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1138: TRANSPORT BIPAP & HIGH-FLOW NASAL O2 DURING EARLY MOBILITY ACCELERATE RECOVERY AFTER CARDIAC SURGERY

Learning Objectives: Noninvasive Ventilation(NIV) with bilevel positive pressure ventilation (BiPAP) is done using a nasal or face mask or nasal cannula. With a recognition of its benefits there has been an increase in its use, however with this increasing utilization there is evidence of inappropriate use. This study was aimed at studying the effect of having a pulmonology consult on the overall utility of BiPAP intervention. Methods: This study was a retrospective, QIP, with data collection period 9/1/2017 through to 12/31/2017. IRB exempt status was granted. Patients were identified from a step-down unit database with all admissions, those who were ordered NIV with BiPAP were included in our study. Patients were excluded if they were pregnant, <18 years old or incarcerated. The primary objective was to quantify the use of NIV with and without a pulmonology consult. Secondary objectives included Length of stay difference with pulmonology consult, indications for NIV use, NIV adjustment frequency, ICU admission, readmission rates and health care cost. Results: 142 patients (pts) admitted to step down during our study period required NIV with BiPAP. The average age was 61.6 years. The indications included Post Operative Hypoxia (8pts), Acute Heart Failure(42pts), Hypoxemic Respiratory Failure(24pts) and hypercapnic respiratory failure(68pts). The mean duration of use was 7.4 +/2.6 days. There was inappropriate use of NIV with BiPAP in 37% of patient who had altered mental status or GCS<8. Pulmonology was consulted in 34% of cases within 48 hours of NIV initiation, 38% after 48 hours of NIV initiation and no pulmonology consulted in 28% of patients. Group with BiPAP use with early pulmonology consult(within 48 hours of BiPAP initiation) significantly reduced ICU admissions(15.8%, P value=0.007) patient length of stay(Mean 3.8 days +/0.78, P value<0.0001) and 90-day readmission(7.8, P value = 0.007) in overall analysis. Average cost of BiPAP is 1600 $ per day and one day hospital stay cost is calculated as 2800 $. This amounts to an average (1600 + 2800) x 3.8 = $16,720 saving in health care cost per patient. Conclusions: We found that consulting pulmonology early when using a BiPAP led to reduced ICU admissions, length of stay and 90 day readmission. Having pulmonology on board when employing NIV with BiPAP has the potential to cut back on adverse effects for patients, optimize length of stay, decrease NIV failure and scale back on the monetary health care burden.