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Yang T, Ma Y, Chen X, Yang Q, Pei J, Zhang Z, Qian X, Wang Y, Fan X, Han L. Effect of different noninvasive ventilation interfaces on the prevention of facial pressure injury: A network meta-analysis. Intensive Crit Care Nurs 2024; 81:103585. [PMID: 37977002 DOI: 10.1016/j.iccn.2023.103585] [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: 07/27/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the effect of different noninvasive ventilation interfaces on preventing the facial pressure injury. METHODS This network meta-analysis was conducted following the PRISMA reporting guidelines. Seven electronic databases were systematically searched for randomised controlled trials about the comparative effectiveness of different interfaces in preventing facial pressure injury with noninvasive ventilation in adults and newborns from inception to June 2023. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias assessment tool was used to assess the methodological quality. RESULTS A total of 78 randomised controlled trials involving 7,291 patients were included. The results of network meta-analysis showed that the effectiveness of the eight noninvasive ventilation interfaces on the prevention of facial pressure injury was in the order of: nasal cannula > full-face mask > rotation of nasal mask with nasal prongs > helmet > nasal mask > oronasal mask > nasal prongs > face mask. The use of full-face mask in adults and nasal cannula in newborns had the best effect on preventing the incidence of facial pressure injury. CONCLUSIONS The use of full-face mask in adults and nasal cannula in newborns had the most clinical advantage in preventing the incidence of facial pressure injury and were worthy promoting in clinical practice. IMPLICATIONS FOR CLINICAL PRACTICE This study provides a certain theoretical basis for the selection of appropriate interface for patients with noninvasive ventilation. Clinical practitioners should choose the appropriate interfaces based on the patient's specific condition to reduce the incidence of facial pressure injury, enhance patient comfort, and improve the effectiveness of respiratory therapy.
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Affiliation(s)
- Tingting Yang
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoli Chen
- Department of Pediatrics, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qiuxia Yang
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Juhong Pei
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyao Zhang
- School of Foreign Languages, Lanzhou University of Arts and Science, Lanzhou, Gansu, China
| | - Xiaoling Qian
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yunyun Wang
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiangping Fan
- Department of Nursing, The Third People's Hospital of Lanzhou, Lanzhou, Gansu, China
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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2
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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: 13] [Impact Index Per Article: 6.5] [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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3
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Köhnlein T, Schwarz SB, Nagel S, Windisch W. Home Non-Invasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease: Why, Who, and How? Respiration 2022; 101:709-716. [PMID: 35717945 DOI: 10.1159/000525015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Advanced chronic obstructive pulmonary disease (COPD) might result in chronic hypercapnic ventilatory failure. Similar to neuromuscular and restrictive chest wall diseases, long-term non-invasive positive pressure ventilation (NPPV) is increasingly used in chronic hypercapnic COPD. This review describes the methods, patient selection, ventilatory strategies, and therapeutic effects of long-term Home-NPPV based on randomized controlled clinical trials published since 1985 in English language retrieved from the databases PubMed and Scopus. Long-term NPPV is feasible and effective in stable, non-exacerbated COPD patients with daytime hypercapnia with arterial pressure of carbon dioxide (PaCO2) levels ≥50 mm Hg (6.6 kPa), if the applied ventilatory pressures and application times improve baseline hypercapnia by at least 20%. Patients who survived an acute hypercapnic exacerbation might benefit from long-term NPPV if hypercapnia persists 2-4 weeks after resolution of the exacerbation. Pressure-controlled ventilation or pressure-support ventilation with adequate minimum backup breathing frequencies, in combination with nasal masks or oronasal masks have been successfully used in all larger clinical trials. Ventilatory strategies with mean inspiratory pressures of up to 28 cm H2O are well-tolerated by patients, but limitations exist in patients with impaired cardiac performance. Home-NPPV with a PaCO2-reductive approach might be considered as an additional treatment option in patients with stable chronic hypercapnic COPD.
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Affiliation(s)
- Thomas Köhnlein
- Facharztzentrum Teuchern und Mitteldeutsche Fachklinik für Schlafmedizin, Teuchern, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
| | - Stephan Nagel
- Klinikum St. Georg, Robert-Koch-Klinik, Respiratory Medicine, Leipzig, Germany
| | - Wolfram Windisch
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
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4
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Ribeiro C, Vieira AL, Pamplona P, Drummond M, Seabra B, Ferreira D, Liberato H, Carreiro A, Vicente I, Castro L, Costa P, Carriço F, Martin T, Cravo J, Teixeira N, Grafino M, Conde S, Windisch W, Nunes R. Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2217-2226. [PMID: 34349507 PMCID: PMC8328383 DOI: 10.2147/copd.s314826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.
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Affiliation(s)
- Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Paula Pamplona
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte - Hospital Pulido Valente, Lisboa, Portugal
| | - Marta Drummond
- Centro de Responsabilidade Integrado Sono e VNI do Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diva Ferreira
- Pulmonology Department, Centro Hospitalar do Médio Ave, Famalicão, Portugal
| | - Hedi Liberato
- Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Alexandra Carreiro
- Pulmonology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Inês Vicente
- Pulmonology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Luísa Castro
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Pedro Costa
- Pulmonology Functional Unit, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Filipa Carriço
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Teresa Martin
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Cravo
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Nélson Teixeira
- Pulmonology Department, Unidade Local de Saúde do Nordeste, Bragança, Portugal
| | - Mónica Grafino
- Pulmonology Department, Hospital da Luz, Lisboa, Portugal
| | - Sara Conde
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Rui Nunes
- Faculty of Medicine, Porto University, Porto, Portugal
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5
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Kaminska M, Rimmer KP, McKim DA, Nonoyama M, Giannouli E, Morrison D, O’Connell C, Petrof BJ, Maltais F. Long-term non-invasive ventilation in patients with chronic obstructive pulmonary disease (COPD): 2021 Canadian Thoracic Society Clinical Practice Guideline update. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2021. [DOI: 10.1080/24745332.2021.1911218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Marta Kaminska
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montréal, Québec
| | - Karen P. Rimmer
- Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Douglas A. McKim
- Division of Respirology, University of Ottawa and The Ottawa Hospital Research Institute, CANVent Respiratory Services, Ottawa, Ontario, Canada
| | - Mika Nonoyama
- University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Eleni Giannouli
- Division of Respiratory Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Debra L. Morrison
- Division of Respirology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colleen O’Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
| | - Basil J. Petrof
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montréal, Québec
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
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6
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Lebret M, Léotard A, Pépin JL, Windisch W, Ekkernkamp E, Pallero M, Sánchez-Quiroga MÁ, Hart N, Kelly JL, Patout M, Funk GC, Duiverman ML, Masa JF, Simonds A, Murphy PB, Wijkstra PJ, Dreher M, Storre J, Khouri C, Borel JC. Nasal versus oronasal masks for home non-invasive ventilation in patients with chronic hypercapnia: a systematic review and individual participant data meta-analysis. Thorax 2021; 76:1108-1116. [PMID: 33859049 DOI: 10.1136/thoraxjnl-2020-215613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal interface for the delivery of home non-invasive ventilation (NIV) to treat chronic respiratory failure has not yet been determined. The aim of this individual participant data (IPD) meta-analysis was to compare the effect of nasal and oronasal masks on treatment efficacy and adherence in patients with COPD and obesity hypoventilation syndrome (OHS). METHODS We searched Medline and Cochrane Central Register of Controlled Trials for prospective randomised controlled trials (RCTs) of at least 1 month's duration, published between January 1994 and April 2019, that assessed NIV efficacy in patients with OHS and COPD. The main outcomes were diurnal PaCO2, PaO2 and NIV adherence (PROSPERO CRD42019132398). FINDINGS Of 1576 articles identified, 34 RCTs met the inclusion criteria and IPD were obtained for 18. Ten RCTs were excluded because only one type of mask was used, or mask data were missing. Data from 8 RCTs, including 290 IPD, underwent meta-analysis. Oronasal masks were used in 86% of cases. There were no differences between oronasal and nasal masks for PaCO2 (0.61 mm Hg (95% CI -2.15 to 3.38); p=0.68), PaO2 (-0.00 mm Hg (95% CI -4.59 to 4.58); p=1) or NIV adherence (0·29 hour/day (95% CI -0.74 to 1.32); p=0.58). There was no interaction between the underlying pathology and the effect of mask type on any outcome. INTERPRETATION Oronasal masks are the most used interface for the delivery of home NIV in patients with OHS and COPD; however, there is no difference in the efficacy or tolerance of oronasal or nasal masks.
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Affiliation(s)
- Marius Lebret
- Pneumology Department, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
| | | | - Jean Louis Pépin
- HP2 Laboratory INSERM U1042, Univ. Grenoble Alpes, Grenoble, France
| | - Wolfram Windisch
- Department of Pneumology and Critical Care Medicine, Cologne Merheim Hospital, Cologne, Germany.,Depatment of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Emelie Ekkernkamp
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - Mercedes Pallero
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Julia L Kelly
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Maxime Patout
- Departement of pneumology and intensive care, University Hospital, Rouen, France
| | - Georg Chistian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Marieke L Duiverman
- Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, Netherlands
| | - Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain
| | - Anita Simonds
- National Institute of Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Respiratory Medicine, Imperial College London, London, UK
| | | | - Peter J Wijkstra
- Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Michael Dreher
- Pneumology and Intensive Care Medicine, Universitatsklinikum Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Jan Storre
- Pneumology Department, University Medical Center Freiburg, Freiburg, Germany.,Praxis Pneumologie Solln, Munich, Germany
| | - Charles Khouri
- HP2 Laboratory INSERM 1042, Grenoble Universites, Saint-Martin-d'Heres, France
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7
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Majorski DS, Callegari JC, Schwarz SB, Magnet FS, Majorski R, Storre JH, Schmoor C, Windisch W. Oronasal versus Nasal Masks for Non-Invasive Ventilation in COPD: A Randomized Crossover Trial. Int J Chron Obstruct Pulmon Dis 2021; 16:771-781. [PMID: 33814901 PMCID: PMC8009345 DOI: 10.2147/copd.s289755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The impact of oronasal and nasal masks on the quality of nocturnal non-invasive ventilation (NIV) needs to be clarified. This trial was designed to compare the impact of oronasal and nasal masks on the objective quality and subjective acceptance of nocturnal NIV in COPD-patients. Patients and Methods In a randomized crossover trial, 30 COPD-patients with well-established high-intensity NIV (mean inspiratory/expiratory positive airway pressure 26±3/5±1 cmH2O, mean respiratory back-up rate 17±1/min) were ventilated for two consecutive nights on oronasal and nasal masks, respectively. Results Full polysomnography, nocturnal blood gas measurements, and subjective assessments were performed. There was a tendency towards improved sleep efficiency (primary outcome) when an oronasal mask was worn (+9.9%; 95% CI:-0.2%-20.0%; P=0.054). Sleep stages 3/4 were favored by the oronasal mask (+12.7%; 95% CI: 6.0%-19.3%; P=<0.001). Subjective assessments were comparable with the exception of items related to leakage (P<0.05 in favor of nasal masks). The mean transcutaneous PCO2 value for oronasal masks (47.7±7.4 mmHg) was comparable to that of nasal masks (48.9±6.6 mmHg) (P=0.11). There was considerable diversity amongst individual patients in terms of sleep quality and gas exchange following mask exchange. Subjective mask preference was not associated with sleep quality, but with nocturnal dyspnea. Over 40% of patients subsequently switched to the mask that they were not previously accustomed to. Conclusion In general, oronasal and nasal masks are each similarly capable of successfully delivering NIV in COPD-patients. However, the individual response to different interfaces is extremely heterogeneous, while subjective mask preference is independent from objective measures, but associated with dyspnea. Trial Registration German Clinical Trials Registry (DRKS00007741).
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Affiliation(s)
- Daniel S Majorski
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Jens C Callegari
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Sarah B Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Friederike S Magnet
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Rodion Majorski
- Department of Neurology and Neurophysiology, Helios Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Jan H Storre
- Praxis Pneumologie Solln, Munich, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Center - University Medical Hospital, Freiburg, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
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8
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Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
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Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
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9
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Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
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10
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Patout M, Lhuillier E, Kaltsakas G, Benattia A, Dupuis J, Arbane G, Declercq PL, Ramsay M, Marino P, Molano LC, Artaud-Macari E, Viacroze C, Steier J, Douiri A, Muir JF, Cuvelier A, Murphy PB, Hart N. Long-term survival following initiation of home non-invasive ventilation: a European study. Thorax 2020; 75:965-973. [PMID: 32895315 DOI: 10.1136/thoraxjnl-2019-214204] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although home non-invasive ventilation (NIV) is increasingly used to manage patients with chronic ventilatory failure, there are limited data on the long-term outcome of these patients. Our aim was to report on home NIV populations and the long-term outcome from two European centres. METHODS Cohort analysis including all patients established on home NIV from two European centres between 2008 and 2014. RESULTS Home NIV was initiated in 1746 patients to treat chronic ventilatory failure caused by (1) obesity hypoventilation syndrome±obstructive sleep apnoea (OHS±OSA) (29.5%); (2) neuromuscular disease (NMD) (22.7%); and (3) obstructive airway diseases (OAD) (19.1%). Overall cohort median survival following NIV initiation was 6.6 years. Median survival varied by underlying aetiology of respiratory failure: rapidly progressive NMD 1.1 years, OAD 2.7 years, OHS±OSA >7 years and slowly progressive NMD >7 years. Multivariate analysis demonstrated higher mortality in patients with rapidly progressive NMD (HR 4.78, 95% CI 3.38 to 6.75), COPD (HR 2.25, 95% CI 1.64 to 3.10), age >60 years at initiation of home NIV (HR 2.41, 95% CI 1.92 to 3.02) and NIV initiation following an acute admission (HR 1.38, 95% CI 1.13 to 1.68). Factors associated with lower mortality were NIV adherence >4 hours per day (HR 0.64, 95% CI 0.51 to 0.79), OSA (HR 0.51, 95% CI 0.31 to 0.84) and female gender (HR 0.79, 95% CI 0.65 to 0.96). CONCLUSION The mortality rate following initiation of home NIV is high but varies significantly according to underlying aetiology of respiratory failure. In patients with chronic respiratory failure, initiation of home NIV following an acute admission and low levels of NIV adherence are poor prognostic features and may be amenable to intervention.
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Affiliation(s)
- Maxime Patout
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elodie Lhuillier
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Unité de recherche clinique, Centre Henri Becquerel, Rouen, Haute-Normandie, France
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amira Benattia
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | | | - Gill Arbane
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pierre-Louis Declercq
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Michelle Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Marino
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luis-Carlos Molano
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Elise Artaud-Macari
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Catherine Viacroze
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Joerg Steier
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, London, UK
| | - Abdel Douiri
- Guy's and St Thomas' NHS Trust and King's College London, National Institute for Health Research Comprehensive Biomedical Research Centre, London, UK
| | - Jean-Francois Muir
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Antoine Cuvelier
- EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, F 76000, Normandie Univ, UNIRouen, Rouen, France
| | - Patrick Brian Murphy
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK .,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, London, UK
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11
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Klingshirn H, Gerken L, Heuschmann P, Haas K, Schutzmeier M, Brandstetter L, Stangl S, Wurmb T, Kippnich M, Reuschenbach B. [Quality of Care for People with Home Mechanical Ventilation in Germany: A Scoping Review]. DAS GESUNDHEITSWESEN 2020; 82:729-739. [PMID: 32650350 PMCID: PMC7518336 DOI: 10.1055/a-1164-6516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund
Die außerklinische Intensivversorgung von Menschen
mit Langzeitbeatmung ist ein stark anwachsender Bereich mit vielseitigen
Versorgungsbedarfen. Ziel dieses Scoping Reviews ist es, den aktuellen
Forschungsstand zur Qualität der Versorgung beatmeter Menschen in der
außerstationären Intensivpflege in Deutschland darzustellen und
Forschungslücken aufzudecken.
Methode
Anhand definierter Einschlusskriterien wurden 4 Datenbanken nach
Publikationen zur Versorgung von außerklinisch beatmeten Menschen in
Deutschland durchsucht. Datenextraktion und Synthese erfolgten nach der Methode
der „data driven thematic analysis“. Eine Differenzierung
zwischen Forschung und Expertenmeinung fand statt.
Ergebnisse
Die Suche ergab 493 Treffer, von denen insgesamt 68
Publikationen eingeschlossen wurden, darunter 2 Leitlinien (3%), 45
(66%) Forschungsarbeiten und 21 (31%) Expertenmeinungen.
Inhaltlich konnten folgende Themenfelder identifiziert werden: Organisation und
Steuerung der Beatmung (n=43; 63%), pflegerische (n=23;
34%), medizinische (n=39; 57%), therapeutische
(n=7; 10%) und Hilfsmittelversorgung (n=24;
35%), sowie die Sicht beatmeter Personen und deren Angehörigen
(n=33; 49%) und weitere Themen (n=13; 19%).
Schlussfolgerung
Obwohl der Qualitätsdiskurs zur Versorgung
beatmeter Personen in der außerklinischen Intensivpflege breit
geführt wird, fehlen Studien zur Bedarfsgerechtigkeit von
Versorgungsleistungen, zu Selbstbestimmung und Teilhabe in Abhängigkeit
der Wohnform oder zur Rolle einzelner ‚Health Professionals‘ im
interprofessionellen Team.
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Affiliation(s)
| | - Laura Gerken
- Katholische Stiftungshochschule München, München
| | - Peter Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg.,Zentrale für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg.,Deutsches Zentrum für Herzinsuffizienz (DZHI), Universität Würzburg, Würzburg
| | - Kirsten Haas
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Martha Schutzmeier
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Lilly Brandstetter
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Thomas Wurmb
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg
| | - Maximilian Kippnich
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg
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12
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Long-Term Noninvasive Ventilation in the Geneva Lake Area: Indications, Prevalence, and Modalities. Chest 2020; 158:279-291. [PMID: 32243941 DOI: 10.1016/j.chest.2020.02.064] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution. RESEARCH QUESTION To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software. STUDY DESIGN AND METHODS Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants). RESULTS A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being > 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime Paco2 was most often normalized. Adherence to treatment was satisfactory, with 8% only using their device < 3.5 h/d. Bilevel positive pressure ventilators in spontaneous/timed mode was the default mode (86%), with a low use of autotitrating modes. NIV was initiated electively in 50% of the population, in a hospital setting in 82%, and as outpatients in 15%. INTERPRETATION Use of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov.
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13
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14
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Huang H, Feng H, Zhuge D. M1 Macrophage Activated by Notch Signal Pathway Contributed to Ventilator-Induced Lung Injury in Chronic Obstructive Pulmonary Disease Model. J Surg Res 2019; 244:358-367. [PMID: 31323391 DOI: 10.1016/j.jss.2019.06.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ventilator-induced lung injury (VILI) in chronic obstructive pulmonary disease (COPD) is still a problem. We intended to explore the role of macrophage polarity in VILI and the underlying mechanism. MATERIALS AND METHODS COPD model was created by cigarette smoke and ventilated. Macrophages were isolated, and the wet/dry (W/D) ratio was determined after modeling, and proteins in bronchoalveolar lavage fluid (BALF) were assessed by bicinchoninic acid assay. Histopathology was observed by Hematoxylin-Eosin staining. Tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels were measured by enzyme-linked immunosorbent assay. Macrophage polarity was assessed by flow cytometry. Protein levels were measured by Western blot and mRNA by quantitative real-time polymerase chain reaction. RESULTS Pathology statement was worsened, and the W/D ratio, protein level in BALF, TNF-α level, and IL-6 levels were elevated in cigarette smoke-induced COPD model. Notch-1 intracellular domain, hairy and enhancer of split (Hes) 1, Hes5, hairy/enhancer-of-split related with YRPW motif protein 1, CD86, TNF-α, and inducible nitric oxide synthases expressions were raised, whereas CD206, IL-4, and IL-10 expressions were decreased in macrophages after ventilation, shifting macrophage polarity to M1 phenotype. After the inhibition of Notch signaling, pathology statement was improved, and the W/D ratio, protein level in BALF, TNF-α, IL-6, Notch-1 intracellular domain, Hes1, Hes5, hairy/enhancer-of-split related with YRPW motif protein 1, CD86, TNF-α, and inducible nitric oxide synthases expressions were decreased while CD206, IL-4, and IL-10 expressions were elevated after ventilation, shifting macrophage polarity to M2 phenotype partially. CONCLUSIONS Mechanical ventilation in cigarette-induced COPD could activate the Notch signal pathway and further shift the polarity of macrophage toward M1 phenotype, leading to VILI in cigarette-induced COPD.
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Affiliation(s)
- Hongping Huang
- Department of Eastern Respiratory Medicine, Linyi People's Hospital, Linyi, China
| | - Hui Feng
- Linyi People's Hospital Office, Linyi People's Hospital, Linyi, China.
| | - Dong Zhuge
- Department of Eastern General Internal Medicine, Linyi People's Hospital, Linyi, China
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15
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Castro-Codesal ML, Olmstead DL, MacLean JE. Mask interfaces for home non-invasive ventilation in infants and children. Paediatr Respir Rev 2019; 32:66-72. [PMID: 31130424 DOI: 10.1016/j.prrv.2019.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/25/2022]
Abstract
The selection of the mask interface for non-invasive ventilation (NIV) is recognized to be an essential part for therapy success. While nasal masks are the first recommended option in children and adults, there are indications for other mask types such as intolerance or complications from nasal masks. Evidence comparing performance, adherence and complication risk among mask interfaces in pediatrics is, however, scarce and information is often extrapolated from adult studies. Given this gap in knowledge and the lack of guidelines on NIV initiation in children, mask selection often relies on the clinicians' knowledge and expertise. Careful mask selection, a well-fitting headgear and time investment for mask desensitization are some important recommendations for adequate mask adaptation in children. Frequent mask-related complications include nasal symptoms, unintentional leak, mask displacement, skin injury, and midface hypoplasia. Close monitoring and a pro-active approach may help to minimize complications and promote the optimal use of home NIV.
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Affiliation(s)
- Maria L Castro-Codesal
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada.
| | - Deborah L Olmstead
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
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16
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Ergan B, Oczkowski S, Rochwerg B, Carlucci A, Chatwin M, Clini E, Elliott M, Gonzalez-Bermejo J, Hart N, Lujan M, Nasilowski J, Nava S, Pepin JL, Pisani L, Storre JH, Wijkstra P, Tonia T, Boyd J, Scala R, Windisch W. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J 2019; 54:13993003.01003-2019. [DOI: 10.1183/13993003.01003-2019] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/13/2019] [Indexed: 02/07/2023]
Abstract
BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
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17
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Yazar EE, Özlü T, Sarıaydın M, Taylan M, Ekici A, Aydın D, Coşgun İG, Durmuş Koçak N. Prospective cross-sectional multicenter study on domiciliary noninvasive ventilation in stable hypercapnic COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2367-2374. [PMID: 30127600 PMCID: PMC6089109 DOI: 10.2147/copd.s164384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Domiciliary noninvasive ventilation (NIV) use in stable hypercarbic COPD is becoming increasingly widespread. However, treatment compliance criteria and factors related to compliance remain to be defined. Methods This research was designed as a prospective, cross-sectional, multicenter real-life study. Chronic hypercapnic COPD patients who were using domiciliary NIV for at least 1 year and being followed up in 19 centers across Turkey were included in the study. The patients who used NIV regularly, night or daytime and ≥5 hours/d, were classified as “high-compliance group,” and patients who used NIV irregularly and <5 hours/d as “low-compliance group.” Results Two hundred and sixty-six patients with a mean age of 64.5±10.3 years were enrolled, of whom 75.2% were males. They were using domiciliary NIV for 2.8±2 years. Spontaneous time mode (p<0.001) and night use (p<0.001) were more frequent in the high-compliance group (n=163). Also, mean inspiratory positive airway pressure values of the high-compliance group were significantly higher than the low-compliance group (n=103; p<0.001). Cardiac failure (p=0.049) and obesity (p=0.01) were significantly more frequent in the high-compliance group. There were no difference between 2 groups regarding hospitalization, emergency department and intensive care unit admissions within the last year, as well as modified Medical Research Council dyspnea and COPD Assessment Test scores. With regard to NIV-related side effects, only conjunctivitis was observed more frequently in the high-compliance group (p=0.002). Conclusion Determination of the patients who have better compliance to domiciliary NIV in COPD may increase the success and effectiveness of treatment. This highly comprehensive study on this topic possesses importance as it suggests that patient and ventilator characteristics may be related to treatment compliance.
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Affiliation(s)
- Esra Ertan Yazar
- Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey,
| | - Tevfik Özlü
- Department of Pulmonology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Muzaffer Sarıaydın
- Department of Pulmonology, School of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Mahşuk Taylan
- Department of Pulmonology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Aydanur Ekici
- Department of Pulmonology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Derya Aydın
- Department of Pulmonology, Balıkesir Chest Disease Government Hospital, Balıkesir, Turkey
| | - İbrahim Güven Coşgun
- Department of Pulmonology, Afyonkarahisar Government Hospital, Afyonkarahisar, Turkey
| | - Nagihan Durmuş Koçak
- Department of Pulmonology, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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18
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Brill AK, Pickersgill R, Moghal M, Morrell MJ, Simonds AK. Mask pressure effects on the nasal bridge during short-term noninvasive ventilation. ERJ Open Res 2018; 4:00168-2017. [PMID: 29637077 PMCID: PMC5890023 DOI: 10.1183/23120541.00168-2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/23/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to assess the influence of different masks, ventilator settings and body positions on the pressure exerted on the nasal bridge by the mask and subjective comfort during noninvasive ventilation (NIV). We measured the pressure over the nasal bridge in 20 healthy participants receiving NIV via four different NIV masks (three oronasal masks, one nasal mask) at three different ventilator settings and in the seated or supine position. Objective pressure measurements were obtained with an I-Scan pressure-mapping system. Subjective comfort of the mask fit was assessed with a visual analogue scale. The masks exerted mean pressures between 47.6±29 mmHg and 91.9±42.4 mmHg on the nasal bridge. In the supine position, the pressure was lower in all masks (57.1±31.9 mmHg supine, 63.9±37.3 mmHg seated; p<0.001). With oronasal masks, a change of inspiratory positive airway pressure (IPAP) did not influence the objective pressure over the nasal bridge. Subjective discomfort was associated with higher IPAP and positively correlated with the pressure on the skin. Objective measurement of pressure on the skin during mask fitting might be helpful for mask selection. Mask fitting in the supine position should be considered in the clinical routine.
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Affiliation(s)
- Anne-Kathrin Brill
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,Dept of Pulmonary Medicine, University and University Hospital Bern, Bern, Switzerland
| | - Rachel Pickersgill
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK
| | - Mohammad Moghal
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
| | - Anita K Simonds
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
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19
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Storre JH, Callegari J, Magnet FS, Schwarz SB, Duiverman ML, Wijkstra PJ, Windisch W. Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease: patient selection and perspectives. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535515 PMCID: PMC5836655 DOI: 10.2147/copd.s154718] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine basis. In particular, there is ongoing debate about Home-NIV in chronic hypercapnic COPD regarding the overall effects, the most favorable treatment strategy, the selection of eligible patients, and the time point at which it is prescribed. The current review focuses on specific aspects of patient selection and discusses the various scientific as well as clinical-guided perspectives on Home-NIV in patients suffering from chronic hypercapnic COPD. In addition, special attention will be given to the topic of ventilator settings and interfaces.
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Affiliation(s)
- Jan Hendrik Storre
- Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Jens Callegari
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Friederike Sophie Magnet
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Marieke Leontine Duiverman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
| | - Peter Jan Wijkstra
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
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