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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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2
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Adi O, Via G, Salleh SH, Chuan TW, Rahman JA, Muhammad NAN, Atan R, Yunos N. Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department. Am J Emerg Med 2021; 49:385-392. [PMID: 34271286 DOI: 10.1016/j.ajem.2021.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
STUDY OBJECTIVE To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). METHODS Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate. RESULTS 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP. CONCLUSION In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.
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Affiliation(s)
- Osman Adi
- Raja Permaisuri Bainun Hospital, Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Jalan Raja Ashman (Jalan Hospital), 30450 Ipoh, Perak, Malaysia.
| | - Gabriele Via
- Cardiac Anesthesia & Intensive Care - Cardiocentro Ticino, Lugano, Switzerland.
| | - Siti Hafsah Salleh
- Raja Permaisuri Bainun Hospital, Trauma & Emergency Department, Hospital Slim River, Slim River, Perak, Malaysia.
| | - Tan Wan Chuan
- Raja Permaisuri Bainun Hospital, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Jalan Raja Ashman (Jalan Hospital), 30450 Ipoh, Perak, Malaysia.
| | - Jamalludin Ab Rahman
- International Islamic University, Department of Community Medicine, Faculty of Medicine, Kuantan, Pahang, Malaysia.
| | - Nik Azlan Nik Muhammad
- Department of Emergency Medicine, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Rafidah Atan
- Department of Anaesthesiology, Faculty of Medicine, Malaysia Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Malaysia.
| | - Nor'Azim Yunos
- Department of Anaesthesiology, Faculty of Medicine, Malaysia Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Malaysia.
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Gulla KM, Kabra SK, Lodha R. Feasibility of Pediatric Non-Invasive Respiratory Support in Low- and Middle-Income Countries. Indian Pediatr 2021. [PMID: 33941707 PMCID: PMC8639409 DOI: 10.1007/s13312-021-2377-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-Invasive respiratory support can be viewed as mechanical respiratory support without endotracheal intubation and it includes continuous positive airway pressure, bi-level positive airway pressure, high flow nasal cannula, and non-invasive positive pressure ventilation. Over past few years, non-invasive respiratory support is getting more popular across pediatric intensive care units for acute respiratory failure as well as for long-term ventilation support at home. It reduces the need for invasive mechanical ventilation, decreases the risk of nosocomial pneumonia as well as mortality in selected pediatric and adult population. Unfortunately, majority of available studies on non-invasive respiratory support have been conducted in high-income countries, which are different from low-and middle-income countries (LMICs) in terms of resources, manpower, and the disease profile. Hence, we need to consider disease profile, severity at hospital presentation, availability of age-appropriate equipment, ability of healthcare professionals to manage patients on non-invasive respiratory support, and cost-benefit ratio. In view of the relatively high cost of equipment, there is a need to innovate to develop indigenous kits/devices with available resources in LMICs to reduce the cost and potentially benefit health system. In this review, we highlight the role of non-invasive respiratory support in different clinical conditions, practical problems encountered in LMICs setting, and few indigenous techniques to provide non-invasive respiratory support.
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4
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Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline. Intensive Care Med 2020; 46:697-713. [PMID: 32157356 PMCID: PMC7223056 DOI: 10.1007/s00134-020-05948-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
Abstract
Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure at risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula, noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that: in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately post-extubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery.
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Duncan CN, Talano JAM, McArthur JA. Acute Respiratory Failure and Management. CRITICAL CARE OF THE PEDIATRIC IMMUNOCOMPROMISED HEMATOLOGY/ONCOLOGY PATIENT 2019. [PMCID: PMC7123688 DOI: 10.1007/978-3-030-01322-6_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute respiratory failure is a common reason for admission to the pediatric intensive care unit in oncology patients. Acute respiratory complications are also common after pediatric hematopoietic stem cell transplant (HSCT), accounting for a high proportion of HSCT-related morbidity and mortality. Evaluation of these patients requires a thorough workup that includes identification and treatment of infectious etiologies, and treatment for noninfectious causes once infectious causes are ruled out. These patients should be closely monitored for development of pediatric acute respiratory distress syndrome (PARDS) with early escalation of respiratory support. Patients undergoing a trial of noninvasive ventilation (NIV) should be continuously monitored to ensure they are responding. Prolonged delay of endotracheal intubation in patients who do not improve or worsen on NIV could worsen their outcome. Optimal treatment of immunocompromised patients with acute lung failure requires early and aggressive lung protective ventilation, prevention of fluid overload, and rapid diagnosis of underlying causes to facilitate prompt disease-directed therapy.
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Affiliation(s)
| | - Julie-An M. Talano
- Children’s Hospital of Wisconsin-Milwaukee, Medical College of Wisconsin, Milwaukee, WI USA
| | - Jennifer A. McArthur
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN USA
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6
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Cortegiani A, Madotto F, Gregoretti C, Bellani G, Laffey JG, Pham T, Van Haren F, Giarratano A, Antonelli M, Pesenti A, Grasselli G. Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:157. [PMID: 29895331 PMCID: PMC5998562 DOI: 10.1186/s13054-018-2079-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022]
Abstract
Background The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013. Electronic supplementary material The online version of this article (10.1186/s13054-018-2079-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
| | - Fabiana Madotto
- Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - John G Laffey
- Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland.,Interdepartemental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Tai Pham
- Interdepartemental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Frank Van Haren
- College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.,Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Antonio Pesenti
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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7
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Wang T, Liu G, He K, Lu X, Liang X, Wang M, Zhu R, Li Z, Chen F, Ke J, Lin Q, Qian C, Li B, Wei J, Lv J, Li L, Gao Y, Wu G, Yu X, Wei W, Deng Y, Wang F, Zhang H, Zheng Y, Zhan H, Liao J, Tian Y, Yao D, Zhang J, Chen X, Yang L, Wu J, Chai Y, Shou S, Yu M, Xiang X, Zhang D, Chen F, Xie X, Li Y, Wang B, Zhang W, Miao Y, Eddleston M, He J, Ma Y, Xu S, Li Y, Zhu H, Yu X. The efficacy of initial ventilation strategy for adult immunocompromised patients with severe acute hypoxemic respiratory failure: study protocol for a multicentre randomized controlled trial (VENIM). BMC Pulm Med 2017; 17:127. [PMID: 28931394 PMCID: PMC5607592 DOI: 10.1186/s12890-017-0467-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Acute respiratory failure (ARF) is still one of the most severe complications in immunocompromised patients. Our previous systematic review showed noninvasive mechanical ventilation (NIV) reduced mortality, length of hospitalization and ICU stay in AIDS/hematological malignancy patients with relatively less severe ARF, compared to invasive mechanical ventilation (IMV). However, this systematic review was based on 13 observational studies and the quality of evidence was low to moderate. The efficacy of NIV in more severe ARF and in patients with other causes of immunodeficiency is still unclear. We aim to determine the efficacy of the initial ventilation strategy in managing ARF in immunocompromised patients stratified by different disease severity and causes of immunodeficiency, and explore predictors for failure of NIV. Methods and analysis The VENIM is a multicentre randomized controlled trial (RCT) comparing the effects of NIV compared with IMV in adult immunocompromised patients with severe hypoxemic ARF. Patients who meet the indications for both forms of ventilatory support will be included. Primary outcome will be 30-day all-cause mortality. Secondary outcomes will include in-hospital mortality, length of stay in hospital, improvement of oxygenation, nosocomial infections, seven-day organ failure, adverse events of intervention, et al. Subgroups with different disease severity and causes of immunodeficiency will also be analyzed. Discussion VENIM is the first randomized controlled trial aiming at assessing the efficacy of initial ventilation strategy in treating moderate and severe acute respiratory failure in immunocompromised patients. The result of this RCT may help doctors with their ventilation decisions. Trial registration ClinicalTrials.gov NCT02983851. Registered 2 September 2016.
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Affiliation(s)
- Tao Wang
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Gang Liu
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Kun He
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Xin Lu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Xianquan Liang
- Emergency Department, Guiyang Second People Hospital, Guiyang, China
| | - Meng Wang
- Department of Science and Technology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Rong Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
| | - Zongru Li
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Feng Chen
- Department of Emergency, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jun Ke
- Department of Emergency, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Qingming Lin
- Department of Emergency, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Chuanyun Qian
- Emergency Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo Li
- Emergency Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jie Wei
- Department of Emergency, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingjun Lv
- Department of Emergency, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Li
- Emergency Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanxia Gao
- Emergency Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guofeng Wu
- Emergency Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaohong Yu
- Emergency Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Weiqin Wei
- Emergency Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ying Deng
- Department of Emergency, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fengping Wang
- Department of Emergency, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Zhang
- Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yun Zheng
- Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hong Zhan
- Department of Emergency Medicine, The First Affiliated Hospital of SUN Yat-sen University, Guangzhou, China
| | - Jinli Liao
- Department of Emergency Medicine, The First Affiliated Hospital of SUN Yat-sen University, Guangzhou, China
| | - Yingping Tian
- Emergency Department, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongqi Yao
- Emergency Department, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingsong Zhang
- Department of Emergency, First affiliated hospital of Nanjing Medical University, Nanjing, China
| | - Xufeng Chen
- Department of Emergency, First affiliated hospital of Nanjing Medical University, Nanjing, China
| | - Lishan Yang
- Department of Emergency, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jiali Wu
- Department of Emergency, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yanfen Chai
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Muming Yu
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Xudong Xiang
- Department of Emergency Medicine, Second Xiangya Hospital, Institute of Emergency Medicine and Difficult Diseases, Central South University, Changsha, China
| | - Dongshan Zhang
- Department of Emergency Medicine, Second Xiangya Hospital, Institute of Emergency Medicine and Difficult Diseases, Central South University, Changsha, China
| | - Fengying Chen
- Department of Emergency, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiufeng Xie
- Department of Emergency, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yong Li
- Department of Emergency, Cangzhou City Center Hospital, Cangzhou, China
| | - Bo Wang
- Department of Emergency, Cangzhou City Center Hospital, Cangzhou, China
| | - Wenzhong Zhang
- Department of Emergency, First Hospital of Handan City, Handan, China
| | - Yongli Miao
- Department of Emergency, First Hospital of Handan City, Handan, China
| | - Michael Eddleston
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jianqiang He
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yong Ma
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Shengyong Xu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yi Li
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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8
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Esquinas AM, Benhamou MO, Glossop AJ, Mina B. Noninvasive Mechanical Ventilation in Acute Ventilatory Failure: Rationale and Current Applications. Sleep Med Clin 2017; 12:597-606. [PMID: 29108614 DOI: 10.1016/j.jsmc.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Noninvasive ventilation plays a pivotal role in acute ventilator failure and has been shown, in certain disease processes such as acute exacerbation of chronic obstructive pulmonary disease, to prevent and shorten the duration of invasive mechanical ventilation, reducing the risks and complications associated with it. The application of noninvasive ventilation is relatively simple and well tolerated by patients and in the right setting can change the course of their illness.
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Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Non-invasive Ventilatory Unit, Hospital Morales Meseguer, Avenida Marques Velez, Murcia 30008, Spain.
| | - Maly Oron Benhamou
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
| | - Alastair J Glossop
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2HE, UK
| | - Bushra Mina
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY 10065, USA
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9
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Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev 2017; 26:26/145/170028. [DOI: 10.1183/16000617.0028-2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/02/2017] [Indexed: 12/15/2022] Open
Abstract
Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre- and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with “do not intubate” status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.
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10
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Jónsdóttir B, Jaworowski Å, San Miguel C, Melander O. IL-8 predicts early mortality in patients with acute hypercapnic respiratory failure treated with noninvasive positive pressure ventilation. BMC Pulm Med 2017; 17:35. [PMID: 28178959 PMCID: PMC5299680 DOI: 10.1186/s12890-017-0377-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Patients with Acute Hypercapnic Respiratory Failure (AHRF) who are unresponsive to appropriate medical treatment, are often treated with Noninvasive Positive Pressure Ventilation (NPPV). Clinical predictors of the outcome of this treatment are scarce. Therefore, we evaluated the role of the biomarkers IL-8 and GDF-15 in predicting 28-day mortality in patients with AHRF who receive treatment with NPPV. Methods The study population were 46 patients treated with NPPV for AHRF. Clinical and background data was registered and blood samples taken for analysis of inflammatory biomarkers. IL-8 and GDF-15 were selected for analysis, and related to risk of 28-day mortality (primary endpoint) using Cox proportional hazard models adjusted for gender, age and various clinical parameters. Results Of the 46 patients, there were 3 subgroup in regards to primary diagnosis: Acute Exacerbation of COPD (AECOPD, n = 34), Acute Heart Failure (AHF, n = 8) and Acute Exacerbation in Obesity Hypoventilation Syndrome (AEOHS, n = 4). There was significant difference in the basic characteristic of the subgroups, but not in the clinical parameters that were used in treatment decisions. 13 patients died within 28 days of admission (28%). The Hazard Ratio for 28-days mortality per 1-SD increment of IL-8 was 3.88 (95% CI 1.86–8.06, p < 0.001). When IL-8 values were divided into tertiles, the highest tertile had a significant association with 28 days mortality, HR 10.02 (95% CI 1.24–80.77, p for trend 0.03), compared with the lowest tertile. This correlation was maintained when the largest subgroup with AECOPD was analyzed. GDF-15 was correlated in the same way, but when put into the same model as IL-8, the significance disappeared. Conclusion IL-8 is a target to explore further as a predictor of 28 days mortality, in patients with AHRF treated with NPPV.
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Affiliation(s)
- Brynja Jónsdóttir
- The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden. .,Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden. .,Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Åsa Jaworowski
- Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden
| | - Carmen San Miguel
- Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
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11
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Rathi NK, Haque SA, Nates R, Kosturakis A, Wang H, Dong W, Feng L, Erfe RJ, Guajardo C, Withers L, Finch C, Price KJ, Nates JL. Noninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients. J Crit Care 2017; 39:56-61. [PMID: 28213266 DOI: 10.1016/j.jcrc.2017.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/20/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure. MATERIAL AND METHODS A retrospective cohort study of consecutive adult intensive care unit (ICU) cancer patients who received either conventional invasive mechanical ventilation or NIPPV as first-line therapy for hypoxemic respiratory failure. RESULTS Of the 1614 patients included, the NIPPV failure group had the greatest hospital length of stay, ICU length of stay, ICU mortality (71.3%), and hospital mortality (79.5%) as compared with the other 2 groups (P < .0001). The variables independently associated with NIPPV failure included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P=.031), non-Caucasian race (OR, 1.61; 95% CI, 1.14-2.26; P=.006), presence of a hematologic malignancy (OR, 1.87; 95% CI, 1.33-2.64; P=.0003), and a higher Sequential Organ Failure Assessment score (OR, 1.12; 95% CI, 1.08-1.17; P < .0001). There was no difference in mortality when comparing early vs late intubation (less than or greater than 24 or 48 hours) for the NIPPV failure group. CONCLUSION Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.
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Affiliation(s)
- Nisha K Rathi
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Sajid A Haque
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ron Nates
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alyssa Kosturakis
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hao Wang
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wenli Dong
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rose J Erfe
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christina Guajardo
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura Withers
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clarence Finch
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kristen J Price
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph L Nates
- Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Huang HB, Xu B, Liu GY, Lin JD, Du B. Use of noninvasive ventilation in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:4. [PMID: 28061910 PMCID: PMC5219799 DOI: 10.1186/s13054-016-1586-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
Background Acute respiratory failure (ARF) remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is needed. We aimed to evaluate the effect of early noninvasive ventilation (NIV) compared with oxygen therapy alone in this patient population. Methods We searched for relevant studies in MEDLINE, EMBASE, and the Cochrane database up to 25 July 2016. Randomized controlled trials (RCTs) were included if they reported data on any of the predefined outcomes in immunocompromised patients managed with NIV or oxygen therapy alone. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Results Five RCTs with 592 patients were included. Early NIV significantly reduced short-term mortality (RR 0.62, 95% CI 0.40 to 0.97, p = 0.04) and intubation rate (RR 0.52, 95% CI 0.32 to 0.85, p = 0.01) when compared with oxygen therapy alone, with significant heterogeneity in these two outcomes between the pooled studies. In addition, early NIV was associated with a shorter length of ICU stay (MD −1.71 days, 95% CI −2.98 to 1.44, p = 0.008) but not long-term mortality (RR 0.92, 95% CI 0.74 to 1.15, p = 0.46). Conclusions The limited evidence indicates that early use of NIV could reduce short-term mortality in selected immunocompromised patients with ARF. Further studies are needed to identify in which selected patients NIV could be more beneficial, before wider application of this ventilator strategy. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1586-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui-Bin Huang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.,Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, People's Republic of China
| | - Biao Xu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.,Critical Care Medicine Center, the PLA 302 Hospital, No. 100 Xisihuanzhong Road, Fengtai District, Beijing, 100039, People's Republic of China
| | - Guang-Yun Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Jian-Dong Lin
- Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, People's Republic of China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
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13
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Carron M. A new horizon for the use of non-invasive ventilation in patients with acute respiratory distress syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:348. [PMID: 27761452 DOI: 10.21037/atm.2016.09.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Non-invasive ventilation (NIV) has assumed an important role in the management of acute respiratory failure (ARF). NIV, compared with standard medical therapy, improves survival and reduces complications in selected patients with ARF. NIV represents the first-line intervention for some forms of ARF, such as chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The use of NIV is also well supported for immunocompromised patients who are at high risk for infectious complications from endotracheal intubation. Selection of appropriate patients is crucial for optimizing NIV success rates. Appropriate ventilator settings, a well-fitting and comfortable interface, and a team skilled and experienced in managing NIV are key components to its success. In a recent issue of the Journal of the American Medical Association, Patel et al. reported the results of their single-center trial of 83 patients with acute respiratory distress syndrome (ARDS) who were randomly assigned to NIV delivered via a helmet or face mask. Patients assigned to the helmet group exhibited a significantly lower intubation rate and were more likely to survive through 90 days. This perspective reviews the findings of this trial in the context of current clinical practice and in light of data from the literature focused on the potential reasons for success of NIV delivered through a helmet compared to face mask. The implications for early management of patients with ARDS are likewise discussed.
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Affiliation(s)
- Michele Carron
- Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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14
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Wang T, Zhang L, Luo K, He J, Ma Y, Li Z, Zhao N, Xu Q, Li Y, Yu X. Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. BMC Pulm Med 2016; 16:129. [PMID: 27567894 PMCID: PMC5002326 DOI: 10.1186/s12890-016-0289-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/19/2016] [Indexed: 01/12/2023] Open
Abstract
Background To determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients. Methods We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted. Results Thirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay. Conclusions The overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0289-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Wang
- Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Lixi Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Kai Luo
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Jianqiang He
- Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yong Ma
- Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zongru Li
- Department of Pneumology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Na Zhao
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Yi Li
- Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China.
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15
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Bhatti H, Ramdass A, Cury JD, Jones LM, Shujaat A, Louis M, Seeram V, Bajwa AA. Operator dependent factors implicated in failure of non-invasive positive pressure ventilation (NIPPV) for respiratory failure. CLINICAL RESPIRATORY JOURNAL 2016; 11:901-905. [PMID: 26663322 DOI: 10.1111/crj.12434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-invasive Positive Pressure Ventilation (NIPPV) is employed for the management of acute respiratory failure and studies have shown that it can prevent the need for endotracheal intubation, mechanical ventilation and associated complications. Given limited studies evaluating the factors, other than those related patient or underlying disease severity, that may lead to NIPPV failure, we performed this study to gain insight into current practices in terms of utilization of NIPPV and operator dependent factors that may possibly contribute to failure of NIPPV. METHOD After institutional board review approval a retrospective chart review was performed of consecutive patients who were initiated on and failed NIPPV between January 2009 and December 2009. Data was recorded regarding baseline demographics, admission diagnosis, indications for NIPPV, presence of contraindications, type of NIPPV and initial settings, ABG analysis before and after initiation, whether a titration of the settings was performed or not, operator related factors that may have contributed to failure of NIPPV and clinical outcomes. RESULTS Among 1095 patients screened, 111 failed NIPPV. The mean age was 60 years with 59% males. The most frequent indication for initiating NIPPV was COPD exacerbation (N = 27) followed by pneumonia (N = 26). CPAP was used in 5(6%) patients. Median inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) setting were 10 and 5 cm of H2 O respectively. Three most common reasons for failure were an inappropriate indication (33%), Progression of underlying disease (30%) and lack of titration (23%). Overall mortality was 22%. Mortality was higher when NIPPV failure was seen among patients with an inappropriate indication or an overlooked contraindication compared to those with an appropriate indication (27% vs 17%). CONCLUSIONS Excluding progression of underlying disease, operator dependent factors linked to NIPPV failure are; inappropriate indication, lack of adequate titration and an overlooked contraindication. Inappropriate utilization of NIPPV in respiratory failure is associated with higher mortality.
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Affiliation(s)
- Hammad Bhatti
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | - Avinash Ramdass
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James D Cury
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Lisa M Jones
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Adil Shujaat
- University of Buffalo at State University of New York, Buffalo, NY, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Vandana Seeram
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Abubakr A Bajwa
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
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16
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Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R. Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol 2014; 14:66. [PMID: 25110463 PMCID: PMC4126617 DOI: 10.1186/1471-2253-14-66] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 07/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask. Methods Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6–8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment. Results PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV. Conclusions In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients. Trial registration German clinical trials register: DRKS00005132.
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Affiliation(s)
- Norbert Schwabbauer
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Björn Berg
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Jürgen Hetzel
- Department of Internal Medicine, Division of Pulmonary Medicine, University of Tübingen, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
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17
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Tu GW, Ju MJ, Han Y, He HY, Rong RM, Xu M, Xue ZG, Zhu TY, Luo Z. Moderate-dose glucocorticoids as salvage therapy for severe pneumonia in renal transplant recipients: a single-center feasibility study. Ren Fail 2014; 36:202-9. [PMID: 24172054 DOI: 10.3109/0886022x.2013.846771] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This study aimed to assess the effectiveness and safety of moderate-dose glucocorticoids (GCs) with mechanical ventilation as salvage therapy for renal transplant recipients with severe pneumonia, which was non-responsive to conventional treatment. A retrospective study was conducted involving renal transplant recipients diagnosed with severe pneumonia and did not respond to conventional treatment. All immunosuppressants were then completely withdrawn, and the patients were initially administered with methylprednisolone at doses of 2.0-2.5 mg/kg/day once every 12 h. This dosage was continued until oxygenation improved, and the treatment was gradually tapered (by 20 mg every 2-3 days) to the previous maintenance dosage. Ten patients were recruited from year 2008 to 2012. Two patients who underwent emergency endotracheal intubation were intubated on days 3 and 8, respectively, another one died from recurrent pneumothorax. The mean PaO2/FiO2 of the nine survivors was significantly increased by the increasing treatment duration; whereas the lung injury scores (LIS) and the sequential organ failure assessment (SOFA) score were both significantly decreased. The use of moderate-dose GCs may play a role as salvage therapy for renal transplant recipients with severe pneumonia. However, further study with larger trials to is needed.
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Affiliation(s)
- Guo-Wei Tu
- Department of Anesthesiology and Surgical Intensive Care Unit, Zhongshan Hospital, Fudan University , Shanghai , China
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18
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Johnson CS, Frei CR, Metersky ML, Anzueto AR, Mortensen EM. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study. BMC Pulm Med 2014; 14:7. [PMID: 24468062 PMCID: PMC3914374 DOI: 10.1186/1471-2466-14-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/22/2014] [Indexed: 11/30/2022] Open
Abstract
Background Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality. Methods In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age ≥65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality. Results Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53). Conclusions Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with pneumonia.
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Affiliation(s)
| | | | | | | | - Eric M Mortensen
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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Lorencio C, Sirvent J. Ventilación no invasiva: ¿cuándo, cómo y dónde? Med Intensiva 2012; 36:601-3. [DOI: 10.1016/j.medin.2012.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 01/14/2023]
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