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Demoule A, Baptiste A, Thille AW, Similowski T, Ragot S, Prat G, Mercat A, Girault C, Carteaux G, Boulain T, Perbet S, Decavèle M, Belin L, Frat JP. Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure. Crit Care 2024; 28:174. [PMID: 38783367 PMCID: PMC11118550 DOI: 10.1186/s13054-024-04903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population. METHODS This was a secondary analysis of a multicenter, randomized, controlled trial. Dyspnea was quantified by a visual analog scale (dyspnea-VAS) from zero to 100 mm. Dyspnea was measured in 259 of the 310 patients included. Factors associated with intubation were assessed with a competing risks model taking into account ICU discharge. The Cox model was used to evaluate factors associated with 90-day mortality. RESULTS At baseline (randomization in the parent trial), median dyspnea-VAS was 46 (interquartile range, 16-65) mm and was ≥ 40 mm in 146 patients (56%). The intubation rate was 45%. Baseline variables independently associated with intubation were moderate (dyspnea-VAS 40-64 mm) and severe (dyspnea-VAS ≥ 65 mm) dyspnea at baseline (sHR 1.96 and 2.61, p = 0.023), systolic arterial pressure (sHR 2.56, p < 0.001), heart rate (sHR 1.94, p = 0.02) and PaO2/FiO2 (sHR 0.34, p = 0.028). 90-day mortality was 20%. The cumulative probability of survival was lower in patients with baseline dyspnea-VAS ≥ 40 mm (logrank test, p = 0.049). Variables independently associated with mortality were SAPS 2 ≥ 25 (p < 0.001), moderate-to-severe dyspnea at baseline (p = 0.073), PaO2/FiO2 (p = 0.118), and treatment arm (p = 0.046). CONCLUSIONS In patients admitted to the ICU for de novo acute hypoxemic respiratory failure, dyspnea is associated with a higher risk of intubation and with a higher mortality. TRIAL REGISTRATION clinicaltrials.gov Identifier # NCT01320384.
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Affiliation(s)
- Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France.
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.
| | - Amandine Baptiste
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Unité de Recherche Clinique, AP-HP, Paris, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département R3S, AP-HP, 75013, Paris, France
| | - Stephanie Ragot
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Gwénael Prat
- Service de Médecine Intensive et Réanimation, CHU de Brest, Brest, France
| | - Alain Mercat
- Service de Réanimation médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
| | - Christophe Girault
- UNIROUEN, UR 3830, Medical Intensive Care Unit, Rouen University Hospital, Normandie University, Rouen, France
| | - Guillaume Carteaux
- Hôpitaux Universitaires Henri Mondor, Service de Médecine Intensive Réanimation, Université Paris Est Créteil, Groupe de Recherche Clinique CARMAS, AP-HP, Créteil, France
| | - Thierry Boulain
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France
| | - Sébastien Perbet
- Réanimation Médico-Chirurgicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- GReD, UMR/CNRS 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Hôpital Universitaire Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Lisa Belin
- Site Pitié-Salpêtrière, Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, APHP-Sorbonne Université, Paris, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
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Zanza C, Saglietti F, Tesauro M, Longhitano Y, Savioli G, Balzanelli MG, Romenskaya T, Cofone L, Pindinello I, Racca G, Racca F. Cardiogenic Pulmonary Edema in Emergency Medicine. Adv Respir Med 2023; 91:445-463. [PMID: 37887077 PMCID: PMC10604083 DOI: 10.3390/arm91050034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
Cardiogenic pulmonary edema (CPE) is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung's alveolar spaces due to an elevated cardiac filling pressure. All cardiac diseases, characterized by an increasing pressure in the left side of the heart, can cause CPE. High capillary pressure for an extended period can also cause barrier disruption, which implies increased permeability and fluid transfer into the alveoli, leading to edema and atelectasis. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Some studies claim that these patients may have higher levels of surfactant protein B in the bloodstream. The correct approach to patients with CPE should include a detailed medical history and a physical examination to evaluate signs and symptoms of CPE as well as potential causes. Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should occur in the meantime. The identification of the specific CPE phenotype is essential to set the most appropriate therapy for these patients. Non-invasive ventilation (NIV) should be considered early in the treatment of this disease. Diuretics and vasodilators are used for pulmonary congestion. Hypoperfusion requires treatment with inotropes and occasionally vasopressors. Patients with persistent symptoms and diuretic resistance might benefit from additional approaches (i.e., beta-agonists and pentoxifylline). This paper reviews the pathophysiology, clinical presentation, and management of CPE.
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Affiliation(s)
- Christian Zanza
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Francesco Saglietti
- Department of Emergency and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | - Manfredi Tesauro
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Tatsiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Cofone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Ivano Pindinello
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
| | - Fabrizio Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
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3
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Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema. Am J Emerg Med 2022; 56:71-76. [DOI: 10.1016/j.ajem.2022.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/17/2022] Open
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4
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Faqihi BM, Trethewey SP, Morlet J, Parekh D, Turner AM. Bilevel positive airway pressure ventilation for non-COPD acute hypercapnic respiratory failure patients: A systematic review and meta-analysis. Ann Thorac Med 2021; 16:306-322. [PMID: 34820018 PMCID: PMC8588943 DOI: 10.4103/atm.atm_683_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to prespecified criteria (PROSPERO-CRD42018089875). Randomized controlled trials (RCTs) assessing the effectiveness of BiPAP versus continuous positive airway pressure (CPAP), invasive mechanical ventilation, or O2 therapy in adults with non-COPD AHRF were included. The primary outcomes of interest were the rate of endotracheal intubation (ETI) and mortality. Risk-of-bias assessment was performed, and data were synthesized and meta-analyzed where appropriate. Two thousand four hundred and eighty-five records were identified after removing duplicates. Eighty-eight articles were identified for full-text assessment, of which 82 articles were excluded. Six studies, of generally low or uncertain risk-of-bias, were included involving 320 participants with acute cardiogenic pulmonary edema (ACPO) and solid tumors. No significant differences were seen between BiPAP ventilation and CPAP with regard to the rate of progression to ETI (risk ratio [RR] = 1.49, 95% confidence interval [CI], 0.63-3.62, P = 0.37) and in-hospital mortality rate (RR = 0.71, 95% CI, 0.25-1.99, P = 0.51) in patients with AHRF due to ACPO. The efficacy of BiPAP appears similar to CPAP in reducing the rates of ETI and mortality in patients with AHRF due to ACPO. Further research on other non-COPD conditions which commonly cause AHRF such as obesity hypoventilation syndrome is needed.
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Affiliation(s)
- Bandar M Faqihi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Respiratory Therapy Department, College of Applied Medical Sciences, King Saud bin Abdul Aziz University for Health Sciences, Saudi Arabia
| | | | - Julien Morlet
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Dhruv Parekh
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
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5
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2021; 45:298-312. [PMID: 34059220 DOI: 10.1016/j.medine.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, Spain
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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6
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients With Severe Acute Respiratory Failure. Arch Bronconeumol 2021; 57:415-427. [PMID: 34088393 DOI: 10.1016/j.arbr.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analog classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid, Spain; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients with Severe Acute Respiratory Failure. Arch Bronconeumol 2020. [PMID: 33309418 DOI: 10.1016/j.arbres.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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8
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2020; 45:298-312. [PMID: 33309463 DOI: 10.1016/j.medin.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, España
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - I Gutiérrez Ibarluzea
- Fundación vasca de Innovación e Investigación Sanitarias, Barakaldo, Vizcaya, España
| | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria deExtremadura (INUBE), Cáceres, España
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo deTrabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, España
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, España
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Madrid, España
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Madrid, España
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Madrid, España
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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10
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Berbenetz N, Wang Y, Brown J, Godfrey C, Ahmad M, Vital FMR, Lambiase P, Banerjee A, Bakhai A, Chong M. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2019; 4:CD005351. [PMID: 30950507 PMCID: PMC6449889 DOI: 10.1002/14651858.cd005351.pub4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-invasive positive pressure ventilation (NPPV) has been used to treat respiratory distress due to acute cardiogenic pulmonary oedema (ACPE). We performed a systematic review and meta-analysis update on NPPV for adults presenting with ACPE. OBJECTIVES To evaluate the safety and effectiveness of NPPV compared to standard medical care (SMC) for adults with ACPE. The primary outcome was hospital mortality. Important secondary outcomes were endotracheal intubation, treatment intolerance, hospital and intensive care unit length of stay, rates of acute myocardial infarction, and adverse event rates. SEARCH METHODS We searched CENTRAL (CRS Web, 20 September 2018), MEDLINE (Ovid, 1946 to 19 September 2018), Embase (Ovid, 1974 to 19 September 2018), CINAHL Plus (EBSCO, 1937 to 19 September 2018), LILACS, WHO ICTRP, and clinicaltrials.gov. We also reviewed reference lists of included studies. We applied no language restrictions. SELECTION CRITERIA We included blinded or unblinded randomised controlled trials in adults with ACPE. Participants had to be randomised to NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care (SMC) compared with SMC alone. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected articles for inclusion. We extracted data with a standardised data collection form. We evaluated the risks of bias of each study using the Cochrane 'Risk of bias' tool. We assessed evidence quality for each outcome using the GRADE recommendations. MAIN RESULTS We included 24 studies (2664 participants) of adult participants (older than 18 years of age) with respiratory distress due to ACPE, not requiring immediate mechanical ventilation. People with ACPE presented either to an Emergency Department or were inpatients. ACPE treatment was provided in an intensive care or Emergency Department setting. There was a median follow-up of 13 days for hospital mortality, one day for endotracheal intubation, and three days for acute myocardial infarction. Compared with SMC, NPPV may reduce hospital mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; participants = 2484; studies = 21; I2 = 6%; low quality of evidence) with a number needed to treat for an additional beneficial outcome (NNTB) of 17 (NNTB 12 to 32). NPPV probably reduces endotracheal intubation rates (RR 0.49, 95% CI 0.38 to 0.62; participants = 2449; studies = 20; I2 = 0%; moderate quality of evidence) with a NNTB of 13 (NNTB 11 to 18). There is probably little or no difference in acute myocardial infarction (AMI) incidence with NPPV compared to SMC for ACPE (RR 1.03, 95% CI 0.91 to 1.16; participants = 1313; studies = 5; I2 = 0%; moderate quality of evidence). We are uncertain as to whether NPPV increases hospital length of stay (mean difference (MD) -0.31 days, 95% CI -1.23 to 0.61; participants = 1714; studies = 11; I2 = 55%; very low quality of evidence). Adverse events were generally similar between NPPV and SMC groups, but evidence was of low quality. AUTHORS' CONCLUSIONS Our review provides support for continued clinical application of NPPV for ACPE, to improve outcomes such as hospital mortality and intubation rates. NPPV is a safe intervention with similar adverse event rates to SMC alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.
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Affiliation(s)
| | - Yongjun Wang
- Schulich School of Medicine & Dentistry, Western UniversityKresge Building, Rm. K1LondonONCanada
| | | | | | - Mahmood Ahmad
- Royal Free Hospital, Royal Free London NHS Foundation TrustCardiology DepartmentLondonUK
| | - Flávia MR Vital
- Cochrane Brazil Minas GeraisAv. Cristiano Ferreira Varella, 555MuriaéMinas GeraisBrazil36888‐233
| | - Pier Lambiase
- The Heart Hospital, University College London HospitalsCentre for Cardiology in the Young16‐18 Westmoreland Street,LondonUKW1G 8PH
| | - Amitava Banerjee
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Ameet Bakhai
- Royal Free London NHS Foundation TrustBarnet General Hospital Cardiology DepartmentBarnet General HospitalThames House, Wellhouse LaneBarnetEnfieldUKEN5 3DJ
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11
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Ventilación mecánica no invasiva versus presión continua positiva en la vía aérea en el edema agudo de pulmón cardiogénico en una unidad de cuidados intensivos. Arch Bronconeumol 2019; 55:63-64. [DOI: 10.1016/j.arbres.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022]
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12
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Long B, Koyfman A, Gottlieb M. Management of Heart Failure in the Emergency Department Setting: An Evidence-Based Review of the Literature. J Emerg Med 2018; 55:635-646. [DOI: 10.1016/j.jemermed.2018.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/09/2018] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
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13
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Dangers L, Montlahuc C, Kouatchet A, Jaber S, Meziani F, Perbet S, Similowski T, Resche-Rigon M, Azoulay E, Demoule A. Dyspnoea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact: A prospective observational study. Eur Respir J 2018; 52:13993003.02637-2017. [PMID: 29976650 DOI: 10.1183/13993003.02637-2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2018] [Indexed: 11/05/2022]
Abstract
Dyspnoea is a frequent and intense symptom in intubated patients, but little attention has been paid to dyspnoea during noninvasive mechanical ventilation in the intensive care unit (ICU).The objectives of this study were to quantify the prevalence, intensity and prognostic impact of dyspnoea in patients receiving noninvasive ventilation (NIV) for acute respiratory failure (ARF) based on secondary analysis of a prospective observational cohort study in patients who received ventilatory support for ARF in 54 ICUs in France and Belgium. Dyspnoea was measured by a modified Borg scale.Among the 426 patients included, the median (interquartile range) dyspnoea score was 4 (3-5) on admission and 3 (2-4) after the first NIV session (p=0.001). Dyspnoea intensity ≥4 after the first NIV session was associated with the Sequential Organ Failure Assessment Score (odds ratio (OR) 1.12, p=0.001), respiratory rate (OR 1.03, p=0.032), anxiety (OR 1.92, p=0.006), leaks (OR 2.5, p=0.002) and arterial carbon dioxide tension (OR 0.98, p=0.025). Dyspnoea intensity ≥4 was independently associated with NIV failure (OR 2.41, p=0.001) and mortality (OR 2.11, p=0.009), but not with higher post-ICU burden and altered quality of life.Dyspnoea is frequent and intense in patients receiving NIV for ARF and is associated with a higher risk of NIV failure and poorer outcome.
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Affiliation(s)
- Laurence Dangers
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie et Réanimation Médicale (Dépt "R3S"), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Claire Montlahuc
- Service de Biostatistique et Information Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, INSERM, UMR-1153 (CRESS), Epidémiologie Clinique, Statistique pour la Recherche en Santé (ECSTRA), Paris, France
| | - Achille Kouatchet
- Service de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
| | - Samir Jaber
- Dépt d'Anesthésie et Réanimation, Hôpital Saint-Eloi, Montpellier, France.,Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg and EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Sébastien Perbet
- Réanimation Médico-Chirurgicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA-7281, Université d'Auvergne, Clermont-Ferrand, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie et Réanimation Médicale (Dépt "R3S"), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistique et Information Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, INSERM, UMR-1153 (CRESS), Epidémiologie Clinique, Statistique pour la Recherche en Santé (ECSTRA), Paris, France
| | - Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint-Louis, Paris, France
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14
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Moret Iurilli C, Brunetti ND, Di Corato PR, Salvemini G, Di Biase M, Ciccone MM, Procacci V. Hyperacute Hemodynamic Effects of BiPAP Noninvasive Ventilation in Patients With Acute Heart Failure and Left Ventricular Systolic Dysfunction in Emergency Department. J Intensive Care Med 2018; 33:128-133. [DOI: 10.1177/0885066617740849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: Acute heart failure (AHF) is one of the leading causes of admission to emergency department (ED); severe hypoxemic AHF may be treated with noninvasive ventilation (NIV). Despite the demonstrated clinical efficacy of NIV in relieving symptoms of AHF, less is known about the hyperacute effects of bilevel positive airway pressure (BiPAP) ventilation on hemodynamics of patients admitted to ED for AHF. We therefore aimed to assess the effect of BiPAP ventilation on principal hemodynamic, respiratory, pulse oximetry, and microcirculation indexes in patients admitted to ED for AHF, needing NIV. Methods: Twenty consecutive patients admitted to ED for AHF and left ventricular systolic dysfunction, needing NIV, were enrolled in the study; all patients were treated with NIV in BiPAP mode. The following parameters were measured at admission to ED (T0, baseline before treatment), 3 hours after admission and initiation of BiPAP NIV (T1), and after 6 hours (T2): arterial blood oxygenation (pH, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio, Paco2, lactate concentration, HCO3−), hemodynamics (tricuspid annular plane systolic excursion, transpulmonary gradient, transaortic gradient, inferior vena cava diameter, brain natriuretic peptide [BNP] levels), microcirculation perfusion (end-tidal CO2 [etco2], peripheral venous oxygen saturation [SpvO2]). Results: All evaluated indexes significantly improved over time (analysis of variance, P < .001 in quite all cases.). Conclusions: The BiPAP NIV may rapidly ameliorate several hemodynamic, arterial blood gas, and microcirculation indexes in patients with AHF and left ventricular systolic dysfunction.
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Affiliation(s)
| | | | | | - Giuseppe Salvemini
- Emergency Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | | | - Vito Procacci
- Emergency Department, Ospedali Riuniti University Hospital, Foggia, Italy
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15
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Rizzetti DA, Quadros JRB, Ribeiro BE, Callegaro L, Veppo AA, Wiggers GA, Peçanha FM. Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water. ACTA ACUST UNITED AC 2018; 43:409-415. [PMID: 29340488 PMCID: PMC5792039 DOI: 10.1590/s1806-37562017000000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/15/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. METHODS This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. RESULTS We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. CONCLUSIONS When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.
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Affiliation(s)
| | | | - Bruna Esmerio Ribeiro
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | - Letícia Callegaro
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | - Aline Arebalo Veppo
- . Residência Multiprofissional em Saúde, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | | | - Franck Maciel Peçanha
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
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16
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Masip J, Peacock WF, Price S, Cullen L, Martin-Sanchez FJ, Seferovic P, Maisel AS, Miro O, Filippatos G, Vrints C, Christ M, Cowie M, Platz E, McMurray J, DiSomma S, Zeymer U, Bueno H, Gale CP, Lettino M, Tavares M, Ruschitzka F, Mebazaa A, Harjola VP, Mueller C. Indications and practical approach to non-invasive ventilation in acute heart failure. Eur Heart J 2018; 39:17-25. [PMID: 29186485 PMCID: PMC6251669 DOI: 10.1093/eurheartj/ehx580] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/11/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022] Open
Abstract
In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.
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Affiliation(s)
- Josep Masip
- Department of Intensive Care, Consorci Sanitari Integral, University of Barcelona, Jacint Verdaguer 90, Sant Joan Despí, ES-08970 Barcelona, Spain
- Department of Cardiology, Hospital Sanitas CIMA, Barcelona, Manuel Girona 33, ES 08034 Barcelona, Spain
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women’s Hospital. Faculty of Health, Queensland University of Technology and University of Queensland, Brisbane, Australia
| | - F Javier Martin-Sanchez
- Department of Emergency, Hospital Clínico San Carlos. Instituto de Investigacıón Sanitaria (IdISSC), Madrid, Spain
| | - Petar Seferovic
- Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Department of Cardiology, VA San Diego, USA
| | - Oscar Miro
- Department of Emergency, Hospital Clínic, “Processes and Pathologies, Emergencies Research Group” IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Christiaan Vrints
- Faculty of Medicine and Health Sciences at University of Antwerp, Antwerp, Belgium
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Katonsspital, Lucerne, Switzerland
| | - Martin Cowie
- Department of Cardiology, Imperial College London (Royal Brompton Hospital & Harefield Foundation Trust), London, UK
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - John McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Salvatore DiSomma
- Department of Emergency, Sant’Andrea Hospital. II Faculty of Medicine and Psychology, “LaSapienza”, Rome University, Rome, Italy
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Klinikum Ludwigshafen, Germany
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Department of Cardiology, Hospital 12 de Octubre, Madrid, Universidad Complutense de Madrid, Madrid, Spain
| | - Chris P Gale
- Department of Cardiology, York Teaching Hospital, Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, York, UK
| | | | - Mucio Tavares
- Department of Emergency, Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, U942 Inserm, APHP Hôpitaux Universitaires Saint Louis Lariboisiére, Université Paris Diderot and Hospital Lariboisiére, Paris, France
| | - Veli-Pekka Harjola
- Department of Emergency Medicine and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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17
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Pengo MF, Bonafini S, Fava C, Steier J. Cardiorespiratory interaction with continuous positive airway pressure. J Thorac Dis 2018; 10:S57-S70. [PMID: 29445529 PMCID: PMC5803058 DOI: 10.21037/jtd.2018.01.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/09/2018] [Indexed: 12/27/2022]
Abstract
The treatment of choice for obstructive sleep apnoea (OSA) is continuous positive airway pressure therapy (CPAP). Since its introduction in clinical practice, CPAP has been used in various clinical conditions with variable and heterogeneous outcomes. In addition to the well-known effects on the upper airway CPAP impacts on intrathoracic pressures, haemodynamics and blood pressure (BP) control. However, short- and long-term effects of CPAP therapy depend on multiple variables which include symptoms, underlying condition, pressure used, treatment acceptance, compliance and usage. CPAP can alter long-term cardiovascular risk in patients with cardiorespiratory conditions. Furthermore, the effect of CPAP on the awake patient differs from the effect on the patients while asleep, and this might contribute to discomfort and removal of the use interface. The purpose of this review is to highlight the physiological impact of CPAP on the cardiorespiratory system, including short-term benefits and long-term outcomes.
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Affiliation(s)
- Martino F. Pengo
- King’s College London, Faculty of Life Sciences and Medicine, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Sara Bonafini
- Department of Medicine, General Medicine and Hypertension Unit, University of Verona, Italy
| | - Cristiano Fava
- Department of Medicine, General Medicine and Hypertension Unit, University of Verona, Italy
| | - Joerg Steier
- King’s College London, Faculty of Life Sciences and Medicine, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
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18
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Belenguer-Muncharaz A, Mateu-Campos L, González-Luís R, Vidal-Tegedor B, Ferrándiz-Sellés A, Árguedas-Cervera J, Altaba-Tena S, Casero-Roig P, Moreno-Clarí E. Non-Invasive Mechanical Ventilation Versus Continuous Positive Airway Pressure Relating to Cardiogenic Pulmonary Edema in an Intensive Care Unit. Arch Bronconeumol 2017; 53:561-567. [PMID: 28689679 DOI: 10.1016/j.arbres.2017.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To compare the application of non-invasive ventilation (NIV) versus continuous positive airway pressure (CPAP) in the treatment of patients with cardiogenic pulmonary edema (CPE) admitted to an intensive care unit (ICU). METHODS In a prospective, randomized, controlled study performed in an ICU, patients with CPE were assigned to NIV (n=56) or CPAP (n=54). Primary outcome was intubation rate. Secondary outcomes included duration of ventilation, length of ICU and hospital stay, improvement of gas exchange, complications, ICU and hospital mortality, and 28-day mortality. The outcomes were analyzed in hypercapnic patients (PaCO2>45mmHg) with no underlying chronic lung disease. RESULTS Both devices led to similar clinical and gas exchange improvement; however, in the first 60min of treatment a higher PaO2/FiO2 ratio was observed in the NIV group (205±112 in NIV vs. 150±84 in CPAP, P=.02). The rate of intubation was similar in both groups (9% in NIV vs. 9% in CPAP, P=1.0). There were no differences in duration of ventilation, ICU and length of hospital stay. There were no significant differences in ICU, hospital and 28-d mortality between groups. In the hypercapnic group, there were no differences between NIV and CPAP. CONCLUSIONS Either NIV or CPAP are recommended in patients with CPE in the ICU. Outcomes in the hypercapnic group with no chronic lung disease were similar using NIV or CPAP.
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Affiliation(s)
- Alberto Belenguer-Muncharaz
- Intensive Care Unit, Hospital General Universitario de Castelló, Spain; Unidad Predepartamental Medicina, Facultad Ciencias de la Salud, Universitat Jaume I de Castelló, Spain.
| | - Lidón Mateu-Campos
- Intensive Care Unit, Hospital General Universitario de Castelló, Spain; Unidad Predepartamental Medicina, Facultad Ciencias de la Salud, Universitat Jaume I de Castelló, Spain
| | | | | | - Amparo Ferrándiz-Sellés
- Intensive Care Unit, Hospital General Universitario de Castelló, Spain; Unidad Predepartamental Medicina, Facultad Ciencias de la Salud, Universitat Jaume I de Castelló, Spain
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19
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Briones Claudett KH. Acidemia in severe acute cardiogenic pulmonary edema treated with noninvasive pressure support ventilation. J Cardiovasc Med (Hagerstown) 2016; 17:225-6. [DOI: 10.2459/jcm.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Peacock WF, Cannon CM, Singer AJ, Hiestand BC. Considerations for initial therapy in the treatment of acute heart failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:399. [PMID: 26556500 PMCID: PMC4641403 DOI: 10.1186/s13054-015-1114-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of patients presenting to the emergency department with acute heart failure (AHF) is challenging due to the similarity of AHF symptoms to other conditions such as chronic obstructive pulmonary disease and pneumonia. Additionally, because AHF is most common in an older population, the presentation of coexistent pathologies further increases the challenge of making an accurate diagnosis and selecting the most appropriate treatment. Delays in the diagnosis and treatment of AHF can result in worse outcomes and higher healthcare costs. Rapid initiation of treatment is thus necessary for optimal disease management. Early treatment decisions for patients with AHF can be guided by risk-stratification models based on initial clinical data, including blood pressure, levels of troponin, blood urea nitrogen, serum creatinine, B-type natriuretic peptide, and ultrasound. In this review, we discuss methods for differentiating high-risk and low-risk patients and provide guidance on how treatment decisions can be informed by risk-level assessment. Through the use of these approaches, emergency physicians can play an important role in improving patient management, preventing unnecessary hospitalizations, and lowering healthcare costs. This review differs from others published recently on the topic of treating AHF by providing a detailed examination of the clinical utility of diagnostic tools for the differentiation of dyspneic patients such as bedside ultrasound, hemodynamic changes, and interrogation of implantable cardiac devices. In addition, our clinical guidance on considerations for initial pharmacologic therapy in the undifferentiated patient is provided. It is crucial for emergency physicians to achieve an early diagnosis of AHF and initiate therapy in order to reduce morbidity, mortality, and healthcare costs.
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Affiliation(s)
- William F Peacock
- Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030, USA.
| | - Chad M Cannon
- Department of Emergency Medicine, The University of Kansas Hospital, 3901 Rainbow Blvd, MS1910, Kansas City, KS 66160, USA.
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, HSC-L4-080, Stony Brook, NY, 11794, USA.
| | - Brian C Hiestand
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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21
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Kuo DC, Peacock WF. Diagnosing and managing acute heart failure in the emergency department. Clin Exp Emerg Med 2015; 2:141-149. [PMID: 27752588 PMCID: PMC5052845 DOI: 10.15441/ceem.15.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 12/11/2022] Open
Abstract
Heart failure is a clinical syndrome that results from the impairment of ventricular filling or ejection of blood and affects millions of people worldwide. Diagnosis may not be straightforward and at times may be difficult in an undifferentiated patient. However, rapid evaluation and diagnosis is important for the optimal management of acute heart failure. We review the many aspects of diagnosing and treating acute heart failure in the emergency department.
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Affiliation(s)
- Dick C Kuo
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - W Frank Peacock
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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22
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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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23
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Abstract
After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique.
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Affiliation(s)
- Arantxa Mas
- Critical Care Department, Consorci Sanitari Integral (CSI), Hospital Sant Joan Despí Moisès Broggi and Hospital General de l’Hospitalet, University of Barcelona, Barcelona, Spain
| | - Josep Masip
- Critical Care Department, Consorci Sanitari Integral (CSI), Hospital Sant Joan Despí Moisès Broggi and Hospital General de l’Hospitalet, University of Barcelona, Barcelona, Spain
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