Application Of Non-invasive Mechanical Ventilation Research Articles

Noninvasive mechanical ventilation

Noninvasive mechanical ventilation (NIMV) is positive pressure ventilation applied through a mask without an artificial airway and is frequently used in acute and chronic respiratory failure. It is the first choice in the weaning process for patients with acute cardiogenic pulmonary edema, acute exacerbations of chronic obstructive pulmonary disease (COPD), and COPD patients with invasive mechanical ventilation. The choice of device, mode, and mask is important to the application and success of NIMV. In appropriate diagnosis and indication, NIMV should be the first choice in patients who are cooperative, able to protect their airways, clinically stable, and to whom the mask can be applied. In this review, the NIMV application, especially in acute respiratory failure, is summarized.

Rationales and methodology of the noninvasive ventilation in CPAP mode in pre‑hospital care for exacerbations of chronic obstructive pulmonary disease and cardiac pulmonary edema

Review of literature on the rationale and features of the application of noninvasive mechanical ventilation in CPAP mode in providing emergency medical care to patients with exacerbation of COPD and acute cardiogenic pulmonary edema.

Unusual complications of non-invasive mechanical ventilation (NIV) and high-flow nasal cannula (HFNC): A systematic review.

The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular Dystrophy was successfully ventilated. Since then, the use of NIV has been on the rise throughout the world. Although a very modern and safe therapy, complications during its application are inevitable. In addition to some well-known complications, others have described more rare entities. In this article, we described such rare complications as pneumoperitoneum, pneumocephalus, parotitis, gastric perforation, and barotrauma. The purpose of this review was to describe unusual complications of NIV, their prevalence, and the mechanisms by which such complications arise. We performed a clinical review by searching PubMed, Embase, and Cochrane libraries with Mesh terms: 'non-invasive mechanical ventilation', 'high-flow nasal cannula', 'rare complication', 'unusual complication', and 'unexpected complication'. These terms were cross-referenced with other keywords: 'pneumoperitoneum', 'parotitis', 'pneumocephalus', 'gastric insufflation', and 'barotrauma'. We included 26 research papers. When applying mechanical ventilation, it is necessary to have a strong knowledge of the mechanics of the device as well as familiarity with the complications that may occur during its use, including less common ones. Prompt and effective treatment of such complications is required, as well as careful consideration of the potential causes of such events, during the application of NIV or HFNC.

Clinical impact of COVID-19 on Turkish children with neurological and neuromuscular diseases: One center experience.

This study aims to explore the effects of new type of coronavirus disease (COVID-19) in children with neurological and/or neuromuscular diseasesA retrospective study was conducted at State Hospital of Denizli. Pediatric patients diagnosed with COVID-19 who were hospitalized between March 18, 2020 and January 18, 2021 were included in the study. Children were divided into two groups: those with (group I) and without neurological and /or neuromuscular disorders (group II).Male cases were more than female cases in group I. The difference between group I and group II was significant in terms of seizure (47.3%; 1.7%), dyspnea (36.8%, 6.2%) and number of days with fever (2.6 ± 1.9; 1.58 ± 1.42) (P < .01, P < .01, P = .02). Hypoxemia (7, 11; 36.8%, 4.5%) and abnormal auscultation findings (8, 44; 42.1%, 18.1%) were more common in children in group I, hypertension was more common in group II (0, 8; 0%, 3.3%). Lung involvement of COVID-19 was found to be more severe in group I (P = .04). The frequency of hospitalization in the intensive care unit (P < .01) and application of noninvasive mechanical ventilation (NIMV) (P < .01); the number of days followed-up in the intensive care (P < .01) and in the hospital (P = .02) of the patients in group I were higher than those in group II.It is recognized that children with underlying neurological and/or neuromuscular diseases are severely affected by COVID-19.

Application of Non-invasive Mechanical Ventilation in the Treatment of Respiratory Failure in Elderly Patients with Pulmonary Hypertension

Application of Non-invasive Mechanical Ventilation in the Treatment of Respiratory Failure in Elderly Patients with Pulmonary Hypertension

Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study

BackgroundWe studied patients with coronavirus disease 2019 (COVID-19) infected by severe acute respiratory syndrome coronavirus 2, a virus that originated in Wuhan, China, and is spreading over the country including Jiangsu Province. We studied the clinical characteristics and therapies of severe cases in Jiangsu Province.MethodsA multicenter retrospective cohort study was conducted to analyze clinical, laboratory data and treatment of 60 severe cases with COVID-19 infection in Jiangsu Province between January 24, 2020 and April 20, 2020. The improvement and deterioration subgroups were compared to identify predictors of disease progression.ResultsA total of 653 infected cases with COVID-19 were reported in Jiangsu Province, of which 60 severe cases were included in this study. Up until April 20, 2020, the mortality of severe patients was 0%. The median age was 57 years. The average body mass index of these patients was 25 kg/m². White blood cell counts decreased in 45.0% of patients, lymphopenia in 63.3%, thrombocytopenia in 13.3% and procalcitonin levels in 88.3% of the patients were less than 0.5 ng/mL. There were no statistically significant differences in immunoglobulin therapy and GCs therapy between the improvement and deterioration subgroups. Logistic regression analysis identified higher levels of troponin T (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.00-1.08; P = 0.04), antiviral therapy with aerosol inhalation of interferon (OR: 6.33; 95% CI: 1.18-33.98; P = 0.03), and the application of non-invasive mechanical ventilation (OR: 1.99; 95%CI: 1.17-3.41; P = 0.01) as predictors of disease progression, whereas higher lymphocyte count (OR: 0.11; 95% CI: 0.02-0.57; P = 0.01) and early prone ventilation were associated with improvement (OR: 0.11; 95% CI: 0.01-0.98; P = 0.04).ConclusionsCOVID-19 infection had a low mortality rate in Jiangsu Province, China. The higher levels of troponin T and lower lymphocyte count were predictors of disease progression. Early prone ventilation may be an effective treatment for severe cases.

Can NT-pro BNP Levels Predict Prognosis of Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit?

Background:The prognostic value of amino terminal pro-brain natriuretic peptide levels in patients with acute exacerbation of chronic obstructive pulmonary disease has not been fully established.Aims:To investigate the predictive value of amino terminal pro-brain natriuretic peptide levels in terms of mortality, need for noninvasive mechanical ventilation, invasive mechanical ventilation, and weaning success.Study Design:Cohort study.Methods:Patients who were admitted to intensive care unit between December 2015 and December 2016 due to acute exacerbation of chronic obstructive pulmonary disease were included in the study. Demographic data, noninvasive mechanical ventilation application, need for invasive mechanical ventilation, amino terminal pro-brain natriuretic peptide level, duration of mechanical ventilation, intensive care unit and hospital stay, weaning success, and mortality rates were recorded.Results:A total of 110 patients (75 males) were included in the study. The mean age of the participants was 69 (61-76) years, and the mean Acute Physiology and Chronic Health Evaluation II score was 19 (15-23). The mean amino terminal pro-brain natriuretic peptide level was found to be lower in cases with noninvasive mechanical ventilation success than those with noninvasive mechanical ventilation failure (p=0.053). In addition, the mean amino terminal pro-brain natriuretic peptide level was significantly higher (4740 pg/mL vs. 3004 pg/mL, p=0.001) in patients who needed invasive mechanical ventilation support than in patients who did not. The mortality rate was significantly higher in patients who had an increasing trend of amino terminal pro-brain natriuretic peptide levels during hospitalization than in patients who had decreasing levels (59% vs. 23%, p=0.015). Based on the receiver operating characteristic analysis, the increasing trend of amino terminal pro-brain natriuretic peptide levels during intensive care unit stay predicted mortality with area under curve of 0.84 (p<0.0001, 95% CI: 0.75-0.93) and predicted invasive mechanical ventilation need with area under curve of 0.68.Conclusion:In cases of acute exacerbation of chronic obstructive pulmonary disease requiring mechanical ventilation, amino terminal pro-brain natriuretic peptide measurement and monitoring of its trend may be a valuable asset in predicting mortality, noninvasive mechanical ventilation, weaning success, and need for invasive mechanical ventilation.

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure.

Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV.The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material.This guideline committee developed recommendations for 11 actionable questions in a PICO (population-intervention-comparison-outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders.

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

Comparison of the effects of continuous and intermittent non invasive mechanical ventilation on cardiorespiratory parameters and autonomic modulation of healthy individuals

Study design: Cross-sectional study. Objective: To evaluate the influence of continuous and intermittent noninvasive mechanical ventilation (NIV) on cardiac autonomic modulation and cardiorespiratory parameters in healthy women. Methods: Twenty subjects performed two types of NIV: continuous through CPAP and intermittent through Müller Reanimator. Initially they remained at rest for 20 minutes in spontaneous breathing. Then volunteers were subjected to 20 minutes of NIV application with the selected technique and finally remained at rest for 20 minutes in spontaneous breathing. Cardiorespiratory parameters and heart rate variability (HRV) were measured in all these moments. Results: There were no significant differences when comparing the two techniques. Differences were observed in HRV and cardiorespiratory parameters when analyzed individually. Lower values of heart rate and respiratory rate were observed in continuous ventilation when compared to values during ventilation with spontaneous breathing (p &lt;0.005). In both techniques we observed significant increases in SpO2 during ventilation compared to spontaneous breathing. We observed an increase in parasympathetic modulation (RMSSD, HF ms2 and SD1) and overall variability (SDNN, RR triangular and SD2) in both techniques when compared ventilation to spontaneous breathing (p &lt;0.005). Conclusion: There was no difference comparing the two types of NIV. However, when analyzed individually we observe different behavior of cardiorespiratory parameters and autonomic modulation

Factors Related to NIMV Failure in Hospitalized COPD Patients With Exacerbation

SESSION TITLE: COPD Posters VI SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Non-invasive mechanical ventilation (NIMV) is routinely used in exacerbations of COPD patients admitted with hypercapnia. In this study treatment results and factors affecting successful NIMV application in COPD patients in chest clinics were investigated. METHODS: All COPD patients admitted to emergency clinics with acute hypercapnic respiratory failure between May 2010 and May 2012 were included in this study. After first application of NIMV in emergency clinics, patients were hospitalized and NIMV was continued in patient wards. Demographic properties, comorbidities, arterial blood gas findings on admission and follow-up, hematologic and biochemical findings were noted. Factors influencing success and failure (transfer to ICU or death) of NIMV application were investigated. RESULTS: NIMV was successful in 377 patients (83.6%) and unsuccessful in 67 patients (16.4%). Factors affecting the failure were found as low albumin, high CRP, unresolved pH and PaCO2 levels 1 hour after application of NIMV, higher number of comorbidities, presence of any malignancy and low IPAP. CONCLUSIONS: Our success rate is high in hospitalized patients having NIMV due to COPD exacerbation. In this study, we found multiple factors leading to failure of NIMV in COPD exacerbations. We think that clinicians should be careful about applying NIMV in COPD patients carrying these negative factors during exacerbation and should consider early admission to the ICU. CLINICAL IMPLICATIONS: Clinicians can predict NIMV failure by using multipl parametres . DISCLOSURE: The following authors have nothing to disclose: Meltem Agca, Fatma Tokgoz, Dildar Yetis, Fatma Merve Tepetam, Aysun Misirlioglu, Hakan Gunen, Tulay Yarkin

Acute Respiratory Failure: Pathophysiological Basis From A Multidisciplinary Clinical Approach.

Acute Respiratory Failure: Pathophysiological Basis from a Multidisciplinary Clinical Approach Acute Respiratory Failure (ARF) is a syndrome characterized by the inability of the respiratory system to maintain adequate arterial O2 and CO2 levels according to the demands of cellular metabolism. ARF may be caused by the failure of the exchanger, lung, organ or pump, or failure of the respiratory muscles. ARF can be classified by the dysfunctional element or the evolution time when the condition occurs. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is the most important cause of adults hipoxemic respiratory failure, which results from multiple clinical factors such as sepsis or trauma [1]. Although the main cause was clinically resolved, the mechanism that determines the progression may persist and lead to complications. However, It is demonstrated that the clinical causes of respiratory failure increase the intensive care units (ICU) stay, the sanitary cost and the global mortality [2]. For this reason, multidisciplinary and pathophysiological focus on respiratory failure is necessary for the management of these patients. The application of non-invasive mechanical ventilation (NIMV) has acquired major relevance in the last few years in the management of ARF, in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV compared to invasive mechanical ventilation is that it can be used earlier outside ICU. The evidence strongly supports its use in patients with chronic obstructive pulmonary disease (COPD) exacerbation, patients with acute cardiogenic pulmonary edema and immunosuppressed patients. This issue is focused on the mechanism associated with ARF, some clinical syndromes, and the pathophysiological bases for the use of ventilatory strategies, with a multidisciplinary approach.

Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation.

Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

Application of five-segemental care model for chronic obstructive pulmonary disease patients with non-invasive mechanical ventilation

Objective To evaluate the effect of five-segemental care model for chronic obstructive pulmonary disease patients with non-invasive mechanical ventilation. Methods A total of 70 community-dwelling COPD patients with non-invasive mechanical ventilation were randomly divided into two groups, with 35 cases in each group. The patients in the control group received routine discharge guidance and follow-up education, while the patients and their family members in the experimental group participated in five-segemental care model within two months after discharge. The frequency of acute exacerbations, lung function and blood gas parameters, as well as the quality of life when discharge and at 6 months after discharge were compared between two groups. Results After 6 month of discharge, the PaCO2, PaO2 and FEV1/FVC of the experimental group were (61.3±5.2)mmHg, (58.4±4.7)mmHg, and (66.8±16.3)%, which had no significant differences compared with the control groups (t=-0.159, 0.477, 0.968; P>0.05). After 6 month of discharge, the times of acute exacerbation were (2.5±1.1) of the experimental group and (3.4±2.1) of the control group. There was significant difference between two groups (t=-3.696, P<0.01). Conclusions The application of five-segemental care model can improve COPD patients′ self-care knowledge and skills, promote patients′ compliance on the application of non-invasive mechanical ventilation, reduce the frequency of acute exacerbations and improve the patients′ quality of life. Key words: Pulmonary disease, chronic obstructive; Lung function; Life quality; Five-segemental care; Non-invasive positive pressure ventilation

Ventilación mecánica no invasiva en pre e intraoperatorio y vía aérea difícil

Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival.There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period.The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications.Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients.

Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report.

The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated.

Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease

Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the frequent causes of acute respiratory failure. In our study, we aimed to compare helmet with face mask in noninvasive mechanical ventilation (NIMV) on patients who had acute respiratory failure because of exacerbation of COPD in intensive care unit (ICU). Thirty patients, taken into ICU for exacerbation of COPD, were included in the study. Patients were divided into two groups as face mask group (Group Y) and helmet group (Group H). Appropriate mechanical ventilation settings were recorded after the starting period and NIMV was applied to patients continuously for two hours with these settings. Respiratory frequency (f), blood gas (PaO(2), PaCO(2), PH) and PaO(2)/FiO(2) values and hemodynamic data of all patients were recorded periodically. Compliance of patients were evaluated with patient tolerance scale (PTS). Duration of stay of the patients in ICU and complications were also noted. Demographic characteristics of patients, mechanical ventilator settings and hemodynamic data of the patients in the two groups were found to be similar (p>0.05). Frequency values measured during NIMV are also similar at all measurement times (p>0.05). It was determined that there was a remarkable decrease in respiratory frequency, in both groups after the application of NIMV (p< 0.001). There was no difference with respect to PaO(2), PH and PaO(2)/FiO(2) values at all measurement times, between groups (p> 0.05). PaCO(2) values in the beginning were similar in both groups but PaCO(2) measured at other measurement times for group H were statistically higher compared to the other group (p< 0.05). PTC score measured at during NIMV in group H were remarkably higher (p< 0.05). Helmet developed as an alternative to face mask has a better patient tolerance and accordingly in increases success rate in NIMV. But it must be keeping mind that the decrease in PaCO(2) value is slow with helmet.

Aplicação da ventilação não-invasiva em insuficiência respiratória aguda após cirurgia cardiovascular

To examine ventilatory response, oxygenation-related, and hemodynamics of patients with hypoxemic acute respiratory failure (ARF) submitted to noninvasive mechanical ventilation (NIV) during the postoperative phase of cardiovascular surgery in order to identify predictive variables of success, and to compare the different types of NIV. Seventy patients with hypoxemic ARF were randomized to one of three modalities of NIV--continuous positive airway pressure (CPAP) and ventilation with two pressure levels (PEEP + SP and BiPAP). Ventilation, oxygenation-related, and hemodynamics variables were analyzed at pre-application, and 3, 6, and 12 hours after the protocol began. Thirteen patients were excluded. Thirty-one patients progressed to independence from ventilatory support and comprised the success group, and 26 required orotracheal intubation and were considered the nonsuccess group. Age, initial heart rate (HR), and respiratory rate (RR) showed elevated levels in the nonsuccess group (p=0.042, 0.029, and 0.002, respectively). A greater number of intraoperative complications were seen in the nonsuccess group (p=0.025). Oxygenation variables increased only in the success group. Among the NIV types, 57.9% of patients in the ventilator group, 57.9% in the two-pressure levels group, and 47.3% in the CPAP group progressed with success. Oxygenation and RR variables showed improvement only in the groups with two pressure levels. Patients with hypoxemic ARF in the postoperative stage after cardiovascular surgery showed better oxygenation, RR, and HR during NIV application. In older patients and those with higher baseline RR and HR values, NIV was not sufficient to reverse ARF. The two-pressure level modes showed better results.

The Use of Noninvasive Mechanical Ventilation for the Treatment of Acute Exacerbations of Copd in Canada

Noninvasive mechanical ventilation (NIMV) is accepted as a life-saving treatment for patients presenting to the emergency department and other acute care settings with severe exacerbations of chronic obstructive pulmonary disease (COPD). It was hypothesized that there is marked national variability in the use of NIMV. Therefore, the use of NIMV for COPD exacerbations in urban centres across Canada was evaluated. All Canadian hospitals affiliated with a university training program were surveyed, and a request for involvement in this survey was posted on the Canadian Society of Respiratory Therapy professional practice listserv. Survey information was received from all 33 sites (100%) that were contacted. Marked differences in the application of NIMV were identified across all regions in Canada, ranging from requiring extensive monitoring in the intensive care unit to application on a general internal medical unit with intermittent noninvasive blood pressure monitoring. There were sites that rarely used NIMV for COPD exacerbations and others where it was routine practice. NIMV is a life-saving treatment for acute exacerbations of COPD. Despite clear clinical evidence, its use has not penetrated throughout all the larger urban hospitals in Canada. This may be more problematic in sites without 24 h respiratory therapy support. There are barriers to the routine application of NIMV that can be overcome using established guidelines and available evidence.

Nursing of Aged Patients with Type II Respiratory Failure in the Early Application of Noninvasive Mechanical Ventilation

目的 探讨应用无创性通气治疗老年Ⅱ型呼吸衰竭的护理.方法在常规治疗的同时,实验组与对照组分别应用无创通气和呼吸兴奋剂治疗,观察2组患者治疗前、后、治疗间歇期动脉血气变化及康复例数.结果实验组患者治疗后血气明显改善(P<0.01),康复例数明显多于对照组(P<0.01).结论应用无创通气可促进呼吸衰竭患者的康复,护士要加强对患者的心理支持,严密监测生命体征,保持呼吸道通畅,熟练掌握无创通气呼吸机的性能、使用方法,防止并发症。