Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review

Using a novel in-mask non-invasive ventilator microphone to improve talker intelligibility in healthy and hospitalised adults

Purpose: Non-invasive ventilation (NIV) provides respiratory support without invasive endotracheal intubation but can hinder patients' ability to communicate effectively. The current study presents preliminary results using a novel in-mask ventilator microphone to enhance talker intelligibility while receiving NIV.Method: A proof-of-concept study assessed sentence intelligibility of five healthy adult talkers using a prototype model of the microphone under continuous positive airway pressure (CPAP; 5/5 cm H2O) and bilevel positive airway pressure (BiPAP; 8/4 cm H2O) ventilator conditions. A pilot study then assessed intelligibility, subjective comprehensibility and naturalness, and patient- and conversation partner-reported communication outcomes for eight patients undergoing therapeutic NIV while being treated in an intensive care unit (ICU).Result: Intelligibility increased significantly with the microphone on in the BiPAP condition for healthy volunteers. For patients undergoing NIV in an ICU, intelligibility, comprehensibility, and patient and conversation partner ratings of conversation satisfaction significantly improved with the microphone on. Patients with lower baselines without the microphone in certain measures (intelligibility, comprehensibility) generally showed a greater microphone benefit than patients with higher baselines.Conclusion: Use of a novel microphone integrated into NIV improved intelligibility during ventilation for both healthy volunteers and patients undergoing therapeutic NIV. Additional clinical studies will define precise benefits and implications of such improved intelligibility.

Nurses' strategies to enable continuous positive airway pressure therapy in a general medical ward context: A qualitative study

BACKGROUND

Continuous positive airway pressure is a non-invasive therapy beneficial for patients with acute respiratory failure. The need for this therapy outside intensive care units is growing, but nurses face many challenges to enable this therapy in general medical wards.

AIMS AND OBJECTIVES

The aim of the study was to explore nurses' strategies for enabling continuous positive airway pressure therapy in a general medical ward context.

METHOD

An explorative qualitative design was used including semi-structured interviews with 15 Swedish nurses. Data were analysed using a conventional content analysis.

RESULTS

The nurses' strategies included a non-hierarchical approach when utilising an intra- and interprofessional collaboration. Inexperience was compensated for by collaboration. Nurses' strategies involved advanced patient-centred care using interventions to manage and ease the patient's treatment and discomfort. The creation of an alliance with the patient was crucial to prevent treatment failure. The strategies were interrelated and considered as parts of a whole.

CONCLUSION

Nurses described the strategy of a dynamic team that could be enlarged or decreased in tandem with other professionals, depending on the situation and the nurses' needs. Nurses need to have an attentive response to the patients' physical, psychosocial and relational needs and to maintain trust for a positive therapy outcome.

[Psychological aspects during and after intensive care treatment of ARDS]

Approximately 10% of all patients requiring intensive care develop acute respiratory distress syndrome (ARDS). The COVID-19 pandemic led to an accumulation of patients with severe ARDS. The experience of this severe respiratory failure is accompanied by feelings of existential anxiety in many patients.The complexity of the challenges and stresses that the disease and its treatment pose for the ARDS patient require an early multiprofessional approach to treatment already during intensive care. Psychological approaches are suitable to support the patient as well as the relatives in coping with the disease and to minimise risks for potential subsequent stress. Despite the long-term impairments of patients who have survived ARDS and the resulting need for follow-up care, suitable multimodal follow-up care concepts and the necessary care structures are still lacking. The article presents the psychological support during and after the intensive care treatment of ARDS.

[Influence of nurses on the experience of noninvasive ventilation]

Noninvasive ventilation (NIV) is established as an integral part of intensive care therapy for respiratory insufficiency. However, it is associated with restrictions on patient autonomy and comfort. A successful course of therapy is largely dependent on the acceptance and adherence of the patients concerned. Intensive care nurses can have a significant influence on the success of the therapy by dealing with the subjective experience of the patients and by maintaining close contact with them. The prerequisite for this is profound knowledge of the different technical aspects of therapy and equipment as well as positive and negative factors influencing NIV tolerance in order to be able to offer and implement an individual intervention.