1
|
Landoni G, Likhvantsev V, Kuzovlev A, Cabrini L. Perioperative Noninvasive Ventilation After Adult or Pediatric Surgery: A Comprehensive Review. J Cardiothorac Vasc Anesth 2021; 36:785-793. [PMID: 33893015 DOI: 10.1053/j.jvca.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.
Collapse
Affiliation(s)
- Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy.
| | - Valery Likhvantsev
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Artem Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy; Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| |
Collapse
|
2
|
Chiusolo F, Fanelli V, Ciofi Degli Atti ML, Conti G, Tortora F, Pariante R, Ravà L, Grimaldi C, de Ville de Goyet J, Picardo S. CPAP by helmet for treatment of acute respiratory failure after pediatric liver transplantation. Pediatr Transplant 2018; 22. [PMID: 29171131 DOI: 10.1111/petr.13088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Abstract
ARF after pediatric liver transplantation accounts for high rate of morbidity and mortality associated with this procedure. The role of CPAP in postoperative period is still unknown. The aim of the study was to describe current practice and risk factors associated with the application of helmet CPAP. In this retrospective observational cohort study, 119 recipients were divided into two groups based on indication to CPAP after extubation. Perioperative variables were studied, and determinants of CPAP application were analyzed in a multivariate logistic model. Sixty patients (60/114) developed ARF and were included in the CPAP group. No differences were found between the two groups for primary disease, graft type, and blood product transfused. At multivariate analysis, weight <11 kg (OR = 2.9; 95% CI = 1.1-7.3; P = .026), PaO2 /FiO2 <380 before extubation (OR = 5.4; 95% CI = 2.1-13.6; P < .001), need of vasopressors (OR = 2.6; 95% CI = 1.1-6.4; P = .038), and positive fluid balance >148 mL/kg (OR = 4.0; 95% CI = 1.6-10.1; P = .004) were the main determinants of CPAP application. In the CPAP group, five patients (8.4%) needed reintubation. Pediatric liver recipients with lower weight, higher need of inotropes/vasopressors, higher positive fluid balance after surgery, and lower PaO2 /FiO2 before extubation were at higher odds of developing ARF needing CPAP application.
Collapse
Affiliation(s)
- F Chiusolo
- Department of Anesthesia and Critical Care, ARCO, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - V Fanelli
- Department of Anesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - M L Ciofi Degli Atti
- Department of Epidemiology and Statistical Analysis, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Conti
- Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy
| | - F Tortora
- Department of Anesthesia and Critical Care, ARCO, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - R Pariante
- Department of Anesthesia and Critical Care, ARCO, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Ravà
- Department of Epidemiology and Statistical Analysis, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Grimaldi
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRRCS, Rome, Italy
| | | | - S Picardo
- Department of Anesthesia and Critical Care, ARCO, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
3
|
CHIN K. Overcoming sleep disordered breathing and ensuring sufficient good sleep time for a healthy life expectancy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:609-629. [PMID: 29021511 PMCID: PMC5743861 DOI: 10.2183/pjab.93.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
Recent advances in basic and clinical medicine have resulted in major improvements in human health. Currently sleep has been considered an essential factor in maintaining and promoting a healthy life expectancy. Sleep disorders include more than 60 diseases. Sleep disordered breathings (SDB) have 17 disorders, including sleep apnea. SDB usually induces hypoxemia and hypercapnia, which would have significant effects on cells, organs, and the whole body. We have investigated SDB for nearly 35 years. We found that SDB has significant associations with humoral factors, including coagulation systems, the body's protective factors against diseases, and metabolic and organ diseases. Currently we have been giving attention to the associations among SDB, short sleep duration, and obesity. In addition, SDB is important not only in the home but under critical care such as in the perioperative stage. In this review, I would like to describe several aspects of SDB in relation to systemic diseases and overall health based mainly on our published reports.
Collapse
Affiliation(s)
- Kazuo CHIN
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Chihara Y, Egawa H, Oga T, Tsuboi T, Handa T, Yagi S, Iida T, Yoshizawa A, Yamamoto K, Mishima M, Tanaka K, Uemoto S, Chin K. Predictive Factors for Reintubation following Noninvasive Ventilation in Patients with Respiratory Complications after Living Donor Liver Transplantation. PLoS One 2013; 8:e81417. [PMID: 24339926 PMCID: PMC3855274 DOI: 10.1371/journal.pone.0081417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/12/2013] [Indexed: 12/14/2022] Open
Abstract
Background Postoperative respiratory complications are a major cause of mortality following liver transplantation (LT). Noninvasive ventilation (NIV) appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known. Methods Of 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined. Results Forty-three (24%) of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI) 1.64 to 48.11; p = 0.01), ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007), and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04). The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001). Of the 43 reintubated patients, 22 (51.2%) died during hospitalization following LT vs. 8 (5.9%) of the 136 patients in whom NIV was successful (p<0.0001). Conclusions Because controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.
Collapse
Affiliation(s)
- Yuichi Chihara
- Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Hiroto Egawa
- Department of Gastroenterological Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toru Oga
- Departments of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomomasa Tsuboi
- Departments of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohiro Handa
- Department of Rehabilitation, Kyoto University Hospital, Kyoto, Japan
| | - Shintaro Yagi
- Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Taku Iida
- Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yoshizawa
- Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazuhiko Yamamoto
- Departments of Allergy and Rheumatology, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Koichi Tanaka
- Foundation for Kobe International Medical Alliance, Kobe, Japan
| | - Shinji Uemoto
- Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Chin
- Departments of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| |
Collapse
|
7
|
Abstract
This article focuses on the respiratory management and monitoring of pediatric acute lung injury (ALI) as a specific cause for respiratory failure. Definitive, randomized, controlled trials in pediatrics to guide optimal ventilatory management are few. The only adjunct therapy that has been proved to improve clinical outcome is low tidal volume ventilation, but only in adult patients. Careful monitoring of the patient's respiratory status with airway graphic analysis and capnography can be helpful. Definitive data are needed in the pediatric population to assist in the care of infants, children, and adolescents with ALI to improve survival and functional outcome.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The use of noninvasive ventilation (NIV) has become increasingly popular in the pediatric intensive care unit (PICU) over the last decade. This review intends to assess our current knowledge on the utilization of noninvasive support in children, especially focusing on its efficacy and safety profile. RECENT FINDINGS Recent studies endorse the use of this therapy in the pediatric intensive care setting. NIV appears to be associated with a decrease in the intubation rate in children. Children who are responsive to NIV will usually show improvement in their physiologic parameters shortly after the initiation of this therapy and this improvement is often sustained. NIV is proving to be a well-tolerated alternative to endotracheal intubation, in particular in those patients with primary respiratory failure, postsurgical patients or with postextubation respiratory distress. Most studies represent single-center experience and therefore caution must be exerted when attempting to generalize their results. SUMMARY NIV appears to be a well-tolerated alternative for use in the pediatric population. Its use is associated with decreased intubation rates, which may lead to a decrease in the intubation-related complications. More investigation is needed to fully evaluate the ramifications of increased use of this technology in the PICU.
Collapse
|