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Spinazzola G, Ferrone G, Costa R, Piastra M, Maresca G, Rossi M, Antonelli M, Conti G. Comparative evaluation of three total full-face masks for delivering Non-Invasive Positive Pressure Ventilation (NPPV): a bench study. BMC Pulm Med 2023; 23:189. [PMID: 37259052 DOI: 10.1186/s12890-023-02489-2] [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: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
Historically, the oro-nasal mask has been the preferred interface to deliver Non-Invasive Positive Pressure Ventilation (NPPV) in critically ill patients. To overcome the problems related to air leaks and discomfort, Total Full-face masks have been designed. No study has comparatively evaluated the performance of the total Full-face masks available.The aim of this bench study was to evaluate the influence of three largely diffuse models of total Full -face masks on patient-ventilator synchrony and performance during pressure support ventilation. NPPV was applied to a mannequin, connected to an active test lung through three largely diffuse Full-face masks: Dimar Full-face mask (DFFM), Performax Full-face mask (RFFM) and Pulmodyne Full-face mask (PFFM).The performance analysis showed that the ΔPtrigger was significantly lower with PFFM (p < 0.05) at 20 breaths/min (RRsim) at both pressure support (iPS) levels applied, while, at RRsim 30, DFFM had the longest ΔPtrigger compared to the other 2 total full face masks (p < 0.05). At all ventilator settings, the PTP200 was significantly shorter with DFFM than with the other two total full-face masks (p < 0.05). In terms of PTP500 ideal index (%), we did not observe significant differences between the interfaces tested.The PFFM demonstrated the best performance and synchrony at low respiratory rates, but when the respiratory rate increased, no difference between all tested total full-face masks was reported.
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Affiliation(s)
- Giorgia Spinazzola
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy.
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy.
| | - Giuliano Ferrone
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Roberta Costa
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Marco Piastra
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Gianmarco Maresca
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Marco Rossi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
| | - Giorgio Conti
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito N 8, 00168, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, Rome, Italy
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Huo S, Zhang TT. Ventilation of ordinary face masks. BUILDING AND ENVIRONMENT 2021; 205:108261. [PMID: 34421186 PMCID: PMC8364838 DOI: 10.1016/j.buildenv.2021.108261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 05/15/2023]
Abstract
Wearing of face masks has been identified as an essential means of reducing COVID-19 infection during the pandemic. However, air leakage into ordinary face masks decreases the protection they provide. Wearing a mask also causes both CO2 and humidity to accumulate inside, imposing breathing difficulty and discomfort. To remedy the above problems, this investigation proposed to ventilate ordinary masks by supplying additional HEPA filtered air. The N95, surgical, and cotton masks available on the market, were modified into ventilated masks. The air inside the masks was extracted for measurement of the PM2.5, CO2, and water vapor concentrations. The protection provided by the masks was evaluated in terms of their effectiveness in shielding wearers from ambient PM2.5. Mask comfort was examined in terms of both CO2 concentration and humidity ratio. In addition, a mathematical model was established to solve for the exchanged air flow rates via different routes. Subjective voting by 20 mask wearers was also conducted. Performance of the ventilated face masks were compared against the non-ventilated ones. It was found that the protection provided by the ordinary non-ventilated masks is much lower than that claimed for the filter materials alone due to significantly total inward leakage. The accumulated CO2 and humidity inside masks resulted in discomfort and complaints. For contrast, the ventilated face masks not only enhanced protection by suppressing the inward leakage of ambient airborne particles, but also significantly improved comfort. The wearers preferred a filtered air flow rate ranging from 18 to 23 L/min.
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Affiliation(s)
- Shigao Huo
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Tengfei Tim Zhang
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin, China
- School of Civil Engineering, Dalian University of Technology, Dalian, China
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Nishikimi M, Nishida K, Shindo Y, Shoaib M, Kasugai D, Yasuda Y, Higashi M, Numaguchi A, Yamamoto T, Matsui S, Matsuda N. Failure of non-invasive respiratory support after 6 hours from initiation is associated with ICU mortality. PLoS One 2021; 16:e0251030. [PMID: 33930089 PMCID: PMC8087003 DOI: 10.1371/journal.pone.0251030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022] Open
Abstract
A previous study has shown that late failure (> 48 hours) of high-flow nasal cannula (HFNC) was associated with intensive care unit (ICU) mortality. The aim of this study was to investigate whether failure of non-invasive respiratory support, including HFNC and non-invasive positive pressure ventilation (NPPV), was also associated with the risk of mortality even if it occurs in the earlier phase. We retrospectively analyzed 59 intubated patients for acute respiratory failure due to lung diseases between April 2014 and June 2018. We divided the patients into 2 groups according to the time from starting non-invasive ventilatory support until their intubation: ≤ 6 hours failure and > 6 hours failure group. We evaluated the differences in the ICU mortality between these two groups. The multivariate logistic regression analysis showed the highest mortality in the > 6 hours failure group as compared to the ≤ 6 hours failure group, with a statistically significant difference (p < 0.01). It was also associated with a statistically significant increased 30-day mortality and decreased ventilator weaning rate. The ICU mortality in patients with acute respiratory failure caused by lung diseases was increased if the time until failure of HFNC and NPPV was more than 6 hours.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Emergency Medicine, Northwell Health, NY, NY, United States of America
- Laboratory for Critical Care Physiology at the Feinstein Institutes for Medical Research, Northwell Health, NY, NY, United States of America
- * E-mail:
| | - Kazuki Nishida
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Muhammad Shoaib
- Laboratory for Critical Care Physiology at the Feinstein Institutes for Medical Research, Northwell Health, NY, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuma Yasuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiko Higashi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Yamamoto
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Quintero OI, Chavarro PA, Ospina Tascón GA. Reply to “Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation”. Arch Bronconeumol 2020. [DOI: 10.1016/j.arbres.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Quintero OI, Chavarro PA, Ospina Tascón GA. Reply to "Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation". Arch Bronconeumol 2020; 56:540-541. [PMID: 35373763 DOI: 10.1016/j.arbr.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Oscar Ivan Quintero
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, Colombia.
| | - Paola Andrea Chavarro
- Facultad de Salud, Escuela de Rehabilitación Humana, Universidad del Valle, Calle 4B # 36-00, Cali, Colombia; Department of Intensive Care Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, Colombia
| | - Gustavo Adolfo Ospina Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
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Castro-Codesal ML, Olmstead DL, MacLean JE. Mask interfaces for home non-invasive ventilation in infants and children. Paediatr Respir Rev 2019; 32:66-72. [PMID: 31130424 DOI: 10.1016/j.prrv.2019.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/25/2022]
Abstract
The selection of the mask interface for non-invasive ventilation (NIV) is recognized to be an essential part for therapy success. While nasal masks are the first recommended option in children and adults, there are indications for other mask types such as intolerance or complications from nasal masks. Evidence comparing performance, adherence and complication risk among mask interfaces in pediatrics is, however, scarce and information is often extrapolated from adult studies. Given this gap in knowledge and the lack of guidelines on NIV initiation in children, mask selection often relies on the clinicians' knowledge and expertise. Careful mask selection, a well-fitting headgear and time investment for mask desensitization are some important recommendations for adequate mask adaptation in children. Frequent mask-related complications include nasal symptoms, unintentional leak, mask displacement, skin injury, and midface hypoplasia. Close monitoring and a pro-active approach may help to minimize complications and promote the optimal use of home NIV.
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Affiliation(s)
- Maria L Castro-Codesal
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada.
| | - Deborah L Olmstead
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
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Mayordomo-Colunga J, Pons-Òdena M, Medina A, Rey C, Milesi C, Kallio M, Wolfler A, García-Cuscó M, Demirkol D, García-López M, Rimensberger P. Non-invasive ventilation practices in children across Europe. Pediatr Pulmonol 2018; 53:1107-1114. [PMID: 29575773 DOI: 10.1002/ppul.23988] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/22/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). WORKING HYPOTHESIS No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. STUDY DESIGN Cross-sectional electronic survey. METHODOLOGY The survey was distributed to the ESPNIC mailing list and to researchers in different European centers. RESULTS One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P = 0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children. CONCLUSIONS The present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.
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Affiliation(s)
- Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Martí Pons-Òdena
- Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain
| | - Alberto Medina
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Corsino Rey
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Christophe Milesi
- Pediatric Intensive Care Unit, Academic Hospital Arnaud de Villeneuve, Montpellier, France
| | - Merja Kallio
- PEDEGO Research Group, University of Oulu, Pediatric Department, Oulu University Hospital, Oulu, Finland
| | - Andrea Wolfler
- Intensive Care Unit, Department of Pediatrics, Children's Hospital V Buzzi, Milan, Italy
| | - Mireia García-Cuscó
- Pediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Koç University School of Medicine, Istanbul, Turkey
| | - Milagros García-López
- Pediatric Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal
| | - Peter Rimensberger
- Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
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Abedini A, Kiani A, Taghavi K, Khalili A, Fard AJ, Fadaizadeh L, Salimi A, Parsa T, Aarabi A, Farzanegan B, Tootkaboni MP. High-Frequency Jet Ventilation in Nonintubated Patients. Turk Thorac J 2018; 19:127-131. [PMID: 30083403 DOI: 10.5152/turkthoracj.2018.17025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.
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Affiliation(s)
- Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khalili
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangiri Fard
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Salimi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Parsa
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Aarabi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Pourabdollah Tootkaboni
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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