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Toujani S, Dabboussi S, Snene H, Mjid M, Kamoun S, Hedhli A, Cheikh Rouhou S, Cheikh R, Beji M, Ouahchi Y, Cherif J. [Home non-invasive ventilation for chronic obstructive pulmonary disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:235-241. [PMID: 29650284 DOI: 10.1016/j.pneumo.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.
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Affiliation(s)
- S Toujani
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie.
| | - S Dabboussi
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital Militaire, Tunis, Tunisie
| | - H Snene
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - M Mjid
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - S Kamoun
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - A Hedhli
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - S Cheikh Rouhou
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - R Cheikh
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital Militaire, Tunis, Tunisie
| | - M Beji
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - Y Ouahchi
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - J Cherif
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
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Mercadante S, Giarratano A, Cortegiani A, Gregoretti C. Application of palliative ventilation: potential and clinical evidence in palliative care. Support Care Cancer 2017; 25:2035-2039. [PMID: 28444449 DOI: 10.1007/s00520-017-3710-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/10/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy. .,Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.
| | - Antonello Giarratano
- Anesthesia and Intensive Care and Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy.,Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Andrea Cortegiani
- Anesthesia and Intensive Care and Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy.,Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy
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Rabec C, Rodenstein D, Leger P, Rouault S, Perrin C, Gonzalez-Bermejo J. [Ventilator modes and settings during non-invasive ventilation: effects on respiratory events and implications for their identification. 2011]. Rev Mal Respir 2013; 30:818-31. [PMID: 24314706 DOI: 10.1016/j.rmr.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/22/2013] [Indexed: 11/26/2022]
Abstract
Compared with invasive ventilation, non-invasive ventilation (NIV) has two unique characteristics: its non-hermetic nature and the fact that the ventilator-lung assembly cannot be considered as a single-compartment model because of the presence of variable resistance represented by the upper airways. When NIV is initiated, the ventilator settings are determined empirically based on clinical evaluation and blood gas variations. However, NIV is predominantly applied during sleep. Consequently, to assess overnight patient-machine "agreement" and efficacy of ventilation, more specific and sophisticated monitoring is needed. The effectiveness of NIV might therefore be more correctly assessed by sleep studies than by daytime assessment. The simplest monitoring can be done from flow and pressure curves from the mask or the ventilator circuit. Examination of these tracings can give useful information to evaluate if the settings chosen by the operator were the right ones for that patient. However, as NIV allows a large range of ventilatory parameters and settings, it is mandatory to have information about this to better understand patient-ventilator interaction. Ventilatory modality, mode of triggering, pressurization slope, use or not of positive end expiratory pressure and type of exhalation as well as ventilator performances may all have physiological consequences. Leaks and upper airway resistance variations may, in turn, modify these patterns. This article discusses the equipment available for NIV, analyses the effect of different ventilator modes and settings and of exhalation and connecting circuits on ventilatory traces and gives the background necessary to understand their impact on nocturnal monitoring of NIV.
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Affiliation(s)
- C Rabec
- Service de pneumologie et réanimation respiratoire, CHU de Dijon, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21079 Dijon, France.
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Rabec C, Gonzalez-Bermejo J, Arnold V, Rouault S, Gillet V, Perrin C, Alluin F, Muir JF, Veale D. Mise en route d’une ventilation non invasive au domicile : propositions du groupe de travail Casavni. Rev Mal Respir 2010; 27:874-89. [DOI: 10.1016/j.rmr.2010.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/23/2010] [Indexed: 11/15/2022]
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Dubois P, Bérenger E. La ventilation à domicile. Ing Rech Biomed 2009. [DOI: 10.1016/j.irbm.2009.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ventilation non invasive et pathologies chroniques : intérêt, indications et modalités de la VNI chez les patients neuromusculaires. Arch Pediatr 2009; 16:755-7. [DOI: 10.1016/s0929-693x(09)74139-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chabot F, Gomez E, Guillaumot A, Kheir A, Chaouat A. [Acute exacerbations of chronic obstructive pulmonary disease]. Presse Med 2009; 38:485-95. [PMID: 19185446 DOI: 10.1016/j.lpm.2008.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 12/21/2008] [Indexed: 11/19/2022] Open
Abstract
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is defined by modification of the usual COPD symptoms, dyspnea, coughing and sputum, beyond daily variations, with a sudden onset, and requiring modification of the usual treatment. Exacerbations stud the course of COPD. Their frequency is variable, averaging 1-2 per year. Their frequency generally increases with COPD severity. Exacerbations impair patients' quality of life and aggravate disease prognosis by accelerating the decline in FEV1, the primary indicator of respiratory function. The most frequent causes of exacerbations are viral and bacterial respiratory infections and pollution. No cause is identified for nearly one third of all exacerbations. Most exacerbations can be treated at home, if a careful search for signs of clinical severity is negative. Treatment combines inhaled bronchodilator agents (beta-2 agonists, combined if necessary with anticholinergics) and oral corticosteroid therapy (prednisone: 0.5 mg/kg/d for 1 week) when the COPD is severe or signs of severity accompany the exacerbation. Antibiotic therapy is justified when the sputum appears purulent. Severe exacerbation may require oxygen therapy in cases of severe hypoxemia (PaO(2)<60 mm Hg) or mechanically assisted ventilation, essentially by noninvasive ventilation in cases of respiratory acidosis (pH<7.35). Noninvasive ventilation improves dyspnea and respiratory acidosis, diminishes respiratory frequency, intubation, duration of hospitalization, nosocomial infections, and mortality. Pulmonary follow-up is necessary after an exacerbation, especially to prevent the recurrence of exacerbations by measures that have been demonstrated to be effective, including help in smoking cessation, adaptation of COPD treatment, vaccination against influenza and pneumonia (pneumococci), and respiratory rehabilitation. Early diagnosis and rapid treatment of exacerbations can limit their impact, improve quality of life, and reduce the risk of hospitalization.
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Affiliation(s)
- François Chabot
- Service des Maladies Respiratoires et Réanimation Respiratoire, Hôpitaux de Brabois, CHU de Nancy, Vandoeuvre-les-Nancy, France.
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Perrin C, Jullien V, Duval Y, Defrance C. Place de la ventilation non invasive dans les soins palliatifs et en fin de vie. Rev Mal Respir 2008; 25:1227-36. [DOI: 10.1016/s0761-8425(08)75088-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chabot F, Mougel D. La ventilation non invasive : ce que nous devons à Paul Sadoul. Rev Mal Respir 2008; 25:1223-6. [DOI: 10.1016/s0761-8425(08)75087-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) has become one of the main indications for domiciliary ventilation, which is usually non-invasive (NIV). This review focuses on the pathophysiology processes and clinical trial data that underlie current guidelines from international societies. STATE OF THE ART To date most published studies about domiciliary ventilation in COPD have been short-term and their message is complicated by the presence of significant methodological problems. The two controlled studies of > or =12 months-duration both found that survival was not improved by long-term NIV. Domiciliary ventilation may be considered when long-term oxygen therapy is unsuccessful and when failed with a progressive deterioration in clinical respiratory status with recurrent episodes of acute hypercapnic respiratory failure. A diurnal PaCO(2) > or =55 mmHg (7.3 kPa) is a necessary but not sufficient condition to consider domiciliary ventilation. CONCLUSION Domiciliary ventilation should only be initiated in selected patients on the basis of clinical symptoms and exacerbation frequency. Until further characterization of patients who are likely to respond, the response to treatment should be assessed regularly.
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Affiliation(s)
- A Cuvelier
- Service de Pneumologie et Unité de Soins Intensifs, UPRES EA 3830-IFR MP23, Centre Hospitalier Universitaire de Rouen, France.
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Toussaint M, Steens M, Van Zeebroeck A, Soudon P. Is disinfection of mechanical ventilation tubing needed at home? Int J Hyg Environ Health 2005; 209:183-90. [PMID: 16376145 DOI: 10.1016/j.ijheh.2005.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 09/09/2005] [Accepted: 09/20/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Home mechanical ventilation is used to treat chronic alveolar hypoventilation. Maintenance protocols for home ventilation circuits (HVC) remain empirical and unproven. We have investigated (1) the cleanliness and sterility of the HVC used by home ventilated patients and (2) the efficiency of tubing cleaning and decontamination protocols recommended to them and used for 12 months or more. METHOD HVC cleanliness was assessed in 39 severe restrictive ventilated patients (16 (T) tracheostomy vs. 23 (N) noninvasive) and in 7 new valves as control. In the first experiment (Exp1), a visual and bacteriologic inspection of the expiratory valve (Eva) was conducted during a consultation in our centre. Eva visual cleanliness was assessed on a 10-point scale and Eva bacteriologic contamination analysis was performed on a dry smear. In the second experiment (Exp2), these analyses were repeated after a cleaning sequence chosen at random, either chemical (ammonium-chlorhexidine complex) (A) or mechanical by dishwasher (B). RESULTS In Exp1, 69% of Eva were dirty. Dirtiness was worse in (T) than in (N) (5.3 vs. 2; p<0.001). There was a significant positive correlation between visual cleanliness and bacteriologic contamination (r=0.56; p<0.001). Eva in group (T) were more contaminated than in group (N) (p<0.001). Eva contamination rates reached 22% in group (N) but without the presence of any potentially pathogenic organisms (PPO) and 81% in group (T) where 19% were PPO. In Exp2, EVA visual cleanliness was better after dishwasher cleaning (B) compared to chemical (A) (0.16 vs. 1.05; p<0.001) with similar bacteriological decontamination. CONCLUSION HVC from noninvasive ventilated patients are dirty but not contaminated by PPO. We recommend washing them in a dishwasher or with detergent and hot water without specific disinfection. PPO contaminated 1/5 of invasive HVC, for which we recommend dishwasher cleaning. Decontamination is only indicated when tubing is visually very dirty or/and when tracheostomized patients are particularly sensitive to respiratory tract infections. The expiratory valve must be carefully washed specifically, with care that its balloon is not placed under water.
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Affiliation(s)
- Michel Toussaint
- Centre for Home Mechanical Ventilation Z.H. Inkendaal and Excellence Centre for Neuromuscular Disorders, Inkendaalstraat 1, 1602 Vlezenbeek, Brussels, Belgium.
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