Non-invasive ventilation practices by specialized nurses in acute decompensated heart failure; a cross-sectional study

Abstract Background Acute decompensated heart failure (ADHF) with respiratory insufficiency is associated with an increased risk of readmission and elevated mortality and morbidity. 1Non-invasive ventilation (NIV) plays a pivotal role in the management of patients with ADHF experiencing respiratory decompensation.2The application of positive airway pressure increases intrathoracic pressure, recruits alveoli, reduces venous return, decreases preload and left ventricular afterload, and may enhance left ventricular stroke volume.3 Maximizing device settings is regarded as an essential tool,4 yet there remains a lack of literature identifying the most appropriate parameters for applying NIV. 5 Purpose This study aims to investigate the initial application of NIV by specialized acute care nurses in the treatment of ADHF, with a focus on patterns and variations in its use, as well as their confidence in their own skills and those of their colleagues. Methods This cross-sectional study utilized an open, voluntary response survey to collect data from specialized nurses working in Emergency Rooms (ERs), Cardiac Care Units (CCUs), and Intensive Care Units (ICUs), across all 36 Dutch hospitals (ranging from peripheral to academic) between May and November 2022. Participants were recruited via an open, voluntary survey without prior selection, and data was gathered using a 37-item anonymous survey focused on NIV practices, protocol adherence, self-reported proficiency, and colleagues’ expertise in initiating and adjusting NIV settings. Results A total of 242 specialized nurses participated in this voluntary response survey, with the majority (62%) working in CCUs, followed by 25% in ICUs, and 13% in ERs. The Philips V60 was the most commonly used NIV device especially in CCUs (69%), while the Hamilton ventilator was more frequently used in the ICUs (45%) and ERs (61%) (all, p < 0.001). Protocols for NIV use were available in 82% of hospitals, primarily guiding adjustments based on blood gas values. Self-reported adherence to the protocol was 64% in the CCUs, 49% in the ICUs, and 43% in the ERs (p = 0.131). ICU nurses most frequently adjusted settings based on their own judgment (71%), compared to CCU nurses (51%) and ER nurses (61%) (p < 0.001). ER nurses primarily followed the specialist's orders (p < 0.001). Nurses reported varying levels of confidence in their colleagues' proficiency, with ICU nurses rating their team higher in skills for adjusting ventilation settings (2.07 ± 0.6) compared to ER nurses (2.81 ± 0.9) and CCU nurses (2.33 ± 0.8). However, the majority of them assessed the knowledge of cardiologists regarding the adjustment of NIV settings as insufficient (Table 1). Conclusion This study highlights significant differences in NIV practices and self-reported proficiency among acute care nurses across different clinical settings. ICU nurses reported the highest levels of proficiency, while ER nurses reported the lowest.