Case presentation of nurse-managed noninvasive positive pressure ventilation in an acute ward setting

A woman with obstructive sleep apnea who was admitted to the sleep disorders laboratory at St George Hospital in Sydney, Australia, for assessment subsequently experienced respiratory arrest. She was successfully resuscitated and 10 days later was transferred from the critical care unit to the respiratory ward with a cuffed, fenestrated tracheostomy tube in situ. A hoarse voice, oxygen desaturation, and upper airway stridor when capping the tracheostomy alerted nursing staff to the existence of an upper airway obstruction. Repositioning of the tracheostomy tube alleviated some of the patient's difficulties, but further investigation revealed large vocal polyps as the underlying factor in her episode of respiratory failure. Removal of the polyps and inception of noninvasive positive pressure ventilation resulted in a range of benefits to the patient's health status, including resolution of her respiratory failure, better management of her diabetes, and a markedly improved quality of life.