Take a Deep Breath. Are We Talking Invasive or Non-Invasive?

By: Robert Weissinger, DO, Regional Medical Director, VITAS® Healthcare

The five-year national study reported in the 3rd-quarter issue of Making the Rounds, “Life-Sustaining Procedures, Palliative Care Consultation and Do-Not Resuscitate Status in Dying Patients with COPD in US Hospitals: 2010- 2014,” demonstrates trends reflective of our experiences in the inpatient setting as palliative and hospice medicine specialists.

After reviewing this concerning increase in life-sustaining procedures, my initial question to the authors is: how are mechanical ventilations categorized? Are they reporting mechanical ventilation as invasive (IVS), non-invasive (NIVS) or both?

NIVS is Common

The literature supports the increasing use of NIVS, as the technologies and access have advanced for CPAP and BiPAP. Most emergency departments today are equipped with at least one form of NIVS.

Initially, a patient may have been introduced to these therapies in the emergency department or rescue unit for an acute exacerbation of COPD, before a resuscitation status is available to the medical provider.

I see that as more of a communication lag than a trend toward life-sustaining procedures. Education for patients, families and providers would lessen that lag.

Deeper Interrogation

Make no mistake: the increasing technology noted in the study is a factor. The desire of the patient for any type of mechanical ventilator support (MVS) may demand deeper interrogation into what NIVS means to individual patients, and whether this aggressive technology could in some way modify their short-term goals of care. Again, education is key.

Finally, on a positive (and expiratory!) note, I was pleased to see the increasing rate of palliative care consultations for patients with end-stage COPD. Increased access to hospice and palliative services will increase comfort, quality and dignity at the end of life for our most vulnerable patients.

Education continues to be the key to success, and we at VITAS are obligated to provide it categorically.