Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (18)

Today, we are faced with a scarcity of both experienced ICU nurses and financial resources, this being particularly crucial in North America, from what we can perceive from Europe; in recent years the average number of nursing hours for ICU patients has decreased drastically (ie, around 40 percent) for patients with a similar degree of illness. An improving nursing efficiency, especially through the use of a better classification of the severity of the patients diseases in order to rationally allocate the nurse forces, and the elimination of “routine” tasks of unproven value have reduced the average number of nursing hours spent per ICU patient without detrimental effects on the quality of care.
In our 15-bed general medical ICU, we treat annually around 1,500 patients, and we intubate and mechanically ventilate almost 200 of them. During our study, there was a rather “comfortable” nurse/ patient ratio of 0.9; however, despite this nurse staffing, acute NPPV was clearly an important burden on our ICU, even when only one such patient at a time was present in the unit. Very often, the nurse in charge of a patient receiving acute NPPV had to be helped by a colleague, and, therefore, the nurse/ patient ratio for this particular patient was greater than 1.0. Our feeling was that even with a nurse/ patient allocation close to 1.0, acute NPPV can barely be undertaken without the danger of destabilizing the entire work organization of a given ICU.