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Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2024; 78:453-514. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
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Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
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Rai S, Neeman T, Brown R, Sundararajan K, Rajamani A, Miu M, Panwar R, Nourse M, van Haren FM, Mitchell I, Needham DM. Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study. CRIT CARE RESUSC 2024; 26:8-15. [PMID: 38690186 PMCID: PMC11056421 DOI: 10.1016/j.ccrj.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 05/02/2024]
Abstract
Objective To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. Design Prospective, multicentre observational cohort study. Setting Four tertiary medical-surgical ICUs in Australia. Participants Intubated and non-intubated adult ICU survivors. Main outcome measures Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire. Results Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66-3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53-3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions. Conclusions Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.
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Affiliation(s)
- Sumeet Rai
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Arvind Rajamani
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
| | | | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
| | - Mary Nourse
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Frank M.P. van Haren
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Dale M. Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | - for the PRICE study investigators
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
- Nepean Hospital, Kingswood, Sydney, Australia
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
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Brugnolli A, Chini G, Scartezzini R, Ambrosi E. Qualitative study of COVID-19 patient experiences with non-invasive ventilation and pronation: strategies to enhance treatment adherence. BMJ Open 2023; 13:e077417. [PMID: 38070911 PMCID: PMC10729144 DOI: 10.1136/bmjopen-2023-077417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) treatment combined with pronation in patients with COVID-19 respiratory failure has been shown to be effective in improving respiratory function and better patient outcomes. These patients may experience discomfort or anxiety that may reduce adherence to treatment. OBJECTIVE The aim of this study was to explore and describe the subjective experiences of patients undergoing helmet NIV and pronation during hospitalisation for COVID-19 respiratory failure, with a focus on the elements of care and strategies adopted by patients that enabled good adaptation to treatments. METHOD A qualitative descriptive study, using face-to-face interviews, was carried out with a purposeful sample of 20 participants discharged from a pulmonary intensive care unit who underwent helmet continuous positive airway pressure and pronation during hospitalisation for COVID-19. RESULTS Content analysis of the transcripts revealed feelings and experiences related to illness and treatments, strategies for managing one's own negative thoughts, and practical strategies of one's own and healthcare workers to facilitate adaptation to pronation and helmet. Experience was reflected in five major topics related to specific time points and settings: feelings and experiences, helmet and pronation: heavy but beneficial, positive thinking strategies, patients' practical strategies, support of healthcare professionals (HCPs). CONCLUSIONS This study may be useful to HCPs to improve the quality and appropriateness of care they provide.
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Affiliation(s)
- Anna Brugnolli
- Campus of health sciences, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Gabriele Chini
- Risorse Umane - Polo universitario delle Professioni Sanitarie di Trento, Trento Provincial Authority for Health Services, Trento, Italy
| | - Riccardo Scartezzini
- Pneumology department, Trento Provincial Authority for Health Services, Trento, Italy
| | - Elisa Ambrosi
- Dipartimento di Diagnostica e Sanità Pubblica, Università degli Studi di Verona, Verona, Italy
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Lionello F, Guarnieri G, Arcaro G, Vianello A. High flow nasal oxygen as a "second-line" therapy for COVID-19 patients intolerant to noninvasive ventilation. A retrospective cohort study. Health Sci Rep 2023; 6:e1685. [PMID: 38028672 PMCID: PMC10647974 DOI: 10.1002/hsr2.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Andrea Vianello
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
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Perry MA, Jones B, Devan H, Neill A, Piper A, Ingham T. Non-invasive ventilation for people with neuromuscular disorders in Australia and New Zealand: a qualitative study of clinician perspectives. Med J Aust 2023; 219:270-274. [PMID: 37449654 DOI: 10.5694/mja2.52036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non-invasive ventilation guidelines, and their perspectives on delivering quality non-invasive ventilation services to people with neuromuscular disorders. DESIGN, SETTING, PARTICIPANTS Qualitative study; semi-structured focus groups and individual interviews with Australian and New Zealand clinicians who provide non-invasive ventilation services to people with neuromuscular disorders, recruited from participants at a 2017 sleep medicine conference. Interviews were conducted during 1 October 2017 - 31 May 2018. MAIN OUTCOME MEASURES Major themes identified by an iterative, semantic, and inductive analysis. RESULTS A total of 28 participants attended the four focus group sessions and five individual interviews; fourteen each from New Zealand and Australia, seventeen women and eleven men, eighteen physicians and ten other clinicians. Two major themes were identified: decision making for current practice, and resource constraints. Participants noted variable use of clinical guidelines and limited training to meet the needs of people with neuromuscular disorders who require non-invasive ventilation. They described a lack of dedicated funding, unstructured care pathways, equipment supply levels that do not meet need, low staff-to-patient ratios and staff shortages, and the inability to deliver quality multidisciplinary care. The need for clinical guidelines and service specifications was highlighted as requisite for reducing variation in clinical care. CONCLUSIONS Systemic factors influence the needs-based provision of non-invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non-invasive ventilation care.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | | | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - Alister Neill
- University of Otago, Wellington, New Zealand
- Capital and Coast District Health Board, Newtown, New Zealand
| | - Amanda Piper
- The University of Sydney Central Clinical School, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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6
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Volpato E, Banfi PI, Pagnini F. Acceptance and adherence to non-invasive positive pressure ventilation in people with chronic obstructive pulmonary disease: a grounded theory study. Front Psychol 2023; 14:1134718. [PMID: 37599749 PMCID: PMC10435845 DOI: 10.3389/fpsyg.2023.1134718] [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: 12/30/2022] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Non-Invasive Positive Pressure Ventilation (NPPV) is an established treatment for people with Chronic Obstructive Pulmonary Disease (COPD), but it is often improperly used or rejected. The patterns of acceptance and adherence to NPPV, conceiving constraints, and strengths related to its adaptation have not been explored from a qualitative perspective yet. Objectives This study aims to qualitatively explore patterns of adaptation to NPPV in people affected by COPD and to identify the core characteristics and the specific adaptive challenges during the adaptation process. Methods Forty-two people with moderate or severe COPD were recruited and 336 unstructured interviews were conducted. A Constructivist Grounded Theory was used to gather and analyze data: the transcriptions were mutually gathered in open, selective, and theoretical phases, with open, selective, and theoretical coding, respectively. Results The analysis resulted in a non-linear and dynamic process, characterized by three phases: deciding, trying NPPV, and using NPPV. The patterns revealed that positive and negative NPPV experiences, together with beliefs, emotions, stressful mental states, and behaviors result in different acceptance and adherence rates. Discussions These findings may be helpful to implement new care strategies to promote acceptance and adherence to NPPV.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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7
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Kvam KA, Benatar M, Brownlee A, Caller T, Das RR, Green P, Kolodziejczak S, Russo J, Sanders D, Sethi N, Stavros K, Stierwalt J, Giles Walters N, Bennett A, Wessels SR, Brooks BR. Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology. Neurology 2023; 101:223-232. [PMID: 37524529 PMCID: PMC10401684 DOI: 10.1212/wnl.0000000000207166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/24/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Kathryn A Kvam
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Michael Benatar
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Alisa Brownlee
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Tracie Caller
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Rohit R Das
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Phil Green
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Sherry Kolodziejczak
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - John Russo
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Danica Sanders
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nadia Sethi
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Kara Stavros
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Julie Stierwalt
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nancy Giles Walters
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Amy Bennett
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Scott R Wessels
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Benjamin Rix Brooks
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
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8
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Perry MA, Jones B, Jenkins M, Devan H, Neill A, Ingham T. Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4758. [PMID: 36981666 PMCID: PMC10048586 DOI: 10.3390/ijerph20064758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Non-invasive ventilation (NIV) is a critical therapy for many patients with neuromuscular disorders (NMD), supporting those with respiratory failure to achieve adequate respiration and improve their quality of life. The aim of this study was to explore the experiences of access to, consent, uptake, maintenance and safe use of non-invasive ventilation by people with NMD. Semi-structured individual interviews were conducted with 11 people with NMD, each using NIV for more than 12 months. A critical realism ontological paradigm with contextualism epistemology guided the Reflexive Thematic Analysis. An Equity of Health Care Framework underpinned the analysis. Three themes were interpreted: Uptake and informed consent for NIV therapy; Practicalities of NIV; and Patient-clinician relationships. We identified issues at the system, organization and health professional levels. Conclusions: We recommend the development of national service specifications with clear standards and dedicated funding for patients with NMD and call on the New Zealand Ministry of Health to proactively investigate and monitor the variations in service delivery identified. The specific areas of concern for patients with NMD suggest the need for NMD-related NIV research and service provision responsive to the distinct needs of this population.
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Affiliation(s)
- Meredith A. Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
| | - Matthew Jenkins
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Alister Neill
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Department of Respiratory Medicine, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington 6140, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
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9
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Gigante AR, Tinoco EM, Nogueira C, Conde S, Ribeiro C. Factors influencing non-acceptance of home non-invasive ventilation. Respir Med Res 2022; 82:100938. [DOI: 10.1016/j.resmer.2022.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
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10
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Perry MA, Jenkins M, Jones B, Bowick J, Shaw H, Robinson E, Rowan M, Spencer K, Neill A, Ingham T. "Me and ' that' machine": the lived experiences of people with neuromuscular disorders using non-invasive ventilation. Disabil Rehabil 2022; 45:1847-1856. [PMID: 35649702 DOI: 10.1080/09638288.2022.2076939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Neuromuscular disorders (NMD) encompasses a wide range of conditions, with respiratory weakness a common feature. Respiratory care can involve non-invasive ventilation (NIV) resulting in fewer hospital admissions, a lower mortality rate and improved quality of life. The aim of this study was to explore the 'lived experience' of NIV by people with NMD. METHODS Interpretive Phenomenological Analysis (IPA) with semi-structured, face to face interviews with 11 people with NMD, using bi-level positive airway pressure for NIV for more than 12 months. RESULTS Three themes were interpreted: (i) Alive, with a life; (ii) Me and 'that' machine; and (iii) Precariousness of this life. NIV enabled hope, independence and the opportunity to explore previously perceived unattainable life experiences. Yet, participants felt dependent on the machine. Furthermore, practical considerations and fear of NIV failure created a sense of precariousness to life and a reframing of personal identity. CONCLUSION The findings highlight the broad ranging positive and negative effects that may occur for people with NMD when using this important therapy. Ongoing non-judgemental support and empathy are required from health professionals as the use of NIV challenged concepts such as 'living life well' for people with NMD. IMPLICATIONS FOR REHABILITATIONNeuromuscular disorders may result in respiratory weakness requiring non-invasive ventilation (NIV).When prescribed early, NIV can results in fewer hospital admissions, a lower mortality rate and improved quality of life.The relationship of people with NMD with their NIV machine is complex and impacts on and requires adjustment to their identity.NIV users acknowledged that NIV provided hope but simultaneously recognised the precariousness of NIV on their life.In order to better support people with NMD healthcare professionals need to better understand how the physical, psychological and social implications of NIV affect an individual's life.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Matthew Jenkins
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand.,Foundation for Equity & Research New Zealand, Wellington, New Zealand
| | - Jarrod Bowick
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hannah Shaw
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Emma Robinson
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Morgan Rowan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kate Spencer
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Alister Neill
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand.,Foundation for Equity & Research New Zealand, Wellington, New Zealand
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11
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Schellenberg MD, Imach S, Iberl G, Kirchner M, Herth F, Trudzinski F. Clinical characterization and possible pathophysiological causes of the Deventilation Syndrome in COPD. Sci Rep 2022; 12:1099. [PMID: 35058534 PMCID: PMC8776740 DOI: 10.1038/s41598-022-05118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
In daily routine, many COPD patients report early onset augmented dyspnea following use of NIV (Deventilation Syndrome, DVS) as a negative side-effect. The aim of this study is the clinical characterization and concrete definition of DVS. This monocenter prospective observational study collected demographic, physiologic and symptomatic data from 67 in-patients with severe COPD Gold III–IV and chronic hypercapnic failure before, during and after use of an established NIV. During their inpatient follow-up, we examined patients during the first hour after termination of nocturnal NIV. DVS was defined by the authors as an increase of ≥ 2 points on the Borg scale during the first 30 min in patients who reported repeated dyspnea after the use of NIV. We monitored cardiovascular and respiratory data and measured diaphragm excursion. Subjective dyspnea was documented by use of the Borg scale and questionnaires. In addition, respirator and demographic data were collected. DVS occurred in 58% of our COPD patient collective, showing predominant emphysema phenotype. Patients with DVS were more severely ill than non-DVS concerning bronchial obstruction (FEV1 0.6 vs. 0.8 l, p < 0.05) and hypercapnia during spontaneous breathing (pre NIV pCO2: 54.5 vs. 49.3 mmHg, p < 0.02). DVS patients showed significantly higher respiratory rates (RR) (20.1 vs. 18.1/min p < 0.05) after termination of NIV. This trial characterizes and defines early onset augmented dyspnea after the use of NIV, referred to as DVS. It is hereby brought to attention as a frequent side effect of long-term home ventilation and possible pathophysiologic mechanisms are elucidated.
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12
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Crimi C, Cortegiani A. Why, whether and how to use high-flow nasal therapy in acute exacerbations of chronic obstructive pulmonary disease. J Comp Eff Res 2021; 10:1317-1321. [PMID: 34668720 DOI: 10.2217/cer-2021-0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, Policlinico 'G Rodolico-San Marco' University Hospital, Via S. Sofia, 78, Catania 95123, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological & Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro, 129, Palermo 90127, Italy
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13
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Wehlmann H, Ochmann T. [Influence of nurses on the experience of noninvasive ventilation]. Med Klin Intensivmed Notfmed 2021; 116:702-707. [PMID: 34191044 DOI: 10.1007/s00063-021-00836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Henning Wehlmann
- Interdisziplinäre Intensivstation, Klinik für Anästhesie und Intensivmedizin, Alexianer St. Hedwig Kliniken Berlin, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland.
| | - Tobias Ochmann
- Medizinische Intensivstation, Klinik für Kardiologie, Internistische Intensivmedizin und Angiologie, Zentrum für Innere Medizin, Kath. Marienkrankenhaus Hamburg, Hamburg, Deutschland
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14
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Alnajada AA, Blackwood B, Mobrad A, Akhtar A, Pavlov I, Shyamsundar M. High flow nasal oxygen for acute type two respiratory failure: a systematic review. F1000Res 2021; 10:482. [PMID: 34621510 PMCID: PMC8453312 DOI: 10.12688/f1000research.52885.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO 2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO 2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO 2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO 2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 - 7.7 vs NIV median 7.6, IQR 6.3 - 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO 2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.
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Affiliation(s)
- Asem Abdulaziz Alnajada
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Abdulmajeed Mobrad
- Prince Sultan college for emergency medical services, King Saud University, Riyadh, Saudi Arabia
| | - Adeel Akhtar
- Emergency department, Royal Victoria Hospital, Belfast, Belfast, UK
| | - Ivan Pavlov
- Emergency department, Hôpital de Verdun, Montréal, Canada
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
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15
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Alnajada AA, Blackwood B, Mobrad A, Akhtar A, Pavlov I, Shyamsundar M. High flow nasal oxygen for acute type two respiratory failure: a systematic review. F1000Res 2021; 10:482. [PMID: 34621510 PMCID: PMC8453312.2 DOI: 10.12688/f1000research.52885.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO 2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO 2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO 2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO 2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 - 7.7 vs NIV median 7.6, IQR 6.3 - 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO 2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.
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Affiliation(s)
- Asem Abdulaziz Alnajada
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Abdulmajeed Mobrad
- Prince Sultan college for emergency medical services, King Saud University, Riyadh, Saudi Arabia
| | - Adeel Akhtar
- Emergency department, Royal Victoria Hospital, Belfast, Belfast, UK
| | - Ivan Pavlov
- Emergency department, Hôpital de Verdun, Montréal, Canada
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
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16
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Leonard R, Forte M, Mehta D, Mujahid H, Stansbury R. The impact of a telemedicine intervention on home non-invasive ventilation in a rural population with advanced COPD. CLINICAL RESPIRATORY JOURNAL 2021; 15:728-734. [PMID: 33709528 DOI: 10.1111/crj.13354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Rural regions have unique challenges with the implementation of new therapies upon discharge from the hospital due to multiple barriers. OBJECTIVES We investigated the effect of home non-invasive ventilation (NIV) plus the implementation of a call center following hospitalization for acute exacerbations of COPD (chronic obstructive lung disease) on NIV usage and readmissions. METHODS In this prospective pilot study, consecutive patients were screened at our institution for diagnosis of hypercarbic respiratory failure or COPD exacerbation from 2018 to 2019. Patients with more than two admissions in the last year were reviewed for eligibility. Of the 82 patients screened, 22 were eligible. There were 10 participants randomized to the intervention (NIV and call center) arm and 10 to NIV alone. RESULTS A total of 20 patients were randomized (mean age of 64, 45% males, BMI of 32). At three months, average usage was 32.1 days out of 90, 35%. When comparing the call center group to the standard group, there was a statistically significant difference in total days of device usage 48.7 compared to 15.5 (significant U-value of 16, critical value of U at p<.05 of 27) and cumulative use in hours 284 versus 87.7 (significant U-value of 20). Participants in the call center group were readmitted on average 4.2 times compared to 2.4 in the control group which was not statistically different (non-significant U-value of 42). In the follow-up period, 9/20 (45%) of the participants died. CONCLUSION This pilot study highlights the challenges in implementing care for advanced COPD in a rural population. Our data suggest that telemedicine may favorably address therapy adherence.
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Affiliation(s)
- Rachel Leonard
- Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA
| | - Michael Forte
- Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA
| | - Devanshi Mehta
- Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA
| | - Hassan Mujahid
- Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA.,Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Robert Stansbury
- Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA
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17
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The Effect of a Non-Invasive Positive Pressure Ventilation Simulation Program on General Ward Nurses' Knowledge and Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062877. [PMID: 33799758 PMCID: PMC8001743 DOI: 10.3390/ijerph18062877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to develop a simulation-based ventilator training program for general ward nurses and identify its effects. Quantitative data were collected from 29 nurses (intervention group: 15, control group: 14), of which seven were interviewed with focus groups to collect qualitative data. The quantitative results revealed significant differences in ventilator-related knowledge (p = 0.029) and self-efficacy (p = 0.026) between the intervention and control groups. Moreover, three themes were derived from meaningful statements in the qualitative data: understanding psychophysical discomfort of the patient while applying the ventilator; helping in ventilator care; and establishing a future ventilator training strategy. The findings confirmed that the non-invasive positive pressure ventilation (NPPV) simulation program is an effective method for improving the knowledge of ventilator nursing and self-efficacy and will be helpful in developing educational methods and strategies related to ventilator nursing for general ward nurses.
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Spurr L. The treatment burden of long-term home noninvasive ventilation. Breathe (Sheff) 2021; 17:200291. [PMID: 34295400 PMCID: PMC8291946 DOI: 10.1183/20734735.0291-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022] Open
Abstract
The prevalence of long-term home noninvasive ventilation (NIV) has progressively increased over recent decades, supported by evidence of clinical effectiveness in a range of conditions leading to chronic respiratory failure [1, 2]. Simultaneous technological developments have improved the reliability, portability, and comfort of devices, making NIV increasingly accessible and acceptable as a treatment option [3]. Clinicians are usually fully cognisant of the clinical outcomes they anticipate when recommending or initiating long-term NIV, for example prolonging life, preventing complications or healthcare utilisation, and/or improving symptoms. The evidence on key clinical outcomes is variable between conditions but is comprehensively evaluated in relevant clinical guidelines; traditionally less emphasis is placed on the potential practical and psychosocial implications of domiciliary NIV. However, the preferences, values and resources of individuals can have a significant impact on NIV usage and therefore may affect potential clinical benefit. This editorial discusses the healthcare-associated workload, also known as the treatment burden, of domiciliary NIV that may be shouldered by patients, their families and caregivers, justifying why the cost/benefit ratio must be carefully considered on an individual basis. Long-term home noninvasive ventilation has practical and psychosocial implications for individuals, families and caregivers. Exploring the impact of the workload of healthcare or “treatment burden” helps determine treatment feasibility and acceptability.https://bit.ly/39YUY2A
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Affiliation(s)
- Lydia Spurr
- Academic and Clinical Dept of Sleep and Breathing, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review. Crit Care Explor 2020; 2:e0121. [PMID: 32695990 PMCID: PMC7314319 DOI: 10.1097/cce.0000000000000121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives: With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs. Data Sources: We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.” Study Selection: We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea. Data Synthesis: Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes. Conclusions: Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.
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