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Research Snapshot Theater: Pulmonary/Quality and Patient Safety, Adult

Outcomes of Noninvasive Ventilation Initiation on Wards With Medical Emergency Team Follow-Up

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 11
Introduction: Non-invasive positive pressure ventilation (NIPPV) is increasingly used in general wards for acute respiratory support, though few studies have assessed its use involving the Medical Emergency Team (MET). To mitigate risks of unrecognized NIPPV failure, our MET protocol mandates structured 8-hour follow-up for ward-initiated NIPPV during MET activation. This study assesses outcomes of this approach.


Methods: We conducted a retrospective study at a 510-bed tertiary hospital with a 20-year MET system. For non-ICU patients started on NIPPV by the MET, the protocol included follow-up assessments by the MET nurse and respiratory therapist at 2, 4, and 8 hours. All MET calls from Jan 2021 to Dec 2024 for dyspnea (RR >28) or desaturation (SpO₂ < 90%) were reviewed following IRB approval. Patients were grouped as ward-initiated NIPPV (NIPPV-G) and NIPPV initiated after immediate ICU transfer (CG). We assessed NIPPV failure rates in NIPPV-G and compared intubation and mortality rates between groups. Descriptive statistics, Chi-square, and t-tests were used, with p < 0.05 considered significant.


Results: Of 4,283 MET calls, 785 were for dyspnea/desaturation, and 102 met inclusion criteria (NIPPV-G: 65; CG: 37). Groups were similar in gender (49% vs 43% male), Charlson Index (5.8 vs 5.6), and initial vitals (all p > 0.05). NIPPV-G patients at initial MET were older (median 70 vs 64 years), had lower APACHE II scores (15.5 vs 18.1), needed less FiO₂ (0.48 vs 0.57), and had higher PCO₂ (53 vs 44 mmHg) and bicarbonate (28 vs 23 mmol/L), all p < 0.04. Pulmonary edema was more common in NIPPV-G (58% vs 38%, p = 0.04), while sepsis was less frequent (20% vs 41%, p = 0.03). Mean time to ICU transfer was longer (5 vs 1.4 hrs; p < 0.01), and NIPPV duration was comparable (9 vs 8 hrs, p=0.59). In NIPPV-G, 28% required ICU transfer during MET follow-up, 4% were late transfers (8–48 hrs), and 68% remained on the ward. Compared to CG, NIPPV-G had lower intubation (20% vs 49%), ICU mortality (6% vs 24%), and hospital mortality (22% vs 43%), all p < 0.03.


Conclusions: MET-managed ward NIPPV with structured follow-up may prevent two-thirds of potential ICU admissions for impending respiratory failure without increasing mortality, particularly benefiting hypercapnic, non-septic patients.