151
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Rialp G, Forteza C, Muñiz D, Romero M. Role of First-Line Noninvasive Ventilation in Non-COPD Subjects With Pneumonia. Arch Bronconeumol 2016; 53:480-488. [PMID: 27988055 DOI: 10.1016/j.arbres.2016.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The use of noninvasive ventilation (NIV) in non-COPD patients with pneumonia is controversial due to its high rate of failure and the potentially harmful effects when NIV fails. The purpose of the study was to evaluate outcomes of the first ventilatory treatment applied, NIV or invasive mechanical ventilation (MV), and to identify predictors of NIV failure. METHODS Historical cohort study of 159 non-COPD patients with pneumonia admitted to the ICU with ventilatory support. Subjects were divided into 2 groups: invasive MV or NIV. Univariate and multivariate analyses with demographic and clinical data were performed. Analysis of mortality was adjusted for the propensity of receiving first-line invasive MV. RESULTS One hundred and thirteen subjects received first-line invasive MV and 46 received first-line NIV, of which 27 needed intubation. Hospital mortality was 35, 37 and 56%, respectively, with no significant differences among groups. In the propensity-adjusted analysis (expressed as OR [95% CI]), hospital mortality was associated with age (1.05 [1.02-1.08]), SAPS3 (1.03 [1.00-1.07]), immunosuppression (2.52 [1.02-6.27]) and NIV failure compared to first-line invasive MV (4.3 [1.33-13.94]). Compared with invasive MV, NIV failure delayed intubation (p=.004), and prolonged the length of invasive MV (p=.007) and ICU stay (p=.001). NIV failure was associated with need for vasoactive drugs (OR 7.8 [95% CI, 1.8-33.2], p=.006). CONCLUSIONS In non-COPD subjects with pneumonia, first-line NIV was not associated with better outcome compared with first-line invasive MV. NIV failure was associated with longer duration of MV and hospital stay, and with increased hospital mortality. The use of vasoactive drugs predicted NIV failure.
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Affiliation(s)
- Gemma Rialp
- Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
| | - Catalina Forteza
- Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Daniel Muñiz
- Servicio de Cuidados Intensivos, Hospital Comarcal d'Inca, Inca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Maria Romero
- Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
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152
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Tanaka LMS, Salluh JIF, Dal-Pizzol F, Barreto BB, Zantieff R, Tobar E, Esquinas A, Quarantini LDC, Gusmao-Flores D. Delirium in intensive care unit patients under noninvasive ventilation: a multinational survey. Rev Bras Ter Intensiva 2016; 27:360-8. [PMID: 26761474 PMCID: PMC4738822 DOI: 10.5935/0103-507x.20150061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/10/2015] [Indexed: 01/23/2023] Open
Abstract
Objective To conduct a multinational survey of intensive care unit professionals to
determine the practices on delirium assessment and management, in addition to
their perceptions and attitudes toward the evaluation and impact of delirium in
patients requiring noninvasive ventilation. Methods An electronic questionnaire was created to evaluate the profiles of the
respondents and their related intensive care units, the systematic delirium
assessment and management and the respondents' perceptions and attitudes regarding
delirium in patients requiring noninvasive ventilation. The questionnaire was
distributed to the cooperative network for research of the
Associação de Medicina Intensiva Brasileira
(AMIB-Net) mailing list and to researchers in different centers in Latin America
and Europe. Results Four hundred thirty-six questionnaires were available for analysis; the majority
of the questionnaires were from Brazil (61.9%), followed by Turkey (8.7%) and
Italy (4.8%). Approximately 61% of the respondents reported no delirium assessment
in the intensive care unit, and 31% evaluated delirium in patients under
noninvasive ventilation. The Confusion Assessment Method for the intensive care
unit was the most reported validated diagnostic tool (66.9%). Concerning the
indication of noninvasive ventilation in patients already presenting with
delirium, 16.3% of respondents never allow the use of noninvasive ventilation in
this clinical context. Conclusion This survey provides data that strongly reemphasizes poor efforts toward delirium
assessment and management in the intensive care unit setting, especially regarding
patients requiring noninvasive ventilation.
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Affiliation(s)
| | | | - Felipe Dal-Pizzol
- Programa de Pós-graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Bruna Brandão Barreto
- Hospital Universitário Prof. Edgar Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Ricardo Zantieff
- Hospital Universitário Prof. Edgar Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Eduardo Tobar
- Departamento de Medicina, Hospital Clinico, Universidad de Chile, Independencia, Chile
| | - Antonio Esquinas
- Departamento de Terapia Intensiva e Unidade de Ventilação não invasiva, Hospital Morales Meseguer, Murcia, Espanha
| | - Lucas de Castro Quarantini
- Hospital Universitário Prof. Edgar Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Dimitri Gusmao-Flores
- Hospital Universitário Prof. Edgar Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
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153
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Messika J, Laissi M, Le Meur M, Ricard JD. Oxygénothérapie humidifiée haut débit : quelles applications en réanimation ? MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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154
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Neuschwander A, Lemiale V, Darmon M, Pène F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Mokart D, Azoulay E. Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome. J Crit Care 2016; 38:295-299. [PMID: 28038339 DOI: 10.1016/j.jcrc.2016.11.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. METHODS Post hoc analysis of a multicenter database within 20 years was performed. All patients with malignancies and Berlin ARDS definition were included. Noninvasive ventilation use was defined as NIV lasting more than 1 hour, whereas failure was defined as a subsequent requirement of invasive ventilation. Conditional backward logistic regression analyses were conducted. RESULTS A total of 1004 met the Berlin definition of ARDS. Noninvasive ventilation was used in 387 patients (38.6%) and NIV failure occurred in 71%, with an in-hospital mortality of 62.7%. Severity of ARDS defined by the partial pressure arterial oxygen and fraction of inspired oxygen ratio (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.15-4.19), pulmonary infection (OR, 1.81; 95% CI, 1.08-3.03), and modified Sequential Organ Failure Assessment (SOFA) score (OR, 1.13; 95% CI, 1.06-1.21) were associated with NIV failure. Factors associated with hospital mortality were NIV failure (OR, 2.52; 95% CI, 1.56-4.07), severe ARDS as compared with mild ARDS (OR, 1.89; 95% CI, 1.05-1.19), and modified SOFA score (OR, 1.12; 95% CI, 1.05-1.19). CONCLUSION Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
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Affiliation(s)
| | - V Lemiale
- ICU, Saint Louis Teaching Hospital, Paris, France
| | - M Darmon
- ICU, Saint Etienne, Teaching Hospital, France
| | - F Pène
- ICU, Cochin Teaching Hospital, Paris, France
| | - A Kouatchet
- ICU, Angers Teaching Hospital, Angers, France
| | - P Perez
- ICU, Brabois Teatching Hospital, Nancy, France
| | - F Vincent
- ICU, Monfermeil Hospital, Montfermeil, France
| | - J Mayaux
- ICU Pitié Salpétrière Teaching Hospital, Paris, France
| | - D Benoit
- ICU, Ghent Teaching Hospital, Ghent, Belgium
| | - F Bruneel
- ICU, Mignot Hospital, Versailles, France
| | - A P Meert
- ICU, Bordet Institut, Bruxelles, Belgium
| | - M Nyunga
- ICU, Roubaix Hospital, Roubaix, France
| | - A Rabbat
- ICU, Cochin Teaching Hospital, Paris, France
| | - D Mokart
- ICU, Paoli Calmettes Institut Marseilles, Marseilles, France
| | - E Azoulay
- ICU, Saint Louis Teaching Hospital, Paris, France.
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155
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Abstract
Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. We performed this meta-analysis to investigate the utility of NPPV intervention in patients with acute respiratory failure (ARF). A comprehensive literature search identified 12 studies enrolling a total of 963 patients from Medline, PubMed, Cochrane and EMBASE databases that assessed the effectiveness of NPPV versus conventional mechanical ventilation and/or non-ventilation therapy in patients with ARF, irrespective of the underlying aetiology, as well as mortality rate and the length of intensive care unit (ICU) or hospital stay. The usage of NPPV was associated with significantly decreased intubation (pooled OR=0.23, 95% CI 0.12-0.42, p<0.001) and ICU mortality rate (pooled OR=0.34, 95% CI 0.20-0.60, p<0.001), but did not influence the hospital mortality rate (pooled OR=0.77, 95% CI 0.32-1.81, p=0.543) and the length of ICU or hospital stay (ICU stay: difference in means=0.38, 95% CI -3.01 to 3.77, p=0.825; hospital stay: difference in means=2.76, 95% CI -1.74 to 7.27, p=0.229). In conclusion, usage of NPPV in patients with ARF is associated with lower intubation and in-ICU mortality rate.
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Affiliation(s)
- Yu-Jing Liu
- Department of Medical Engineering, Army General Hospital, Beijing, China
| | - Jing Zhao
- Department of Thoracic Surgery, Army General Hospital, Beijing, China
| | - Hui Tang
- Department of Medical Engineering, Army General Hospital, Beijing, China
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156
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Mortamet G, Emeriaud G, Jouvet P, Fauroux B, Essouri S. [Non-invasive ventilation in children: Do we need more evidence?]. Arch Pediatr 2016; 24:58-65. [PMID: 27889372 DOI: 10.1016/j.arcped.2016.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/24/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022]
Abstract
Respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit (PICU) and is associated with significant morbidity and mortality. Mechanical ventilation, preferentially delivered by a non-invasive route (NIV), is currently the first-line treatment for respiratory failure since it is associated with a reduction in the intubation rate. This ventilatory support is increasingly used in the PICU, but its wider use contrasts with the paucity of studies in this field. This review aims to describe the main indications of NIV in acute settings: (i) bronchiolitis; (ii) postextubation respiratory failure; (iii) acute respiratory distress syndrome; (iv) pneumonia; (v) status asthmaticus; (vi) acute chest syndrome; (vii) left heart failure; (viii) exacerbation of chronic respiratory failure; (ix) upper airway obstruction and (x) end-of-life care. Most of these data are based on descriptive studies and expert opinions, and few are from randomized trials. While the benefit of NIV is significant in some indications, such as bronchiolitis, it is more questionable in others. Monitoring these patients for the occurrence of NIV failure markers is crucial.
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Affiliation(s)
- G Mortamet
- Unité de soins intensifs pédiatriques, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada; Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada; Unité Inserm U955, équipe 13, institut de recherche biomédicale Mondor, 8, rue du Général-Sarrail, 94000 Créteil, France.
| | - G Emeriaud
- Unité de soins intensifs pédiatriques, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada; Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada
| | - P Jouvet
- Unité de soins intensifs pédiatriques, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada; Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada
| | - B Fauroux
- Unité Inserm U955, équipe 13, institut de recherche biomédicale Mondor, 8, rue du Général-Sarrail, 94000 Créteil, France; Unité de ventilation non invasive et du sommeil de l'enfant, hôpital Necker, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France
| | - S Essouri
- Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada; Département de pédiatrie, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada
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157
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Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2016; 43:192-199. [PMID: 27812731 DOI: 10.1007/s00134-016-4601-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/19/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To develop and validate a scale using variables easily obtained at the bedside for prediction of failure of noninvasive ventilation (NIV) in hypoxemic patients. METHODS The test cohort comprised 449 patients with hypoxemia who were receiving NIV. This cohort was used to develop a scale that considers heart rate, acidosis, consciousness, oxygenation, and respiratory rate (referred to as the HACOR scale) to predict NIV failure, defined as need for intubation after NIV intervention. The highest possible score was 25 points. To validate the scale, a separate group of 358 hypoxemic patients were enrolled in the validation cohort. RESULTS The failure rate of NIV was 47.8 and 39.4% in the test and validation cohorts, respectively. In the test cohort, patients with NIV failure had higher HACOR scores at initiation and after 1, 12, 24, and 48 h of NIV than those with successful NIV. At 1 h of NIV the area under the receiver operating characteristic curve was 0.88, showing good predictive power for NIV failure. Using 5 points as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for NIV failure were 72.6, 90.2, 87.2, 78.1, and 81.8%, respectively. These results were confirmed in the validation cohort. Moreover, the diagnostic accuracy for NIV failure exceeded 80% in subgroups classified by diagnosis, age, or disease severity and also at 1, 12, 24, and 48 h of NIV. Among patients with NIV failure with a HACOR score of >5 at 1 h of NIV, hospital mortality was lower in those who received intubation at ≤12 h of NIV than in those intubated later [58/88 (66%) vs. 138/175 (79%); p = 0.03). CONCLUSIONS The HACOR scale variables are easily obtained at the bedside. The scale appears to be an effective way of predicting NIV failure in hypoxemic patients. Early intubation in high-risk patients may reduce hospital mortality.
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Affiliation(s)
- Jun Duan
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China.
| | - Xiaoli Han
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Linfu Bai
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Lintong Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Shicong Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China
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158
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Petroianni A, Esquinas AM. Noninvasive mechanical ventilation on the ward for severe COPD: still unresolved question of balance among safety and drawbacks? Int J Chron Obstruct Pulmon Dis 2016; 11:2209-2210. [PMID: 27695307 PMCID: PMC5034906 DOI: 10.2147/copd.s117861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Angelo Petroianni
- Department of Cardiovascular and Respiratory diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio M Esquinas
- Intensive Care and Noninvasive Ventilatory Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain
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159
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Abstract
Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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160
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Anitha GFS, Velmurugan L, Sangareddi S, Nedunchelian K, Selvaraj V. Effectiveness of flow inflating device in providing Continuous Positive Airway Pressure for critically ill children in limited-resource settings: A prospective observational study. Indian J Crit Care Med 2016; 20:441-7. [PMID: 27630454 PMCID: PMC4994122 DOI: 10.4103/0972-5229.188171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Aims: Noninvasive ventilation (NIV) is an emerging popular concept, which includes bi-level positive airway pressure or continuous positive airway pressure (CPAP). In settings with scarce resources for NIV machines, CPAP can be provided through various indigenous means and one such mode is flow inflating device - Jackson-Rees circuit (JR)/Bain circuit. The study analyses the epidemiology, various clinical indications, predictors of CPAP failure, and stresses the usefulness of flow inflating device as an indigenous way of providing CPAP. Methods: A prospective observational study was undertaken in the critical care unit of a Government Tertiary Care Hospital, from November 2013 to September 2014. All children who required CPAP in the age group 1 month to 12 years of both sexes were included in this study. They were started on indigenous CPAP through flow inflating device on clinical grounds based on the pediatric assessment triangle, and the duration and outcome were analyzed. Results: This study population included 214 children. CPAP through flow inflating device was successful in 89.7% of cases, of which bronchiolitis accounted for 98.3%. A prolonged duration of CPAP support of >96 h was required in pneumonia. CPAP failure was noted in 10.3% of cases, the major risk factors being children <1 year and pneumonia with septic shock. Conclusion: We conclude that flow inflating devices - JR/Bain circuit are effective as an indigenous CPAP in limited resource settings. Despite its benefits, CPAP is not a substitute for invasive ventilation, as when the need for intubation arises timely intervention is needed.
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Affiliation(s)
| | - Lakshmi Velmurugan
- Department of Pediatrics, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Shanthi Sangareddi
- Department of Pediatrics, Stanley Medical College, Chennai, Tamil Nadu, India
| | | | - Vinoth Selvaraj
- Department of Pediatrics, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India
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161
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Messika J, Hajage D, Panneckoucke N, Villard S, Martin Y, Renard E, Blivet A, Reignier J, Maquigneau N, Stoclin A, Puechberty C, Guétin S, Dechanet A, Fauquembergue A, Gaudry S, Dreyfuss D, Ricard JD. Effect of a musical intervention on tolerance and efficacy of non-invasive ventilation in the ICU: study protocol for a randomized controlled trial (MUSique pour l'Insuffisance Respiratoire Aigue - Mus-IRA). Trials 2016; 17:450. [PMID: 27618935 PMCID: PMC5020479 DOI: 10.1186/s13063-016-1574-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/26/2016] [Indexed: 12/27/2022] Open
Abstract
Background Non-invasive ventilation (NIV) tolerance is a key factor of NIV success. Hence, numerous sedative pharmacological or non-pharmacological strategies have been assessed to improve NIV tolerance. Music therapy in various health care settings has shown beneficial effects. In invasively ventilated critical care patients, encouraging results of music therapy on physiological parameters, anxiety, and agitation have been reported. We hypothesize that a musical intervention improves NIV tolerance in comparison to conventional care. We therefore question the potential benefit of a receptive music session administered to patients by trained caregivers (“musical intervention”) to enhance acceptance and tolerance of NIV. Methods/design We conduct a prospective, three-center, open-label, three-arm randomized trial involving patients in the intensive care unit (ICU) who require NIV, as assessed by the treating physician. Participants are allocated to a “musical intervention” arm (“musical intervention” applied during all NIV sessions), to a “sensory deprivation” arm (sight and hearing isolation during all NIV sessions), or to the control group. The primary endpoint is the change in respiratory comfort (measured with a digital visual scale) before the initiation and after 30 minutes of the first NIV session. The evaluation of the primary endpoint is performed blindly from the treatment group. Secondary endpoints include changes in respiratory and cardiovascular parameters during NIV sessions, the percentage of patients requiring endotracheal intubation, day-90 anxiety/depression and health-related quality of life, post-trauma stress induced by NIV, and the overall assessment of NIV. The follow-up for each participant is 90 days. We expect to randomize a total of 99 participants. Discussion As music intervention is a simple and easy-to-implement non-pharmacological technique, efficacious in reducing anxiety in critically ill patients, it appeared logical to assess its efficacy in NIV, one of the most stressful techniques used in the ICU. Patient centeredness was crucial in choosing the outcomes assessed. Trial registration ClinicalTrials.gov: NCT02265458. Registered on 25 August 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1574-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Messika
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France. .,INSERM, IAME, U1137, F-75018, Paris, France. .,Present address: Réanimation Médico-chirurgicale, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700, Colombes, France.
| | - David Hajage
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010, Paris, France.,INSERM, ECEVE, U1123, F-75010, Paris, France.,INSERM, CIC-EC 1425, UMR 1123, F-75010, Paris, France
| | - Nataly Panneckoucke
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France
| | - Serge Villard
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France
| | - Yolaine Martin
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France
| | - Emilie Renard
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France
| | - Annie Blivet
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France
| | - Jean Reignier
- Centre Hospitalier Départemental de Vendée, Réanimation Médico-Chirurgicale, La Roche-sur-Yon, F-85925 Cedex 9, France
| | - Natacha Maquigneau
- Centre Hospitalier Départemental de Vendée, Réanimation Médico-Chirurgicale, La Roche-sur-Yon, F-85925 Cedex 9, France
| | - Annabelle Stoclin
- Institut Gustave Roussy, Réanimation Médico-chirurgicale, Villejuif, F-94800, France
| | - Christelle Puechberty
- Institut Gustave Roussy, Réanimation Médico-chirurgicale, Villejuif, F-94800, France
| | - Stéphane Guétin
- CHRU de Montpellier, Service de Neurologie, Inserm U1061, Montpellier, F-34000, France
| | - Aline Dechanet
- INSERM, CIC-EC 1425, UMR 1123, F-75010, Paris, France.,APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 Rue des Renouillers, Colombes, F-92700, France.,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France
| | - Amandine Fauquembergue
- INSERM, CIC-EC 1425, UMR 1123, F-75010, Paris, France.,APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 Rue des Renouillers, Colombes, F-92700, France.,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France
| | - Stéphane Gaudry
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010, Paris, France.,INSERM, ECEVE, U1123, F-75010, Paris, France
| | - Didier Dreyfuss
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France.,INSERM, IAME, U1137, F-75018, Paris, France
| | - Jean-Damien Ricard
- AP-HP, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France.,INSERM, IAME, U1137, F-75018, Paris, France
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Abstract
Noninvasive ventilation (NIV) has assumed a prominent role in the treatment of patients with both hypoxemic and hypercapnic acute respiratory failure (ARF). The main theoretic advantages of NIV include avoiding side effects and complications associated with endotracheal intubation, improving patient comfort, and preserving airway defense mechanisms. Factors that affect the success of NIV in patients with ARF are clinicians' expertise, selection of patient, choice of interface, selection of ventilator setting, proper monitoring, and patient motivation. Advances in the understanding of the physiologic aspects of using NIV through different interfaces and ventilator modalities have improved patient-machine interaction, thus enhancing favorable NIV outcome.
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Affiliation(s)
- Giuseppe Bello
- Department of Anesthesia and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - Gennaro De Pascale
- Department of Anesthesia and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy.
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163
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High-flow nasal cannula oxygen supply as treatment in hypercapnic respiratory failure. Am J Emerg Med 2016; 34:1914.e1-2. [DOI: 10.1016/j.ajem.2016.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/01/2016] [Indexed: 01/30/2023] Open
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164
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Carron M. A new horizon for the use of non-invasive ventilation in patients with acute respiratory distress syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:348. [PMID: 27761452 DOI: 10.21037/atm.2016.09.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Non-invasive ventilation (NIV) has assumed an important role in the management of acute respiratory failure (ARF). NIV, compared with standard medical therapy, improves survival and reduces complications in selected patients with ARF. NIV represents the first-line intervention for some forms of ARF, such as chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The use of NIV is also well supported for immunocompromised patients who are at high risk for infectious complications from endotracheal intubation. Selection of appropriate patients is crucial for optimizing NIV success rates. Appropriate ventilator settings, a well-fitting and comfortable interface, and a team skilled and experienced in managing NIV are key components to its success. In a recent issue of the Journal of the American Medical Association, Patel et al. reported the results of their single-center trial of 83 patients with acute respiratory distress syndrome (ARDS) who were randomly assigned to NIV delivered via a helmet or face mask. Patients assigned to the helmet group exhibited a significantly lower intubation rate and were more likely to survive through 90 days. This perspective reviews the findings of this trial in the context of current clinical practice and in light of data from the literature focused on the potential reasons for success of NIV delivered through a helmet compared to face mask. The implications for early management of patients with ARDS are likewise discussed.
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Affiliation(s)
- Michele Carron
- Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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165
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Índice de agua pulmonar extravascular y fracaso de la ventilación no invasiva. ¿Es la última frontera para una correcta decisión? Arch Bronconeumol 2016; 52:447. [DOI: 10.1016/j.arbres.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
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166
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Esquinas AM, Tagliaferri F, Barbagallo M. Extravascular Lung Water Index as a Predictive Factor for Non-Invasive Ventilation Failure. The Last Chance to Make the Right Decision? ARCHIVOS DE BRONCONEUMOLOGÍA (ENGLISH EDITION) 2016; 52:447. [DOI: 10.1016/j.arbr.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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167
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Vadde R, Pastores SM. Management of Acute Respiratory Failure in Patients With Hematological Malignancy. J Intensive Care Med 2016; 31:627-641. [PMID: 26283185 DOI: 10.1177/0885066615601046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute respiratory failure (ARF) is the leading cause of intensive care unit admission in patients with hematologic malignancies and is associated with a high mortality. The main causes of ARF are bacterial and opportunistic pulmonary infections and noninfectious lung disorders. Management consists of a systematic clinical evaluation aimed at identifying the most likely cause, which in turn determines the best first-line empirical treatments. The need for mechanical ventilation is a major determinant of prognosis. Beneficial outcomes have been demonstrated with early use of noninvasive ventilation (NIV) in selected patients with hematologic malignancies. However, most of these studies did not control the time between onset of ARF to NIV implementation nor accounted for the etiology of ARF or the presence of associated organ dysfunction at the time of NIV initiation. Moreover, the benefits demonstrated with NIV in these patients were derived from studies with high mortality rates of intubated patients. Additional studies are therefore warranted to determine the appropriate patients with hematologic malignancy and ARF who may benefit from prophylactic or curative NIV.
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Affiliation(s)
- Rakesh Vadde
- 1 Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen M Pastores
- 2 Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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168
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Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA 2016; 315:2435-41. [PMID: 27179847 PMCID: PMC4967560 DOI: 10.1001/jama.2016.6338] [Citation(s) in RCA: 338] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Noninvasive ventilation (NIV) with a face mask is relatively ineffective at preventing endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Delivery of NIV with a helmet may be a superior strategy for these patients. OBJECTIVE To determine whether NIV delivered by helmet improves intubation rate among patients with ARDS. DESIGN, SETTING, AND PARTICIPANTS Single-center randomized clinical trial of 83 patients with ARDS requiring NIV delivered by face mask for at least 8 hours while in the medical intensive care unit at the University of Chicago between October 3, 2012, through September 21, 2015. INTERVENTIONS Patients were randomly assigned to continue face mask NIV or switch to a helmet for NIV support for a planned enrollment of 206 patients (103 patients per group). The helmet is a transparent hood that covers the entire head of the patient and has a rubber collar neck seal. Early trial termination resulted in 44 patients randomized to the helmet group and 39 to the face mask group. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients who required endotracheal intubation. Secondary outcomes included 28-day invasive ventilator-free days (ie, days alive without mechanical ventilation), duration of ICU and hospital length of stay, and hospital and 90-day mortality. RESULTS Eighty-three patients (45% women; median age, 59 years; median Acute Physiology and Chronic Health Evaluation [APACHE] II score, 26) were included in the analysis after the trial was stopped early based on predefined criteria for efficacy. The intubation rate was 61.5% (n = 24) for the face mask group and 18.2% (n = 8) for the helmet group (absolute difference, -43.3%; 95% CI, -62.4% to -24.3%; P < .001). The number of ventilator-free days was significantly higher in the helmet group (28 vs 12.5, P < .001). At 90 days, 15 patients (34.1%) in the helmet group died compared with 22 patients (56.4%) in the face mask group (absolute difference, -22.3%; 95% CI, -43.3 to -1.4; P = .02). Adverse events included 3 interface-related skin ulcers for each group (ie, 7.6% in the face mask group had nose ulcers and 6.8% in the helmet group had neck ulcers). CONCLUSIONS AND RELEVANCE Among patients with ARDS, treatment with helmet NIV resulted in a significant reduction of intubation rates. There was also a statistically significant reduction in 90-day mortality with helmet NIV. Multicenter studies are needed to replicate these findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01680783.
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Affiliation(s)
- Bhakti K Patel
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Krysta S Wolfe
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Anne S Pohlman
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Jesse B Hall
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - John P Kress
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
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169
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Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is characterized by a noncardiogenic pulmonary edema with bilateral chest X-ray opacities and reduction in lung compliance, and the hallmark of the syndrome is hypoxemia refractory to oxygen therapy. Severe hypoxemia (PaO2/FiO2 < 100 mmHg), which defines severe ARDS, can be found in 20-30 % of the patients and is associated with the highest mortality rate. Although the standard supportive treatment remains mechanical ventilation (noninvasive and invasive), possible adjuvant therapies can be considered. We performed an up-to-date clinical review of the possible available strategies for ARDS patients with severe hypoxemia. MAIN RESULTS In summary, in moderate-to-severe ARDS or in the presence of other organ failure, noninvasive ventilatory support presents a high risk of failure: in those cases the risk/benefit of delayed mechanical ventilation should be evaluated carefully. Tailoring mechanical ventilation to the individual patient is fundamental to reduce the risk of ventilation-induced lung injury (VILI): it is mandatory to apply a low tidal volume, while the optimal level of positive end-expiratory pressure should be selected after a stratification of the severity of the disease, also taking into account lung recruitability; monitoring transpulmonary pressure or airway driving pressure can help to avoid lung overstress. Targeting oxygenation of 88-92 % and tolerating a moderate level of hypercapnia are a safe choice. Neuromuscular blocking agents (NMBAs) are useful to maintain patient-ventilation synchrony in the first hours; prone positioning improves oxygenation in most cases and promotes a more homogeneous distribution of ventilation, reducing the risk of VILI; both treatments, also in combination, are associated with an improvement in outcome if applied in the acute phase in the most severe cases. The use of extracorporeal membrane oxygenation (ECMO) in severe ARDS is increasing worldwide, but because of a lack of randomized trials is still considered a rescue therapy. CONCLUSION Severe ARDS patients should receive a holistic framework of respiratory and hemodynamic support aimed to ensure adequate gas exchange while minimizing the risk of VILI, by promoting lung recruitment and setting protective mechanical ventilation. In the most severe cases, NMBAs, prone positioning, and ECMO should be considered.
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Affiliation(s)
- Davide Chiumello
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
| | - Matteo Brioni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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170
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Gelinas JP, Walley KR. Beyond the Golden Hours. Clin Chest Med 2016; 37:347-65. [DOI: 10.1016/j.ccm.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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171
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Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, Masclans JR. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care 2016; 35:200-5. [PMID: 27481760 DOI: 10.1016/j.jcrc.2016.05.022] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to describe early predictors and to develop a prediction tool that accurately identifies the need for mechanical ventilation (MV) in pneumonia patients with hypoxemic acute respiratory failure (ARF) treated with high-flow nasal cannula (HFNC). MATERIALS AND METHODS This is a 4-year prospective observational 2-center cohort study including patients with severe pneumonia treated with HFNC. High-flow nasal cannula failure was defined as need for MV. ROX index was defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate. RESULTS One hundred fifty-seven patients were included, of whom 44 (28.0%) eventually required MV (HFNC failure). After 12 hours of HFNC treatment, the ROX index demonstrated the best prediction accuracy (area under the receiver operating characteristic curve 0.74 [95% confidence interval, 0.64-0.84]; P<.002). The best cutoff point for the ROX index was estimated to be 4.88. In the Cox proportional hazards model, a ROX index greater than or equal to 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk for MV (hazard ratio, 0.273 [95% confidence interval, 0.121-0.618]; P=.002), even after adjusting for potential confounding. CONCLUSIONS In patients with ARF and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours.
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Affiliation(s)
- Oriol Roca
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jonathan Messika
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
| | - Berta Caralt
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spains also been shown
| | - Marina García-de-Acilu
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Benjamin Sztrymf
- AP-HP, Hôpital Antoine Béclère, Service de Réanimation Polyvalente et Surveillance Continue, F-92140 Clamart, France
| | - Jean-Damien Ricard
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
| | - Joan R Masclans
- Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Critical Care Department, Mar University Hospital, Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
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172
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Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume. Crit Care Med 2016; 44:282-90. [PMID: 26584191 DOI: 10.1097/ccm.0000000000001379] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A low or moderate expired tidal volume can be difficult to achieve during noninvasive ventilation for de novo acute hypoxemic respiratory failure (i.e., not due to exacerbation of chronic lung disease or cardiac failure). We assessed expired tidal volume and its association with noninvasive ventilation outcome. DESIGN Prospective observational study. SETTING Twenty-four bed university medical ICU. PATIENTS Consecutive patients receiving noninvasive ventilation for acute hypoxemic respiratory failure between August 2010 and February 2013. INTERVENTIONS Noninvasive ventilation was uniformly delivered using a simple algorithm targeting the expired tidal volume between 6 and 8 mL/kg of predicted body weight. MEASUREMENTS Expired tidal volume was averaged and respiratory and hemodynamic variables were systematically recorded at each noninvasive ventilation session. MAIN RESULTS Sixty-two patients were enrolled, including 47 meeting criteria for acute respiratory distress syndrome, and 32 failed noninvasive ventilation (51%). Pneumonia (n = 51, 82%) was the main etiology of acute hypoxemic respiratory failure. The median (interquartile range) expired tidal volume averaged over all noninvasive ventilation sessions (mean expired tidal volume) was 9.8 mL/kg predicted body weight (8.1-11.1 mL/kg predicted body weight). The mean expired tidal volume was significantly higher in patients who failed noninvasive ventilation as compared with those who succeeded (10.6 mL/kg predicted body weight [9.6-12.0] vs 8.5 mL/kg predicted body weight [7.6-10.2]; p = 0.001), and expired tidal volume was independently associated with noninvasive ventilation failure in multivariate analysis. This effect was mainly driven by patients with PaO2/FIO2 up to 200 mm Hg. In these patients, the expired tidal volume above 9.5 mL/kg predicted body weight predicted noninvasive ventilation failure with a sensitivity of 82% and a specificity of 87%. CONCLUSIONS A low expired tidal volume is almost impossible to achieve in the majority of patients receiving noninvasive ventilation for de novo acute hypoxemic respiratory failure, and a high expired tidal volume is independently associated with noninvasive ventilation failure. In patients with moderate-to-severe hypoxemia, the expired tidal volume above 9.5 mL/kg predicted body weight accurately predicts noninvasive ventilation failure.
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173
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Pisani I, Comellini V, Nava S. Noninvasive ventilation versus oxygen therapy for the treatment of acute respiratory failure. Expert Rev Respir Med 2016; 10:813-21. [PMID: 27159196 DOI: 10.1080/17476348.2016.1184977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is an ongoing discussion on whether oxygen therapy or noninvasive ventilation (NIV) should be used in patient with acute respiratory failure. While respiratory acidosis, especially in case of COPD exacerbation, is a clear indication for NIV, data available in patients with acute hypoxemic respiratory failure (AHRF) are ambiguous. In addition, recently the use of nasal high flow (NHF) has been increased. Despite that NHF has been studied as an alternative to NIV, the clinical advantages of NHF need to be confirmed. AREAS COVERED The purpose of this review is to enhance our understanding about the management of AHRF in specific settings, focusing on recent papers in which NIV and standard oxygen or NHF have been compared. Expert commentary: The choice of the most appropriate strategy for AHRF treatment should be made based upon patient's clinical status, underlying diseases, level of required respiratory support and patient's tolerance and comfort.
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Affiliation(s)
- Iara Pisani
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
| | - Vittoria Comellini
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
| | - Stefano Nava
- a Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit , Alma Mater University , Bologna , Italy
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174
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Yamauchi LY, Figueiroa M, da Silveira LTY, Travaglia TCF, Bernardes S, Fu C. Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice. Rev Bras Ter Intensiva 2016; 27:252-9. [PMID: 26465247 PMCID: PMC4592120 DOI: 10.5935/0103-507x.20150046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/30/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe post-extubation noninvasive positive pressure ventilation use in intensive care unit clinical practice and to identify factors associated with noninvasive positive pressure ventilation failure. METHODS This prospective cohort study included patients aged ≥ 18 years consecutively admitted to the intensive care unit who required noninvasive positive pressure ventilation within 48 hours of extubation. The primary outcome was noninvasive positive pressure ventilation failure. RESULTS We included 174 patients in the study. The overall noninvasive positive pressure ventilation use rate was 15%. Among the patients who used noninvasive positive pressure ventilation, 44% used it after extubation. The failure rate of noninvasive positive pressure ventilation was 34%. The overall mean ± SD age was 56 ± 18 years, and 55% of participants were male. Demographics; baseline pH, PaCO2 and HCO3; and type of equipment used were similar between groups. All of the noninvasive positive pressure ventilation final parameters were higher in the noninvasive positive pressure ventilation failure group [inspiratory positive airway pressure: 15.0 versus 13.7 cmH2O (p = 0.015), expiratory positive airway pressure: 10.0 versus 8.9 cmH2O (p = 0.027), and FiO2: 41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure ventilation failure group. After fitting, the logistic regression model allowed us to state that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure compared with individuals with inspiratory positive airway pressure < 13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040). CONCLUSION The noninvasive positive pressure ventilation failure group had a longer intensive care unit length of stay and a higher mortality rate. Logistic regression analysis identified that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure.
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Affiliation(s)
- Liria Yuri Yamauchi
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, BR
| | - Maise Figueiroa
- Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Leda Tomiko Yamada da Silveira
- Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Teresa Cristina Francischetto Travaglia
- Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Sidnei Bernardes
- Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Carolina Fu
- Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
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175
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Meeder AM, Tjan DHT, van Zanten ARH. Noninvasive and invasive positive pressure ventilation for acute respiratory failure in critically ill patients: a comparative cohort study. J Thorac Dis 2016; 8:813-25. [PMID: 27162654 PMCID: PMC4842833 DOI: 10.21037/jtd.2016.03.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/16/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Noninvasive positive pressure ventilation (NPPV) for acute respiratory failure in the intensive care unit (ICU) is associated with a marked reduction in intubation rate, complications, hospital length of stay and mortality. Multiple studies have indicated that patients failing NPPV have worse outcomes compared with patients with successful NPPV treatment; however limited data is available on risks associated with NPPV failure resulting in (delayed) intubation and outcomes compared with initial intubation. The purpose of this study is to assess rates and predictors of NPPV failure and to compare hospital outcomes of patients with NPPV failure with those patients primarily intubated without a prior NPPV trial. METHODS A retrospective observational study using data from patients with acute respiratory failure admitted to the ICU in the period 2013-2014. All patients treated with NPPV were evaluated. A sample of patients who were primarily intubated was randomly selected to serve as controls for the group of patients who failed NPPV. RESULTS NPPV failure was recorded in 30.8% of noninvasively ventilated patients and was associated with longer ICU stay [OR, 1.16, 95% confidence interval (95% CI): 1.04-1.30] and lower survival rates (OR, 0.10, 95% CI: 0.02-0.59) compared with NPPV success. Multivariate analysis showed presence of severe sepsis at study entry, higher Simplified Acute Physiology II Score (SAPS-II) score, lower ratio of arterial oxygen tension to fraction of inspired oxygen (PF-ratio) and lower plasma glucose were predictors for NPPV failure. After controlling for potential confounders, patients with NPPV failure did not show any difference in hospital outcomes compared with patients who were primarily intubated. CONCLUSIONS Patients with acute respiratory failure and NPPV failure have worse outcomes compared with NPPV success patients, however not worse than initially intubated patients. An initial trial of NPPV therefore may be suitable in selected cases of patients with acute respiratory failure, since NPPV could be potentially beneficial and does not seem to result in worse outcome in case of NPPV failure compared to primary intubation. A prospective trial is warranted to confirm findings.
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176
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Noninvasive ventilation in acute respiratory distress syndrome: Overcoming the learning curve. J Crit Care 2016; 32:227-8. [DOI: 10.1016/j.jcrc.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 11/23/2022]
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177
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Abstract
Noninvasive ventilation (NIV) improves oxygenation and ventilation, prevents endotracheal intubation, and decreases the mortality rate in select patients with acute respiratory failure. Although NIV is used commonly for acute exacerbations of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema, there are emerging indications for its use in the emergency department. Emergency physicians must be knowledgeable regarding the indications and contraindications for NIV in emergency department patients with acute respiratory failure as well as the means of initiating it and monitoring patients who are receiving it.
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Affiliation(s)
- Michael G Allison
- Critical Care Medicine, St. Agnes Hospital, 900 South Caton Avenue, Baltimore, MD 21229, USA
| | - Michael E Winters
- Emergency Medicine/Internal Medicine/Critical Care Program, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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178
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Fey H, Christ M. Nasale High-flow-Sauerstofftherapie. Notf Rett Med 2016. [DOI: 10.1007/s10049-015-0073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vilaça M, Aragão I, Cardoso T, Dias C, Cabral-Campello G. The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. PLoS One 2016; 11:e0149649. [PMID: 26901060 PMCID: PMC4763309 DOI: 10.1371/journal.pone.0149649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Noninvasive ventilation (NIV) is being used increasingly in patients who have a “do not intubate” (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symptoms in end-of-life care. Objective The aim of this prospective study was to determine the outcome and HRQOL impact of regular use of NIV outcomes on patients with a DNI order who were admitted to the emergency room department (ED). Methods: Eligible for participation were DNI-status patients who receive NIV for acute or acute-on-chronic respiratory failure when admitted to the ED of a tertiary care, university-affiliated, 600-bed hospital between January 2014 and December 2014. Patients were divided into 2 groups: (1) those whose DNI order related to a decision to withhold therapy and (2) those for whom any treatment, including NIV, was provided for symptom relief only. HRQOL was evaluated only in group 1, using the 12-item Short Form Health Survey (SF-12). Long-term outcome was evaluated 90 days after hospital discharge by means of a telephone interview. Results During the study period 1727 patients were admitted to the ED, 243 were submitted to NIV and 70 (29%) were included in the study. Twenty-nine (41%) of the 70 enrollees received NIV for symptom relief only (group2). Active cancer [7% vs 35%, p = 0,004] and neuromuscular diseases [0% vs. 17%] were more prevalent in this group. NIV was stopped in 59% of the patients in group 2 due to lake of clinical benefit. The in-hospital mortality rate was 37% for group 1 and 86% for group 2 0,001). Among patients who were discharged from hospital, 23% of the group 1 and all patients in group 2 died within 90 days. Relative to baseline, no significant decline in HRQOL occurred in group 1 by 90 days postdischarge. Conclusion The survival rate was 49% among DNI-status patients for whom NIV was used as a treatment in ED, and these patients did not experience a decline in HRQOL throughout the study. NIV did not provide significant relief of symptoms in more than half the patients who receive it for that purpose.
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Affiliation(s)
- Marta Vilaça
- Medicine Integrated Master (MIM), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto University (UP), Porto, Portugal
- * E-mail:
| | - Irene Aragão
- Intensive Care Unit (UCIP), Oporto Hospital Center, Porto, Portugal
| | - Teresa Cardoso
- Intensive Care Unit (UCIP), Oporto Hospital Center, Porto, Portugal
| | - Cláudia Dias
- Center for Health Technology and Services Research (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, Oporto University (UP), Porto, Portugal
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Acute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unit mortality in clinical practice. J Crit Care 2016; 31:26-30. [DOI: 10.1016/j.jcrc.2015.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/04/2015] [Accepted: 10/26/2015] [Indexed: 12/16/2022]
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Bhatti H, Ramdass A, Cury JD, Jones LM, Shujaat A, Louis M, Seeram V, Bajwa AA. Operator dependent factors implicated in failure of non-invasive positive pressure ventilation (NIPPV) for respiratory failure. CLINICAL RESPIRATORY JOURNAL 2016; 11:901-905. [PMID: 26663322 DOI: 10.1111/crj.12434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-invasive Positive Pressure Ventilation (NIPPV) is employed for the management of acute respiratory failure and studies have shown that it can prevent the need for endotracheal intubation, mechanical ventilation and associated complications. Given limited studies evaluating the factors, other than those related patient or underlying disease severity, that may lead to NIPPV failure, we performed this study to gain insight into current practices in terms of utilization of NIPPV and operator dependent factors that may possibly contribute to failure of NIPPV. METHOD After institutional board review approval a retrospective chart review was performed of consecutive patients who were initiated on and failed NIPPV between January 2009 and December 2009. Data was recorded regarding baseline demographics, admission diagnosis, indications for NIPPV, presence of contraindications, type of NIPPV and initial settings, ABG analysis before and after initiation, whether a titration of the settings was performed or not, operator related factors that may have contributed to failure of NIPPV and clinical outcomes. RESULTS Among 1095 patients screened, 111 failed NIPPV. The mean age was 60 years with 59% males. The most frequent indication for initiating NIPPV was COPD exacerbation (N = 27) followed by pneumonia (N = 26). CPAP was used in 5(6%) patients. Median inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) setting were 10 and 5 cm of H2 O respectively. Three most common reasons for failure were an inappropriate indication (33%), Progression of underlying disease (30%) and lack of titration (23%). Overall mortality was 22%. Mortality was higher when NIPPV failure was seen among patients with an inappropriate indication or an overlooked contraindication compared to those with an appropriate indication (27% vs 17%). CONCLUSIONS Excluding progression of underlying disease, operator dependent factors linked to NIPPV failure are; inappropriate indication, lack of adequate titration and an overlooked contraindication. Inappropriate utilization of NIPPV in respiratory failure is associated with higher mortality.
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Affiliation(s)
- Hammad Bhatti
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | - Avinash Ramdass
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James D Cury
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Lisa M Jones
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Adil Shujaat
- University of Buffalo at State University of New York, Buffalo, NY, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Vandana Seeram
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Abubakr A Bajwa
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
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Abstract
RATIONALE Randomized trials have shown that noninvasive ventilation (NIV) can reduce the need for intubation and improve the survival of patients with severe exacerbations of chronic obstructive pulmonary disease (COPD); however, it is not known whether hospitals with greater use of NIV achieve lower rates of intubation and better patient outcomes. OBJECTIVES To describe patterns of mechanical ventilation use for patients with COPD across a large sample of hospitals, and to analyze the relationship between use of NIV and other outcomes. METHODS Cross-sectional analysis of 77,576 patients hospitalized for COPD between June 2009 and June 2011 at 386 U.S. hospitals. MEASUREMENTS AND MAIN RESULTS Using hierarchical modeling, we estimated hospital risk-standardized percentages of ventilator starts that were noninvasive (RS-NIV%). We examined the association between RS-NIV% and other outcomes, including risk-standardized rates of invasive ventilation and NIV failure, total ventilation, in-hospital mortality, length of stay, and costs. At the hospital level, the median RS-NIV% was 75.1% (range: 9.2-94.1%). Smaller hospitals and those located in rural areas had higher RS-NIV%. When stratified into quartiles on the basis of the RS-NIV%, hospitals in the highest quartile had lower risk-standardized rates of invasive mechanical ventilation (Q4 vs. Q1: 4.0% vs. 13.3%, P<0.01) and modestly higher risk-standardized total rates of ventilation (Q4 vs. Q1: 23.9% vs. 22.0%, P=0.03). Hospitals with the highest RS-NIV% had lower risk-standardized mortality among ventilated patients who received ventilation (Q4 vs. Q1: 8.5% vs. 9.0%, P=0.01) and marginally lower mortality rates among all patients with COPD (Q4 vs. Q1: 2.2% vs. 2.3%, P=0.03) compared with hospitals with the lowest RS-NIV%. Higher RS-NIV% was associated with lower hospital costs (Q4 vs. Q1: $11,148 vs. $14,032, P<0.001), shorter length of stay (Q4 vs. Q1: 5.5 vs. 6.8 d, P<0.001), and lower NIV failure rates (Q4 vs. Q1: 12.8 vs. 32.5%, P<0.001). CONCLUSIONS Use of NIV as the initial ventilation strategy for patients with COPD varies considerably across hospitals. Institutions with greater use of NIV have lower rates of invasive mechanical ventilation and better patient outcomes.
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Corrêa TD, Sanches PR, de Morais LC, Scarin FC, Silva E, Barbas CSV. Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulm Med 2015; 15:144. [PMID: 26559350 PMCID: PMC4642766 DOI: 10.1186/s12890-015-0139-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is used in critically ill patients with acute respiratory failure (ARF) to avoid endotracheal intubation. However, the impact of NIV use on ARF patient's outcomes is still unclear. Our objectives were to evaluate the rate of NIV failure in hypoxemic patients with an arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg or ≥ 45 mmHg at ICU admission, the predictors of NIV failure, ICU and hospital length of stay and 28-day mortality. METHODS Prospective single center cohort study. All consecutive patients admitted to a mixed ICU during a three-month period who received NIV, except for palliative care purposes, were included in this study. Demographic data, APACHE II score, cause of ARF, number of patients that received NIV, incidence of NIV failure, length of ICU, hospital stay and mortality rate were compared between NIV failure and success groups. RESULTS Eighty-five from 462 patients (18.4 %) received NIV and 26/85 (30.6 %) required invasive mechanical ventilation. NIV failure patients were comparatively younger (67 ± 21 vs. 77 ± 14 years; p = 0.031), had lower arterial bicarbonate (p = 0.005), lower PaCO2 levels (p = 0.032), higher arterial lactate levels (p = 0.046) and APACHE II score (p = 0.034) compared to NIV success patients. NIV failure occurred in 25.0 % of patients with PaCO2 ≥ 45 mmHg and in 33.3 % of patients with PaCO2 < 45 mmHg (p = 0.435). NIV failure was associated with an increased risk of in-hospital death (OR 4.64, 95 % CI 1.52 to 14.18; p = 0.007) and length [median (IQR)] of ICU [12 days (8-31) vs. 2 days (1-4); p < 0.001] and hospital [30 (19-42) vs. 15 (9-33) days; p = 0.010] stay. Predictors of NIV failure included age (OR 0.96, 95 % CI 0.93 to 0.99; p = 0.007) and APACHE II score (OR 1.13, 95 % CI 1.02 to 1.25; p = 0.018). CONCLUSION NIV failure was associated with an increased risk of in-hospital death, ICU and hospital stay and was not affected by baseline PaCO2 levels. Patients that failed were comparatively younger and had higher APACHE II score, suggesting the need for a careful selection of patients that might benefit from NIV. A well-designed study on the impact of a short monitored NIV trial on outcomes is needed.
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Affiliation(s)
- Thiago Domingos Corrêa
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
| | - Paula Rodrigues Sanches
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
| | - Lúbia Caus de Morais
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
| | - Farah Christina Scarin
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
| | - Eliézer Silva
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
| | - Carmen Sílvia Valente Barbas
- Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil. .,Pulmonary and Critical Care Division- INCOR, University of São Paulo, São Paulo, Brazil.
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184
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Martinez-Urbistondo D, Alegre F, Carmona-Torre F, Huerta A, Fernandez-Ros N, Landecho MF, García-Mouriz A, Núñez-Córdoba JM, García N, Quiroga J, Lucena JF. Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care. PLoS One 2015; 10:e0139702. [PMID: 26436420 PMCID: PMC4593538 DOI: 10.1371/journal.pone.0139702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022] Open
Abstract
Background Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context. Objective The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction. Design Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting. Patients The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013. Key Results The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power. Conclusions These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care.
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Affiliation(s)
- Diego Martinez-Urbistondo
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Félix Alegre
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Francisco Carmona-Torre
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Ana Huerta
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Nerea Fernandez-Ros
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Manuel Fortún Landecho
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Jorge M. Núñez-Córdoba
- Clínica Universidad de Navarra, Division of Biostatistics, Research Support Service, Central Clinical Trials Unit, Pamplona, Spain
- Department of Preventive Medicine and Public Health, Medical School, Universidad de Navarra, Pamplona, Spain
- Epidemiology and Public Health Area, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Nicolás García
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
| | - Jorge Quiroga
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Juan Felipe Lucena
- Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain
- * E-mail:
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185
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Curley GF, Laffy JG, Zhang H, Slutsky AS. Noninvasive respiratory support for acute respiratory failure-high flow nasal cannula oxygen or non-invasive ventilation? J Thorac Dis 2015; 7:1092-7. [PMID: 26380720 DOI: 10.3978/j.issn.2072-1439.2015.07.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/09/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Gerard F Curley
- 1 Department of Anesthesia, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada ; 2 Department of Anesthesia, 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada ; 4 Department of Medicine, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - John G Laffy
- 1 Department of Anesthesia, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada ; 2 Department of Anesthesia, 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada ; 4 Department of Medicine, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Haibo Zhang
- 1 Department of Anesthesia, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada ; 2 Department of Anesthesia, 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada ; 4 Department of Medicine, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Arthur S Slutsky
- 1 Department of Anesthesia, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada ; 2 Department of Anesthesia, 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada ; 4 Department of Medicine, St Michael's Hospital, and The Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
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186
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Lefebvre A, Rabbat A. Ventilation non invasive et patients immunodéprimés. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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187
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Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Crit Care Med 2015; 43:1386-94. [PMID: 25768682 DOI: 10.1097/ccm.0000000000000945] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the characteristics and hospital outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease treated in the ICU with initial noninvasive ventilation or invasive mechanical ventilation. DESIGN Retrospective, multicenter cohort study of prospectively collected data. We used propensity matching to compare the outcomes of patients treated with noninvasive ventilation to those treated with invasive mechanical ventilation. We also assessed predictors for noninvasive ventilation failure. SETTING Thirty-eight hospitals participating in the Acute Physiology and Chronic Health Evaluation database from 2008 through 2012. SUBJECTS A total of 3,520 patients with a diagnosis of chronic obstructive pulmonary disease exacerbation including 27.7% who received noninvasive ventilation and 45.5% who received invasive mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Noninvasive ventilation failure was recorded in 13.7% from patients ventilated noninvasively. Hospital mortality was 7.4% for patients treated with noninvasive ventilation; 16.1% for those treated with invasive mechanical ventilation; and 22.5% for those who failed noninvasive ventilation. In the propensity-matched analysis, patients initially treated with noninvasive ventilation had a 41% lower risk of death compared with those treated with invasive mechanical ventilation (relative risk, 0.59; 95% CI, 0.36-0.97). Factors that were independently associated with noninvasive ventilation failure were Simplified Acute Physiology Score II (relative risk = 1.04 per point increase; 95% CI, 1.03-1.04) and the presence of cancer (2.29; 95% CI, 0.96-5.45). CONCLUSIONS Among critically ill adults with chronic obstructive pulmonary disease exacerbation, the receipt of noninvasive ventilation was associated with a lower risk of in-hospital mortality compared with that of invasive mechanical ventilation; noninvasive ventilation failure was associated with the worst outcomes. These results support the use of noninvasive ventilation as a first-line therapy in appropriately selected critically ill patients with chronic obstructive pulmonary disease while also highlighting the risks associated with noninvasive ventilation failure and the need to be cautious in the face of severe disease.
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188
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Abstract
PURPOSE OF REVIEW This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. RECENT FINDINGS The efficacy of NIV is variable depending on the cause of the episode of ARF. In community-acquired pneumonia, NIV is often associated with poor response, with better response in patients with preexisting cardiac or respiratory disease. In patients with pandemic influenza H1N1 and severe ARF, NIV has been associated with high failure rates but relatively favorable mortality. In acute respiratory distress syndrome, NIV should be used very cautiously and restricted to patients with mild-moderate acute respiratory distress syndrome without shock or metabolic acidosis due to the high failure rate observed in several reports. Despite limited evidence, NIV may improve the outcomes of patients with chest trauma and severe ARF. In postoperative ARF, both continuous positive airway pressure and NIV are effective to improve clinical outcomes, particularly in those with abdominal, cardiac, and thoracic surgery. SUMMARY Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.
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189
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Ivanovic M, Petrovic J, Miletic M, Danicic A, Bojovic B, Vukcevic M, Lazovic B, Gluvic Z, Hadzievski L, Allsop T, Webb DJ. Rib-cage-movement measurements as a potential new trigger signal in non-invasive mechanical ventilation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:4511-4514. [PMID: 26737297 DOI: 10.1109/embc.2015.7319397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Non-invasive ventilation performed through an oronasal mask is a standard in clinical and homecare mechanical ventilation. Besides all its advantages, inevitable leaks through the mask cause errors in the feedback information provided by the airflow sensor and, hence, patient-ventilator asynchrony with multiple negative consequences. Here we investigate a new way to provide a trigger to the ventilator. The method is based on the measurement of rib cage movement at the onset of inspiration and during breathing by fibre-optic sensors. In a series of simultaneous measurements by a long-period fibre grating sensor and pneumotachograph we provide the statistical evidence of the 200 ms lag of the pneumo with respect the fibre-optic signal. The lag is registered consistently across three independent delay metrics. Further, we discuss exceptions from this trend and identify the needed improvements to the proposed fibre-sensing scheme.
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190
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Russo A. Expert's comment concerning Grand Rounds case entitled "Subarachnoidal pleural fistula after resection of intradural thoracic disc herniation and multimodal treatment with noninvasive positive pressure ventilation (NPPV)" (H. R. Schlag, S. Muquit, T. B. Hristov, G. Morassi, B. M. Boszczyk, M. Shafafy). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26215178 DOI: 10.1007/s00586-015-4147-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Antonino Russo
- Department of Neurosurgery, University Hospital Birmingham, Birmingham, B15 2TH, UK.
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191
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Matsumoto T, Tomii K, Tachikawa R, Otsuka K, Nagata K, Otsuka K, Nakagawa A, Mishima M, Chin K. Role of sedation for agitated patients undergoing noninvasive ventilation: clinical practice in a tertiary referral hospital. BMC Pulm Med 2015; 15:71. [PMID: 26164393 PMCID: PMC4499444 DOI: 10.1186/s12890-015-0072-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
Background Although sedation is often required for agitated patients undergoing noninvasive ventilation (NIV), reports on its practical use have been few. This study aimed to evaluate the efficacy and safety of sedation for agitated patients undergoing NIV in clinical practice in a single hospital. Methods We retrospectively reviewed sedated patients who received NIV due to acute respiratory failure from May 2007 to May 2012. Sedation level was controlled according to the Richmond Agitation Sedation Scale (RASS). Clinical background, sedatives, failure rate of sedation, and complications were evaluated by 1) sedative methods (intermittent only, switched to continuous, or initially continuous) and 2) code status (do-not-intubate [DNI] or non-DNI). Results Of 3506 patients who received NIV, 120 (3.4 %) consecutive patients were analyzed. Sedation was performed only intermittently in 72 (60 %) patients, was switched to continuously in 37 (31 %) and was applied only continuously in 11 (9 %). Underlying diseases in 48 % were acute respiratory distress syndrome/acute lung injury/severe pneumonia or acute exacerbation of interstitial pneumonia. In non-DNI patients (n = 39), no patient required intubation due to agitation with continuous sedation, and in DNI patients (n = 81), 96 % of patients could continue NIV treatment. PaCO2 level changes (6.7 ± 15.1 mmHg vs. -2.0 ± 7.7 mmHg, P = 0.028) and mortality in DNI patients (81 % vs. 57 %, P = 0.020) were significantly greater in the continuous use group than in the intermittent use group. Conclusions According to RASS scores, sedation during NIV in proficient hospitals may be favorably used to potentially avoid NIV failure in agitated patients, even in those having diseases with poor evidence of the usefulness of NIV. However, with continuous use, we must be aware of an increased hypercapnic state and the possibility of increased mortality. Larger controlled studies are needed to better clarify the role of sedation in improving NIV outcomes in intolerant patients. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0072-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takeshi Matsumoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan. .,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 kawahara-cho, shogoin, sakyo-ku, Kyoto, 606-8507, Japan.
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan. .,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 kawahara-cho, shogoin, sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Kyoko Otsuka
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 kawahara-cho, shogoin, sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 kawahara-cho, shogoin, sakyo-ku, Kyoto, 606-8507, Japan.
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192
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Hilbert G, Navalesi P, Girault C. Is sedation safe and beneficial in patients receiving NIV? Yes. Intensive Care Med 2015; 41:1688-91. [DOI: 10.1007/s00134-015-3935-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/17/2015] [Indexed: 01/27/2023]
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193
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Noninvasive Ventilation in the Treatment of Severe Community-Acquired Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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194
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Zamzam MA, Abd El Aziz AA, Elhefnawy MY, Shaheen NA. Study of the characteristics and outcomes of patients on mechanical ventilation in the intensive care unit of EL-Mahalla Chest Hospital. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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195
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Gregoretti C, Pisani L, Cortegiani A, Ranieri VM. Noninvasive Ventilation in Critically Ill Patients. Crit Care Clin 2015; 31:435-57. [DOI: 10.1016/j.ccc.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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196
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Hidalgo V, Giugliano-Jaramillo C, Pérez R, Cerpa F, Budini H, Cáceres D, Gutiérrez T, Molina J, Keymer J, Romero-Dapueto C. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective. Open Respir Med J 2015; 9:120-6. [PMID: 26312104 PMCID: PMC4541452 DOI: 10.2174/1874306401509010120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/22/2022] Open
Abstract
Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physiotherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physiotherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for respiratory therapists.
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Affiliation(s)
- V Hidalgo
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - C Giugliano-Jaramillo
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - R Pérez
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - F Cerpa
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - H Budini
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - D Cáceres
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - T Gutiérrez
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - J Molina
- Escuela de Kinesiología, Universidad del Desarrollo, Santiago, Chile
| | - J Keymer
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - C Romero-Dapueto
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
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197
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Traumatisme thoracique : prise en charge des 48 premières heures. ANESTHESIE & REANIMATION 2015. [DOI: 10.1016/j.anrea.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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198
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Noninvasive support and ventilation for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16:S102-10. [PMID: 26035360 DOI: 10.1097/pcc.0000000000000437] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the widespread use of noninvasive ventilation in children and in children with acute lung injury and pediatric acute respiratory distress syndrome, there are few scientific data on the utility of this therapy. In this review, we examine the literature regarding noninvasive positive pressure ventilation and use the Research ANd Development/University of California, Los Angeles appropriateness methodology to provide strong or weak recommendations for the use of noninvasive positive pressure ventilation in children with pediatric acute respiratory distress syndrome. DATA SOURCES Electronic searches were made in PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus with the following specific keywords: noninvasive ventilation, noninvasive positive pressure ventilation, continuous positive airway pressure, and high-flow nasal cannula. STUDY SELECTION Studies were eligible for inclusion if they included 10 or more children between 1 month and 18 years old. Randomized and nonrandomized controlled trials, controlled before-and-after studies, concurrent cohort studies, interrupted time series studies, historically controlled studies, cohort studies, cross-sectional studies, and uncontrolled longitudinal studies were included for data synthesis. DATA SYNTHESIS The literature provides a solid physiological rationale for the use of noninvasive positive pressure ventilation in children with pediatric acute respiratory distress syndrome. The addition of noninvasive positive pressure ventilation can improve gas exchange and potentially prevent intubation and mechanical ventilation in some children with mild pediatric acute respiratory distress syndrome. Noninvasive positive pressure ventilation is not indicated in severe pediatric acute respiratory distress syndrome. Noninvasive positive pressure ventilation should be performed only in acute care setting with experienced team, and patient-ventilator synchrony is crucial for success. An oronasal interface provides superior support, but close monitoring of children is required due to the risk of progressive respiratory failure and the potential need for intubation. The use of high-flow nasal cannula is a promising treatment for respiratory disease; however, at this time, the efficacy of high-flow nasal cannula compared with noninvasive positive pressure ventilation is unknown. CONCLUSION Noninvasive positive pressure ventilation can be beneficial in children with pediatric acute respiratory distress syndrome, particularly in those with milder disease. However, further research is needed into the use of noninvasive positive pressure ventilation in children.
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199
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Mosier JM, Hypes C, Joshi R, Whitmore S, Parthasarathy S, Cairns CB. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department. Ann Emerg Med 2015; 66:529-41. [PMID: 26014437 DOI: 10.1016/j.annemergmed.2015.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/08/2015] [Accepted: 04/20/2015] [Indexed: 01/19/2023]
Abstract
Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.
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Affiliation(s)
- Jarrod M Mosier
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ.
| | - Cameron Hypes
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | - Raj Joshi
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | - Sage Whitmore
- Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Sairam Parthasarathy
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ
| | - Charles B Cairns
- Department of Emergency Medicine, University of Arizona, Tucson, AZ
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200
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Shetty K, Sherif L, Babu R, Bhatt G. Noninvasive ventilation in a patient with noncardiogenic pulmonary edema following amlodipine poisoning. J Anaesthesiol Clin Pharmacol 2015; 31:264-6. [PMID: 25948919 PMCID: PMC4411852 DOI: 10.4103/0970-9185.155205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kishan Shetty
- Department of Anaesthesiology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Lulu Sherif
- Department of Anaesthesiology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Rakesh Babu
- Department of Anaesthesiology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Girish Bhatt
- Department of Medicine, Kasturba Medical College, Mangalore, Karnataka, India
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