Non-Invasive Ventilation Therapy Implementation in Medical Wards-A Scoping Review to Understand Hospitals' Protocols...

Area of Science:

• Respiratory Medicine
• Critical Care
• Health Services Research

Background:

• Non-invasive ventilation (NIV) is a key treatment for hypercapnic acute respiratory failure (ARF).
• Effective ward-based implementation of NIV is crucial for patient outcomes.
• Local health guidance documents (LHGDs) guide NIV use in Australian health services.

Purpose of the Study:

• To identify and analyze Australian LHGDs for ward-based NIV in adults with ARF.
• To examine recommendations for NIV initiation, monitoring, maintenance, weaning, and deterioration management.
• To assess the alignment of LHGDs with international guidelines.

Main Methods:

• A scoping review of public health service NIV LHGDs was conducted.
• Data extraction focused on key aspects of NIV care and clinical deterioration.
• Included documents were updated as of September 2025.

Main Results:

• Twenty-two LHGDs were analyzed; only 27.3% referenced international guidelines.
• Significant variation existed in NIV initiation criteria (e.g., ABG values) and SpO2 monitoring targets.
• Most LHGDs lacked clear guidance on medical review, escalation, palliation, and weaning.

Conclusions:

• Australian hospitals exhibit substantial variation in LHGDs for ward-based NIV.
• Inconsistencies in NIV protocols may compromise care quality and patient safety.
• Limited adherence to international guidelines highlights a need for standardization.