Quantitative and Qualitative Inquiry into the Use of Noninvasive Ventilation to Treat Acute Asthma in Adults: A Multi-Site Study

This research project examined the use of noninvasive ventilation (NIV) to treat acute exacerbations of asthma in adults in a regional local health district in New South Wales, Australia. International guidelines are currently inconsistent in their recommendations for the use of NIV to treat acute asthma in adults due to limited evidentiary support. Despite this, NIV is being used as a treatment for acute asthma in Australia. It is not conclusively known whether NIV provides better clinical outcomes for patients compared to standard medical therapy, or the influence of context on nurses’ ability to use this treatment.

The aim of this project was to examine whether NIV provided better clinical outcomes for adult patients with acute asthma compared to those who received standard medical therapy. It was, however, also recognised that the efficacy of a treatment is not limited to its clinical application, but also results from the effects of context. As a result, this research project aimed to examine where and how often NIV was being used to treat acute asthma, if the use of NIV for acute asthma led to improved clinical outcomes for patients, and the experiences of the nurses who used NIV.

This project was guided by the philosophy of pragmatism, a paradigm that determines value by defining practical usefulness. Using pragmatism as a foundation, a mixed methods project was designed. Specifically, a sequential explanatory design was used incorporating two distinct phases – quantitative and qualitative – which were integrated at specified points in the project. The quantitative phase of the project was conducted first and involved retrospective data collection from patients’ medical records to determine the short-, medium- and long-term outcomes of adult patients who had been admitted to hospital with acute exacerbations of asthma and received NIV as a treatment, compared to those who received standard medical treatment. Questions that emerged from the quantitative data were then used to design a qualitative project phase. The qualitative phase used semi-structured interviews with registered nurses to explore their experiences using technology such as NIV and the effect those experiences and their individual context had on their practice.

In the five-year retrospective period examined, there were 71 adult patients admitted with acute exacerbations of asthma who were eligible for NIV. Of those patients, 63% received NIV treatment. In regards to the analysis of outcomes, NIV did not have a significant effect on pH or pCO2 but did have a significant effect on respiratory rate. Using the results from the quantitative data analysis, interviews were conducted with nine nurses working in critical care units from the same area. The interview findings suggest there are several factors that influence the use of NIV as a treatment that do not relate to the technology itself; these include lack of education, isolation, fear, support and mentorship, taking ownership, leadership and intuition.

NIV was used commonly for the treatment of acute exacerbations of asthma in this regional local health district in Australia, but not for all patients who met the criteria for the treatment. This research demonstrates that the use of NIV as a treatment for acute exacerbations of asthma may be beneficial, but it is equally important for healthcare organisations to examine the way in which treatments are implemented into practice or their efficacy may be lost.