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Vergara J, Brenner MJ, Skoretz SA, Pandian V, Freeman-Sanderson A, Dorça A, Suiter D, Brodsky MB. Swallowing during provision of helmet ventilation: Review and provisional multidisciplinary guidance. J Intensive Care Soc 2024; 25:326-332. [PMID: 39224433 PMCID: PMC11366189 DOI: 10.1177/17511437241231704] [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: 09/04/2024] Open
Abstract
Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, SP, Brazil
| | - Michael J Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stacey A Skoretz
- School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, USA
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Australia
| | - Alessandra Dorça
- Department of Health Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Debra Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Pierucci P, de Candia ML, Marzullo A, Mele F, Introna F, Agrisani C, Ingoglia G, Gregoretti C, Carpagnano GE. The eye may be the spy of injury related to NIV interface and prone positioning. Pulmonology 2024; 30:192-194. [PMID: 35798639 PMCID: PMC9252870 DOI: 10.1016/j.pulmoe.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- P Pierucci
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - M L de Candia
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'.
| | - A Marzullo
- Pathology Division, Department of Emergency and Organ Transplantation, University of Bari
| | - F Mele
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - F Introna
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - C Agrisani
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - G Ingoglia
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University, of Palermo, Palermo, Italy; G. Giglio Fundation, Cefal, Palermo, Italy
| | - G E Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
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Chiappero C, Misseri G, Mattei A, Ippolito M, Albera C, Pivetta E, Cortegiani A, Gregoretti C. Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19. Pulmonology 2023; 29 Suppl 4:S9-S17. [PMID: 34326019 PMCID: PMC8266523 DOI: 10.1016/j.pulmoe.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19. METHODS This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study. MAIN FINDINGS Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing. CONCLUSIONS The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.
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Affiliation(s)
- C Chiappero
- Pneumology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino - Molinette hospital, Turin, Italy
| | | | - A Mattei
- Pneumology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino - Molinette hospital, Turin, Italy
| | - M Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). University of Palermo, Italy
| | - C Albera
- Pneumology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino - Molinette hospital, Turin, Italy; University of Turin, School of Medicine, Department of Medical Sciences, Italy
| | - E Pivetta
- Division of Emergency Medicine and High Dependency Unit, Department of General and Specialized Medicine, AOU Città della Salute e della Scienza di Torino - Molinette hospital, Turin, Italy
| | - A Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). University of Palermo, Italy; Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
| | - C Gregoretti
- Fondazione "Giglio", Cefalù, Italy; Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). University of Palermo, Italy
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Lemyze M, Mallat J, Vangrunderbeek N, Granier M. Under-The-Nose Versus Over-The-Nose Face Mask to Prevent Facial Pressure Sores During Face Mask-Delivered Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: A Randomized Controlled Trial. Crit Care Med 2023; 51:1177-1184. [PMID: 37166242 DOI: 10.1097/ccm.0000000000005902] [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: 05/12/2023]
Abstract
OBJECTIVES To determine whether an under-the-nose face mask (FM) as the first-line interface strategy reduces the incidence of facial pressure sores with the same clinical improvement as the one obtained by standard over-the-nose face mask-noninvasive ventilation (FM-NIV) in patients with acute hypercapnic respiratory failure (AHRF). DESIGN A multicenter, prospective randomized controlled study. SETTING Two ICUs from two French tertiary hospitals. PATIENTS A total of 108 patients needed NIV for AHRF. INTERVENTIONS participants were randomized (1/1) to receive either the under-the-nose FM (intervention group) or the over-the-nose FM (control group). The primary endpoint was the reduction of facial pressure sores. Secondary endpoints included patients outcome, NIV failure (intubation or death), arterial blood gas improvement, and interface failure (the need to switch to a total face mask). MEASUREMENTS AND MAIN RESULTS Despite less protective dressings in the intervention group ( n = 4, 5% vs n = 27, 51%; p < 0.001), pressure sores developed less frequently than in the control group ( n = 3, 5% vs n = 39, 74%; p < 0.001). Similar mortality, NIV failure, and arterial blood gas improvement occurred in the two groups. However, under-the-nose FM resulted in a higher interface failure rate than conventional FM ( n = 18, 33% vs n = 5, 9%; p = 0.004), mainly because of excessive unintentional air leaks ( n = 15, 83% vs n = 0, 0%; p < 0.001). CONCLUSIONS In patients with AHRF, under-the-nose FM significantly reduced the incidence of facial pressure sores compared to the most commonly used first-line interface, the standard FM. However, with this new mask, excessive unintentional air leaks more often compelled the attending clinician to switch to another interface to pursue NIV.
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Affiliation(s)
- Malcolm Lemyze
- Department of Critical Care Medicine, Arras Hospital, Arras, France
| | - Jihad Mallat
- Department of Critical Care Medicine, Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Maxime Granier
- Department of Critical Care Medicine, Arras Hospital, Arras, France
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Vaschetto R, Gregoretti C, Scotti L, De Vita N, Carlucci A, Cortegiani A, Crimi C, Mattei A, Scala R, Rocca E, Longhini F, Cammarota G, Misseri G, Dal Molin A, Scolletta S, Nava S, Maggiore SM, Navalesi P. A pragmatic, open-label, multi-center, randomized controlled clinical trial on the rotational use of interfaces vs standard of care in patients treated with noninvasive positive pressure ventilation for acute hypercapnic respiratory failure: the ROTAtional-USE of interface STUDY (ROTA-USE STUDY). Trials 2023; 24:527. [PMID: 37574558 PMCID: PMC10424342 DOI: 10.1186/s13063-023-07560-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND In the last decades, noninvasive ventilation (NIV) has been increasingly used to support patients with hypercapnic and hypoxemic acute respiratory failure. Pressure ulcers are a frequently observed NIV-related adverse effect, directly related to interface type and exposure time. Switching to a different interface has been proposed as a solution to improve patient comfort. However, large studies investigating the benefit of this strategy are not available. Thus, the aim of the ROTAtional-USE of interface STUDY (ROTA-USE STUDY) is to investigate whether a protocolized rotational use of interfaces during NIV is effective in reducing the incidence of pressure ulcers. METHODS The ROTA-USE STUDY is a pragmatic, parallel arm, open-label, multicenter, spontaneous, non-profit, randomized controlled trial requiring non-significant risk medical devices, with the aim to determine whether a rotational strategy of NIV interfaces is associated with a lower incidence of pressure ulcers compared to the standard of care. In the intervention group, NIV mask will be randomly chosen and rotated every 6 h. In the control group, mask will be chosen according to the standard of care of the participating centers and changed in case of discomfort or in the presence of new pressure sores. In both groups, the skin underneath the mask will be inspected every 12 h for any possible damage by blinded assessors. The primary outcome is the proportion of patients developing new pressure sores at 36 h from randomization. The secondary outcomes are (i) onset of pressure sores measured at different time points, i.e., 12, 24, 36, 48, 60, 72, 84, and 96 h; (ii) number and stage of pressure sores and comfort measured at 12, 24, 36, 48, 60, 72, 84, and 96 h; and (iii) the economic impact of the protocolized rotational use of interfaces. A sample size of 239 subjects per group (intervention and control) is estimated to detect a 10% absolute difference in the proportion of patients developing pressure sores at 36 h. DISCUSSION The development of pressure ulcers is a common side effect of NIV that negatively affects the patients' comfort and tolerance, often leading to NIV failure and adverse outcomes. The ROTA-USE STUDY will determine whether a protocolized rotational approach can reduce the incidence, number, and severity of pressure ulcers in NIV-treated patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05513508. Registered on August 24, 2022.
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Affiliation(s)
- Rosanna Vaschetto
- Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy.
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy.
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- G. Giglio Foundation, Cefalù, Italy
| | - Lorenza Scotti
- Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy
| | - Nello De Vita
- Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Annalisa Carlucci
- Dipartimento Di Medicina E Chirurgia, Università Insubria Varese-Como, Varese, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia Analgesia Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessio Mattei
- Respiratory Medicine Unit, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Eduardo Rocca
- Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Dipartimento Di Medicina Translazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Giovanni Misseri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- G. Giglio Foundation, Cefalù, Italy
| | - Alberto Dal Molin
- Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100, Novara, Italy
| | - Sabino Scolletta
- Dipartimento Scienze Mediche, Chirurgiche E Neuroscienze, Università Degli Studi Di Siena, Siena, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - Salvatore Maurizio Maggiore
- University Department of Innovative Technologies in Medicine and Dentistry, Università "G. D'Annunzio" Di Chieti-Pescara, Chieti, Italy
- Clinical Department of Anesthesiology and Critical Care Medicine, SS. Annunziata Hospital, Chieti, Italy
| | - Paolo Navalesi
- Dipartimento Di Medicina - DIMED, Università Di Padova, UOC Istituto Di Anestesia E Rianimazione, Azienda Ospedale-Università Di Padova, Padua, Italy
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Sequential use of noninvasive ventilation and high flow nasal therapy after early extubation in chest trauma patients recovering from acute hypoxaemic respiratory failure. Pulmonology 2023; 29:79-82. [PMID: 36117099 PMCID: PMC9477646 DOI: 10.1016/j.pulmoe.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/28/2023] Open
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Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
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Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
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Amirfarzan H, Cereda M, Gaulton TG, Leissner KB, Cortegiani A, Schumann R, Gregoretti C. Use of Helmet CPAP in COVID-19 - A practical review. Pulmonology 2021; 27:413-422. [PMID: 33583765 PMCID: PMC7849604 DOI: 10.1016/j.pulmoe.2021.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/15/2023] Open
Abstract
Helmet CPAP (H-CPAP) has been recommended in many guidelines as a noninvasive respiratory support during COVID-19 pandemic in many countries around the world. It has the least amount of particle dispersion and air contamination among all noninvasive devices and may mitigate the ICU bed shortage during a COVID surge as well as a decreased need for intubation/mechanical ventilation. It can be attached to many oxygen delivery sources. The MaxVenturi setup is preferred as it allows for natural humidification, low noise burden, and easy transition to HFNC during breaks and it is the recommended transport set-up. The patients can safely be proned with the helmet. It can also be used to wean the patients from invasive mechanical ventilation. Our article reviews in depth the pathophysiology of COVID-19 ARDS, provides rationale of using H-CPAP, suggests a respiratory failure algorithm, guides through its setup and discusses the issues and concerns around using it.
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Affiliation(s)
- H Amirfarzan
- Tufts University School of Medicine, VA Boston Healthcare System, Anesthesiology and Perioperative Medicine, United States.
| | - M Cereda
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Dulles Bldg, Floor 7, Philadelphia, PA 19104, United States.
| | - T G Gaulton
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Dulles Bldg, Floor 7, Philadelphia, PA 19104, United States.
| | - K B Leissner
- Harvard Medical School, VA Boston Healthcare System, Anesthesiology and Perioperative Medicine, United States.
| | - A Cortegiani
- Departmentof Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
| | - R Schumann
- Tufts University School of Medicine, VA Boston Healthcare System, Anesthesiology and Perioperative Medicine, United States.
| | - C Gregoretti
- Departmentof Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Fondazione 'Giglio', Cefalù, Italy.
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9
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Scala R, Accurso G, Ippolito M, Cortegiani A, Iozzo P, Vitale F, Guidelli L, Gregoretti C. Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation - A Concise Review. Respiration 2020; 99:800-817. [PMID: 33207357 DOI: 10.1159/000509762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
Non-invasive ventilation (NIV) has dramatically changed the treatment of both acute and chronic respiratory failure in the last 2 decades. The success of NIV is correlated to the application of the "best ingredients" of a patient's "tailored recipe," including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver. The choice of the interface is crucial for the success of NIV. Type (oral, nasal, nasal pillows, oronasal, hybrid mask, helmet), size, design, material and headgears may affect the patient's comfort with respect to many aspects, such as air leaks, claustrophobia, skin erythema, eye irritation, skin breakdown, and facial deformity in children. Companies are paying great attention to mask development, in terms of shape, materials, comfort, and leak reduction. Although the continuous development of new products has increased the availability of interfaces and the chance to meet different requirements, in patients necessitating several daily hours of NIV, both in acute and in chronic home setting, the rotational use of different interfaces may remain an excellent strategy to decrease the risk of skin breakdown and to improve patient's tolerance. The aim of the present review was to give the readers a background on mask technology and materials in order to enhance their "knowledge" in making the right choice for the interface to apply during NIV in the different clinical scenarios.
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Affiliation(s)
- Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy,
| | - Giuseppe Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Pasquale Iozzo
- Department of Anesthesia and Intensive Care, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Filippo Vitale
- Department of Anesthesia and Intensive Care, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Luca Guidelli
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.,, Cefalù, Italy
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10
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Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: A narrative review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Peko Cohen L, Ovadia-Blechman Z, Hoffer O, Gefen A. Dressings cut to shape alleviate facial tissue loads while using an oxygen mask. Int Wound J 2019; 16:813-826. [PMID: 30838792 DOI: 10.1111/iwj.13101] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022] Open
Abstract
Non-invasive ventilation (NIV) masks are commonly used for respiratory support where intubation or a surgical procedure can be avoided. However, prolonged use of NIV masks involves risk to facial tissues, which are subjected to sustained deformations caused by tightening of the mask and microclimate conditions. The risk of developing such medical device-related pressure ulcers can be reduced by providing additional cushioning at the mask-face interface. In this work, we determined differences in facial tissue stresses while using an NIV mask with versus without using dressing cuts (Mepilex Lite; Mölnlycke Health Care, Gothenburg, Sweden). First, we developed a force measurement system that was used to experimentally determine local forces applied to skin at the bridge of the nose, cheeks, and chin in a healthy sample group while using a NIV mask. We further demonstrated facial temperature distributions after use of the mask using infrared thermography. Next, using the finite element method, we delivered the measured compressive forces per site of the face in the model and compared maximal effective stresses in facial tissues with versus without the dressing cuts. The dressings have shown substantial biomechanical effectiveness in alleviating facial tissues deformations and stresses by providing localised cushioning to the tissues at risk.
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Affiliation(s)
- Lea Peko Cohen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Zehava Ovadia-Blechman
- Department of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Oshrit Hoffer
- Department of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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12
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Crimi C, Pierucci P, Carlucci A, Cortegiani A, Gregoretti C. Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas. Respiration 2019; 97:185-196. [PMID: 30677752 DOI: 10.1159/000495941] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients' life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, Bari, Italy
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy,
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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13
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Cortegiani A, Accurso G, Mercadante S, Giarratano A, Gregoretti C. High flow nasal therapy in perioperative medicine: from operating room to general ward. BMC Anesthesiol 2018; 18:166. [PMID: 30414608 PMCID: PMC6230300 DOI: 10.1186/s12871-018-0623-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High flow nasal therapy (HFNT) is a technique in which humidified and heated gas is delivered to the airways through the nose via small nasal prongs at flows that are higher than the rates generally applied during conventional oxygen therapy. The delivered high flow rates combine mixtures of air and oxygen and enable different inspired oxygen fractions ranging from 0.21 to 1. HFNT is increasingly used in critically ill adult patients, especially hypoxemic patients in different clinical settings. MAIN BODY Noninvasive ventilation delivers positive pressure (end-expiratory and inspiratory pressures or continuous positive airway pressure) via different external interfaces. In contrast, HFNT produces different physiological effects that are only partially linked to the generation of expiratory positive airway pressure. HFNT and noninvasive ventilation (NIV) are interesting non-invasive supports in perioperative medicine. HFNT exhibits some advantages compared to NIV because HFNT is easier to apply and requires a lower nursing workload. Tolerance of HFNT remains a matter of intense debate, and it may be related to selected parameters. Patients receiving HFNT and their respiratory patterns should be closely monitored to avoid delays in intubation despite correct oxygenation parameters. CONCLUSION HFNT seems to be an interesting noninvasive support in perioperative medicine. The present review provides anesthesiologists with an overview of current evidence and practical advice on the application of HFNT in perioperative medicine in adult patients.
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Affiliation(s)
- Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Giuseppe Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
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14
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Alqahtani JS, AlAhmari MD. Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers. Saudi Med J 2018; 39:443-452. [PMID: 29738002 PMCID: PMC6118171 DOI: 10.15537/smj.2018.5.22058] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The last 2 decades have seen a growing trend towards the use of noninvasive ventilation (NIV) therapy in the management of many conditions that cause acute respiratory failure. However, there is a serious side effect that results in using these devices; the development of facial skin pressure damage, specifically pressure ulcers. This skin damage has a considerable effect on patients’ quality of life, treatment adherence and patients’ comfort in addition to the therapy challenges of wound care. The aim of this clinical review is to discuss the different characteristics of NIV interfaces and to provide evidence based recommendations to facilitate the selection and application of such interfaces to reduce NIV interfaces related pressure ulcers.
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Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Kingdom of Saudi Arabia. E-mail.
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15
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Gregoretti C, Cortegiani A, Accurso G, Raineri SM, Giarratano A. Noninvasive Ventilation for Acute Hypoxemic Respiratory Failure/ARDS: the Show Must Go on. Turk J Anaesthesiol Reanim 2018; 46:1-2. [PMID: 30140493 DOI: 10.5152/tjar.2018.290118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Giuseppe Accurso
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
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16
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Raurell-Torredà M, Romero-Collado A, Rodríguez-Palma M, Farrés-Tarafa M, Martí JD, Hurtado-Pardos B, Peñarrubia-San Florencio L, Saez-Paredes P, Esquinas AM. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. ENFERMERIA INTENSIVA 2017; 28:31-41. [PMID: 28153465 DOI: 10.1016/j.enfi.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. OBJECTIVES To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. METHODOLOGY Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. RESULTS Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. CONCLUSIONS The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Vicepresidenta SEEIUC, Coordinadora del documento, Barcelona, España.
| | | | - M Rodríguez-Palma
- Residencia de Mayores José Matía Calvo, Miembro Comité Director GNEAUPP, Cádiz, España
| | - M Farrés-Tarafa
- Campus Docent Sant Joan de Déu, Presidenta del Comité Científico de Enfermería de la SECIP, Barcelona, España
| | - J D Martí
- Hospital Clínic de Barcelona, Miembro del Comité Científico SEPAR, Barcelona, España
| | - B Hurtado-Pardos
- Campus Docent Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España
| | - L Peñarrubia-San Florencio
- Hospital Materno-infantil Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España
| | - P Saez-Paredes
- Hospital General Universitario José María Morales Messeguer, Murcia, España
| | - A M Esquinas
- Hospital General Universitario José María Morales Messeguer, Presidente Asociación Internacional de Ventilación No Invasiva, Murcia, España
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17
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Raurell-Torredà M, Romero-Collado A, Rodríguez-Palma M, Farrés-Tarafa M, Martí J, Hurtado-Pardos B, Peñarrubia-San Florencio L, Saez-Paredes P, Esquinas A. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.enfie.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Worsley PR, Prudden G, Gower G, Bader DL. Investigating the effects of strap tension during non-invasive ventilation mask application: a combined biomechanical and biomarker approach. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:409-417. [PMID: 27942235 PMCID: PMC5136364 DOI: 10.2147/mder.s121712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Non-invasive ventilation is commonly used for respiratory support. However, in some cases, mask application can cause pressure ulcers to specific features of the face, resulting in pain and reduced quality of life for the individual. This study investigated the effects of mask strap tension on the biomechanical and biomarker responses at the skin interface. Healthy participants (n = 13) were recruited and assigned two different masks in a random order, which were fitted with three strap conditions representing increments of 5 mm to increase tension. Masks were worn for 10 minutes at each tension followed by a 10-minute refractory period. Assessment at the device–skin interface included measurements of pressures at the nose and cheeks, temperature and humidity, a selection of inflammatory cytokine concentrations collected from sebum and scores of comfort. The results indicated significantly higher interface pressures at the bridge of the nose compared to the cheeks for both masks (p < 0.05), with nasal interface pressures significantly increasing with elevated strap tension (p < 0.05). One inflammatory cytokine, IL-1α, increased following mask application at the highest tension, with median increases from baselines ranging from 21 to 33%. The other cytokines revealed a less consistent trend with strap tension. The participants reported statistically greater discomfort during elevated strap tension. Temperature and humidity values under the mask were elevated from ambient conditions, although no differences were observed between mask type or strap tension. The bony prominence on the bridge of the nose represented a vulnerable area of skin during respiratory mask application. This study has shown that mask strap tension has a significant effect on the pressure exerted on the nose. This can result in discomfort and an inflammatory response at the skin surface. Further studies are required to investigate respiratory mask application for appropriate individuals with comorbidities.
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Affiliation(s)
- Peter R Worsley
- Southampton General Hospital, Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - George Prudden
- Southampton General Hospital, Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - George Gower
- Southampton General Hospital, Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Dan L Bader
- Southampton General Hospital, Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
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19
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Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, Church AC, Creagh-Brown B, Dodd JW, Felton T, Foëx B, Mansfield L, McDonnell L, Parker R, Patterson CM, Sovani M, Thomas L. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 2016; 71 Suppl 2:ii1-35. [DOI: 10.1136/thoraxjnl-2015-208209] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Ventilation non invasive en réanimation. Choix de l’interface. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Cardiopulmonary resuscitation interface adapted for postextubation continuous noninvasive ventilatory support. Am J Phys Med Rehabil 2015; 94:e80-3. [PMID: 26135377 DOI: 10.1097/phm.0000000000000352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors report that a new oral interface designed for cardiopulmonary resuscitation and use during anesthesia permitted the successful extubation of an "unweanable" 27-yr-old woman with nemaline rod myopathy to continuous noninvasive ventilatory support. She had failed two previous extubation attempts. Tracheotomy and institutional care were avoided as a result.
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22
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Gregoretti C, Pisani L, Cortegiani A, Ranieri VM. Noninvasive Ventilation in Critically Ill Patients. Crit Care Clin 2015; 31:435-57. [DOI: 10.1016/j.ccc.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Scientific and Clinical Abstracts From the WOCN® Society's 46th Annual Conference. J Wound Ostomy Continence Nurs 2014. [DOI: 10.1097/won.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Maruccia M, Ruggieri M, Onesti MG. Facial skin breakdown in patients with non-invasive ventilation devices: report of two cases and indications for treatment and prevention. Int Wound J 2013; 12:451-5. [PMID: 23870043 DOI: 10.1111/iwj.12135] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/23/2013] [Indexed: 11/29/2022] Open
Abstract
Non-invasive ventilation (NIV) provides an effective ventilatory support in patients with respiratory failure without endotracheal intubation. However, there are potential problems with its clinical application and the development of pressure ulcers represents a common complication. Often several intensive care units treat facial skin breakdown related to NIV. In this article, we report our experience in treatment and prevention of these lesions, emphasising the higher risk of certain age groups to develop them, such as preterm infants and elderly patients with comorbidities. We performed daily disinfection of the lesions followed by application of topical cream containing hyaluronic acid (HA) sodium salt. In addition, in order to prevent worsening of injury, we applied a cushion made of gauze pad containing HA sodium salt between the skin and the masks, so as to reduce friction between the NIV devices and the skin. Local medical treatment allowed complete reepithelialisation of the injured skin areas. Systematic monitoring of patients' faces is essential to detect early damages and to intervene with appropriate therapy, especially in preterm infants and elderly. Moreover, refining the devices with the proposed protective cushion can reduce pressure ulcers and increase comfort for the patients.
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Affiliation(s)
- Michele Maruccia
- Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy
| | - Martina Ruggieri
- Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy
| | - Maria G Onesti
- Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy
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25
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Rocco M, Alessandri E, Laderchi A, Marsili S, Conti G. Respiratory failure in COPD. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Carron M, Freo U, BaHammam AS, Dellweg D, Guarracino F, Cosentini R, Feltracco P, Vianello A, Ori C, Esquinas A. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013; 110:896-914. [PMID: 23562934 DOI: 10.1093/bja/aet070] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Non-invasive ventilation (NIV) has become a common treatment for acute and chronic respiratory failure. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing patient discomfort, procedural complications, and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. We performed a detailed review of the relevant medical literature for NIV complications. All major NIV complications are potentially life-threatening and can occur in any patient, but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. This extensive review of the literature shows that careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start can greatly reduce NIV complications.
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Affiliation(s)
- M Carron
- Department of Pharmacology and Anesthesiology, University of Padua, Padua, Italy
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27
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Asynchronies and sleep disruption in neuromuscular patients under home noninvasive ventilation. Respir Med 2012; 106:1478-85. [DOI: 10.1016/j.rmed.2012.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/24/2012] [Accepted: 05/30/2012] [Indexed: 12/22/2022]
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28
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Ahmad Z, Venus M, Kisku W, Rayatt SS. A case series of skin necrosis following use of non invasive ventilation pressure masks. Int Wound J 2012; 10:87-90. [PMID: 22432901 DOI: 10.1111/j.1742-481x.2012.00948.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Two cases of nasal skin necrosis secondary to pressure from the use of continuous positive airway pressure (CPAP) face masks are presented. Both developed skin necrosis as a result of wearing these masks over the nasal bridge. These cases highlight the need for clinical vigilance in application of CPAP masks, the need for monitoring the skin of the nose during CPAP use and the possible need for modifications in design to help prevent this serious complication.
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Affiliation(s)
- Z Ahmad
- Department of Plastic and Reconstructive Surgery, City General Hospital, UHNS, Stoke on Trent, Staffordshire, UK.
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29
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Continuous flow biphasic positive airway pressure by helmet in patients with acute hypoxic respiratory failure: effect on oxygenation. Intensive Care Med 2010; 36:1688-1694. [PMID: 20521025 DOI: 10.1007/s00134-010-1925-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated the effects of periodical high pressure breaths (SIGH) or biphasic positive pressure ventilation (BIPAP) during helmet continuous positive airway pressure (CPAP) in patients with acute hypoxic respiratory failure. METHODS We used a recently developed electromechanical expiratory valve (TwinPAP, StarMed, Mirandola, Italy), which is time-cycled between two customizable positive end-expiratory pressure (PEEP) levels. We studied 21 patients (67 ± 17 years old) undergoing helmet CPAP. Continuous flow CPAP system was set at 60 l/min flow rate while maintaining clinical FiO(2) (51 ± 15%). Five steps, lasting 1 h each, were applied: (1) spontaneous breathing with PEEP 0 cmH(2)O (SB), (2) CPAP with PEEP 8 cmH(2)O (CPAP(basal)), (3) low PEEP, 8 cmH(2)O, for 25 s and high PEEP, 25 cmH(2)O, for 5 s (SIGH), (4) low PEEP, 8 cmH(2)O, for 3 s and high PEEP, 20 cmH(2)O, for 3 s (BIPAP), (5) CPAP with PEEP 8 cmH(2)O (CPAP(final)). We randomized the sequence of SIGH and BIPAP. RESULTS PaO(2) was significantly higher during all steps compared to SB. When compared to CPAP(basal), both SIGH and BIPAP induced a further increase in PaO(2). PaO(2) during SIGH and BIPAP were not different. The oxygenation improvement was maintained during CPAP(final). CONCLUSIONS Superimposed, nonsynchronized positive pressure breaths delivered during helmet CPAP by means of the TwinPAP system may improve oxygenation in patients with acute hypoxemic respiratory failure, even at a rate as low as two breaths per minute.
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