Date of Award

2015

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

First Advisor

Candice Rome

Abstract

Rib fractures in the elderly population, 65 years and older, is more prevalent than any other population. Mortality increases with each year over the age of 65 and with each number of ribs fractured. Rib fractures are painful and can lead to a decreased respiratory effort. This results in complications such as pneumonia, respiratory depression, respiratory failure, Acute Respiratory Distress Syndrome (ARDS), and respiratory infections. Non-Invasive Positive Pressure Ventilation (NIPPV) assists with reducing the patient efforts to breathe while also ensuring spontaneous lung expansion. NIPPV can assist with promoting positive outcomes in patients with respiratory complications. The purpose of this study was to analyze the effectiveness of early NIPPV intervention in elderly patients with rib fractures. A retrospective data analysis was completed with a total of 117 patients from 2013 and 2014. The data included time frame from arrival to NIPPV intervention, unplanned ICU admission and length of stay, overall hospital length of stay, need for other invasive interventions, ISS, pre-existing comorbidities, complications, pain management, and discharge disposition. Patients who never had NIPPV intervention had a significantly lower LOS in the ICU and hospital than those that required NIPPV in the first 24 hours or greater. Patients with complications were significantly more likely to have NIPPV within the first 24 hours or more. Patients admitted to the ICU were significantly less likely to never have had NIPPV. Time until NIPPV intervention was not significant in the LOS of ICU patients or overall hospital LOS. The beneficial factor of early intervention of NIPPV could be disguised by the fact more serious complications require NIPPV intervention. The study did not show significance for correlations with positive or negative outcomes and NIPPV intervention. NIPPV intervention in elderly patients 65 years and older with rib fractures is a proactive approach in potentially decreasing complications and negative outcomes.

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