Incidence of Mortality
When serving as a democratic leader it is important to empower fellow nurses to take an
active role in promoting best evidence-based practice when providing patient care. Noninvasive
positive pressure ventilation has been proven to decrease mortality following acute respiratory
failure. NPPV will allow healthcare providers to adjust levels of oxygen, reduce respiratory rate,
achieve a pulse oximetry of greater than 90%, and monitor arterial blood gas levels just as an
invasive method would. In a randomized study Dr. Rappard, a respirologist, and Dr. Hickey, a
family practice physician (2001) found mortality was decreased from 29% with the use of
invasive ventilation to 9% with the use of NPPV (p. 270). Therefore, as a patient advocate, the
nurse should suggest a trial of NPPV before moving towards invasive procedures.
Risk of Infection
The risk of infection associated with invasive ventilation can lead to higher likelihood of
mortality. Often times, patients experiencing respiratory failure are in an immunocompromised
state which makes NPPV a better option for treating this condition. John Williams et al. (2012)
conducted research that proved this point further by showing NPPV is “associated with few of
the nosocomial complications recognized with endotracheal intubation, such as ventilatorassociated pneumonia, critical illness-associated weakness, pneumothorax, delirium, and
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infections associated with the invasive monitoring” (p. 2). The complications listed can lead to a
longer hospital stay, patient hopelessness, coma, and even death. If these complications can be
avoided by use of NPPV, the nurse has a duty to suggest NPPV before deeming the invasive
ventilation necessary.
Cost of Care
In addition to complications, cost of care is a factor that proves NPPV is a priority
treatment in acute respiratory distress. Unlike invasive procedures, NPPV is a cost effective
method of treating acute respiratory failure. An incremental cost analysis completed by P K
Plant, consultant physician in respiratory medicine, J L Owen, respiratory nurse specialist, S
Parrott, lecturer in health economics, and M W Elliott, consultant in respiratory medicine (2003)
proved NPPV is more cost effective than invasive methods. In the randomized control trial, 239
subjects were treated for respiratory exacerbation. The costs were divided into three units which
included noninvasive treatment, ward treatment, and intensive care treatment. The study proved
that noninvasive ventilation used in a ward was 38-75% less costly than invasive treatment
provided in an intensive care unit (p. 4). NPPV as a treatment method will provide less costly
treatment which will prove beneficial to patients and healthcare providers.
Barriers
There are barriers when implementing a treatment into practice. An example of a barrier
is a facility may lack proper equipment needed to provide NPPV to patients experiencing acute
respiratory distress. However, the facts that prove the cost effectiveness of NPPV show that
investment in proper equipment to provide this form of treatment is beneficial in the long term.
There may be employees who are resistant to this change. It is important for these employees to
note that incorporating the best evidence-based practice into care will provide more autonomy
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for nurses and respect in the interdisciplinary team. Also, a nurse may argue that NPPV is a more
time consuming treatment method. Margaret Ecklund (2013), a nurse practitioner, researched the
difference in time it takes to treat a patient with invasive ventilation versus noninvasive
ventilation. She states: “Studies indicate that nurses spend no additional time at the bedside of
NPPV patients. Interestingly, RTs spend the most time at the bedside in the first eight hours of
therapy for patients requiring NPPV” (p. 4). Therefore, the benefits to the healthcare industry
and to the patient outweigh the barriers when discussing implementation of NPPV as the primary
treatment for acute respiratory distress.
Conclusion
The use of noninvasive positive pressure ventilation is the current best evidence-based
practice in patients experiencing acute respiratory distress. Through research and randomized
control trials, this method of treatment has proven to maximize outcomes and minimize
complications. It is vital a democratic leadership stance is taken with this issue to allow for
collaboration among nurses affected by implementing NPPV into practice. NPPV has a lower
incidence of mortality, has a decreased risk of infection, and is cost effective. The benefits
outweigh the potential barriers that could stem from implementing NPPV as the primary
treatment in acute respiratory failure. As a nurse and a leader in the healthcare industry
awareness of these facts and implementing NPPV into practice is important in maximizing
patient outcomes.
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References
Ecklund, M. (2013, February 6). Noninvasive positive pressure ventilation requires healthcare
team spirit. Retrieved from
http://www.ucdenver.edu/academics/colleges/nursing/Documents/Clinical Sim/NURS
4617/Noninvasive Positive Pressure Ventilation Requires Healthcare Team Spirit.pdf
Marquis, B., & Huston, C. (2012). Understanding the characteristics of leadership and
management. In Leadership and management tools for the new nurse: A case study
approach (7th ed., p. 11). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
Plant, P., Owen, J., Parrot, S., & Elliott, M. (2003, May 3). Cost effectiveness of ward based
non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary
disease: Economic analysis of randomized controlled trial. Retrieved October 18, 2014.
doi: http://dx.doi.org/10.1136/bmj.326.7396.956
Rappard, S., & Hickey, J. (2001). Use of CPAP and BiPAP in acute respiratory failure.
Canadian Family Physician, 47, 269-269. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2016241/pdf/11228026.pdf
Williams, Jr., J., Cox, C., Hargett, W., Gilstrap, D., Castillo, C.,…Sanders, G. (2012, July 1).
Noninvasive positive-pressure ventilation (NPPV) for acute respiratory failure. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047897/pdf/TOC.pdf