Application Of Noninvasive Positive Pressure Ventilation Research Articles

Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective: This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation (NIPPV) in patients with severe bronchial asthma combined with respiratory failure. Methods: 90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group (NIPPV-assisted treatment) and the control group. The differences between the two groups were compared in terms of total effective rate of treatment, days of clinical symptom disappearance, days of hospitalization, lung function indexes, incidence of adverse reactions, and quality of life. Results: Patients in the experimental group had a significantly higher total effective rate of treatment (97.78%) than the control group (75.56%). In terms of pulmonary function indexes, patients in the experimental group showed significant improvement after treatment, especially the increase in forced expiratory volume and forced vital capacity, while these improvements were not as obvious in the control group. In addition, the incidence of adverse reactions was significantly lower in the experimental group than in the control group, suggesting that the application of NIPPV is relatively safe. Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment. Conclusion: This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure. NIPPV can improve lung function, reduce the incidence of adverse effects, increase the overall effectiveness of the treatment, and contribute to the improvement of patients’ quality of life. Therefore, NIPPV should be regarded as an effective and safe treatment in clinical management, especially in patients with severe bronchial asthma combined with respiratory failure, where its application has potential clinical significance.

Effectiveness and Outcomes of Noninvasive Positive Pressure Ventilation in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

Endotracheal intubation and mechanical ventilation in individuals experiencing acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with several complications. Therefore, utilizing noninvasive positive pressure ventilation (NIPPV) is the suggested initial management for these individuals. The current study was done to assess and compare the clinical and physiological parameters before and after the application of NIPPV and also to evaluate the outcomes of NIPPV. A prospective observational study was conducted on 50 patients with COPD experiencing acute exacerbations. These patients were treated with NIPPV. Measurements of blood pressure, respiratory rate (RR), heart rate (HR), dyspnea using the modified Borg scale, and arterial blood gas (ABG) parameters (pH, PaCO2, and PaO2) were recorded at baseline, one hour, six hours, 24 hours, and daily until discharge. The study's outcomes included the subjects who successfully underwent NIPPV and failed during NIPPV. NIPPV effectively reduced the dyspnea score from 7.24 ± 1.58 at baseline to 5.53 ± 1.82 at one hour, 4.11 ± 1.75 at six hours, 2.60 ± 1.03 at 24 hours, and 1.26 ± 0.44 at the time of discharge. Significant improvements were also observed in HRand RR(P < 0.001). When compared to the baseline, the pH level was significantly maintained, PaCO2 was decreased, and PaO2 was increased at various times. Mortality was observed in four patients. NIPPV was successful in 42 (84%)patients, with improvements in ABG and pH for early recovery and reduced hospital stay.

Factors associated with adherence to noninvasive positive pressure ventilation in amyotrophic lateral sclerosis.

This cohort study aimed to investigate the factors associated with noninvasive positive pressure ventilation adherence and assess the long-term effects of noninvasive positive pressure ventilation adherence in patients with amyotrophic lateral sclerosis (ALS). The medical records of patients with ALS admitted to a tertiary hospital for noninvasive positive pressure ventilation initiation were retrospectively reviewed. Pulmonary function parameters, variables of blood gas analysis, the site of symptom onset, the time from onset and diagnosis to noninvasive positive pressure ventilation application, ALS Functional Rating Scale-Revised, neurophysiological index, and the length of hospital stay were evaluated. The adherence to noninvasive positive pressure ventilation was defined as the use of noninvasive positive pressure ventilation for ≥ 2 h/day or ≥ 4 h/day. The correlations between noninvasive positive pressure ventilation adherence or length of hospital stay and other clinical parameters were analyzed. Fifty-one patients with ALS were included in the study. The time from onset and diagnosis to NIPPV application was reduced by 16 months in the adherent group than that in the non-adherent group; however, the parameters of blood gas analysis and pulmonary function tests did not differ significantly between the groups. Furthermore, the neurophysiological index of the abductor digiti minimi muscle was higher by 4.05 in the adherent group than that in the non-adherent group. The adherence to noninvasive positive pressure ventilation prolonged tracheostomy-free survival compared to that of non-adherence. Desaturation events, lower forced vital capacity, last pCO2, bicarbonate, and base excess, and higher differences in pCO2, were associated with an increase in the length of hospital stay. Noninvasive positive pressure ventilation application shortly after symptom onset and ALS diagnosis in patients with CO2 retention and reduced forced vital capacity can be considered for successful adherence. Adherence to noninvasive positive pressure ventilation may result in reduced tracheostomy conversion rates and prolonged tracheostomy-free survival.

Clinical research progress in non-invasive positive pressure ventilation in 2023

Non-invasive positive pressure ventilation (NPPV) is a widely used method of providing respiratory support in a variety of clinical settings, including emergency departments, general wards, and intensive care units. The relevant research articles on NPPV published between 1st October 2022 and 30th September 2023 were retrieved from Medline and reviewed. In the management of acute respiratory failure (ARF) associated with COVID-19, studies have highlighted the significant influence of regional economic status on the choice of respiratory support strategies. It has been observed that NPPV is more suitable for patients with mild to moderate acute respiratory distress syndrome (ARDS) than for those with severe ARDS, as the latter group has an increased risk of delayed intubation. In addition, patients with severe dyspnea tended to benefit more from NPPV compared with high flow nasal cannula (HFNC) and conventional oxygen therapy, with a reduced risk of self-induced lung injury. For non-COVID-19-related ARF, research shows no significant differences in mortality and intubation rates between HFNC and NPPV in patients with hypercapnic ARF. The updated HACOR score and ROX score have been validated to have a high predictive value for clinical outcomes in patients receiving NPPV for hypoxemic ARF. With regard to weaning from invasive mechanical ventilation, immediate application of NPPV after extubation showed a lower mortality rate compared to continued invasive weaning. Moreover, NPPV with active humidification significantly decreased the reintubation rate within 7 days after extubation compared with HFNC. The choice between using NPPV and HFNC should be based on the specific etiology of the patient's condition. The potential effect of noninvasive high-frequency oscillatory ventilation on CO2 clearance was also investigated.

Clinical update in non-invasive positive pressure ventilation for respiratory failure in 2022

In this article, we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure(ARF)/chronic respiratory failure(CRF) between 1st October 2021 and 30th September 2022 through Medline, and reviewed the important advances. Three prospective randomized controlled studies related to the efficacy and safety of NPPV and/or high-flow nasal cannula oxygen therapy (HFNC) on patients with COVID-19 with ARF were reported, showing that NPPV (including continuous positive airway pressure and bilevel positive airway pressure) was able to reduce the intubation rate, but the efficacy of HFNC was contradictory. In addition, progress has been made in outcome prediction models for ARF treated with NPPV, NPPV-related cardiac arrest, and the impact of human-machine interface on NPPV treatment outcomes. The effects of NPPV as preoxygenation method before intubation was reported to be able to reduce severe desaturation during intubation, especially in obese population. The use of NPPV in extubated patients resulting in reduced reintubation rate was also studied. With regard to long-term home application of NPPV, five indicators of successful initiation were proposed, but the success rate was low in clinical practice. Some reports showed that psychological support could improve the adherence to NPPV. The results of these studies contributed to the rational selection and optimal application of NPPV in clinical practice.

Factors and Outcomes Associated with Failed Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure.

BackgroundThe decision guild for non-invasive positive pressure ventilation (NPPV) application in acute respiratory failure (ARF) patients still needs to work out.MethodsAdult patients with acute hypoxemic or hypercapnic respiratory failure were recruited and treated with NPPV or primary invasive mechanical ventilation (IMV). Patients’ characteristic and clinical outcomes were recorded. Logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals for baseline characteristics and clinical outcomes. Subgroup analyses by reason behind successful NPPV were conducted to ascertain if any difference could influence the outcome.ResultsA total of 4525 ARF patients were recruited in our facility between year 2015 and 2017. After exclusion, 844 IMV patients, 66 patients with failed NPPV, and 74 patients with successful NPPV were enrolled. Statistical analysis showed APACHE II score (aOR = 0.93), time between admission and start NPPV (aOR = 0.92), and P/F ratio (aOR = 1.04) were associated with successful NPPV. When comparing with IMV patients, failed NPPV patients displayed a significantly lower APACHE II score, higher Glasgow Coma Scale, longer length of stay in hospital, longer duration of invasive ventilation, RCW/Home ventilator, and some comorbidities.ConclusionAPACHE II score, time between admission and start NPPV, and PaO2 can be predictors for successful NPPV. The decision of NPPV application is critical as ARF patients with failed NPPV have various worse outcomes than patients receiving primary IMV.

Intelligent volume assured pressure support (iVAPS) vs. spontaneous/timed mode as a weaning strategy for intubated COPD patients with acute exacerbation.

Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube. This study was conducted to compare the effectiveness of iVAPS versus standard Spontaneous/timed (S/T) mode in facilitating weaning process of mechanically ventilated chronic obstructive pulmonary disease (COPD) in acute exacerbation. In a prospective randomized study, 80 invasively ventilated COPD patients in acute exacerbations were extubated then immediate applicationof NPPV using either S/T mode (Group I) or iVAPS mode (Group II) was done. Clinical parameters (heart rate, respiratory rate, and arterial blood gas parameters at selected time intervals of treatment were recorded for both groups and analyzed. No significant differences were found between both groups regarding age, sex, mMRC dyspnea scale, CAT score and APACHE II score. Heart rate and mean arterial blood pressure in the two groups decreased with time, but no significant differences were found between the two groups. Likewise, there was no significant difference in RR between S/T and iVAPS groups. Regarding arterial blood gas analysis, there were no detectable differences in PaCO₂ level, PaO₂ level or oxygen saturation. The successful outcome was achieved in (82.5%) in the S/T group vs (80%) in the iVAPS group. The two modes achieved comparable levels of comfort as assessed by VAS and the total Mask Fitness Score. There was no statistically significant difference in reintubation, the duration of NPPV, duration of ICU stay or in mortality rate. iVAPS mode is as effective as fixed-pressure S/T mode in facilitating weaning of hypercapnic COPD patients.

Effectiveness of Noninvasive Positive Pressure Ventilation in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome

Results of invasive positive pressure ventilation (IPPV) in COVID-19 patients with Severe Acute Respiratory Distress Syndrome are discouraging despite its prompt use. However noninvasive positive pressure ventilation (NIPPV) is yet not a common practice internationally because of lack of global evidence advocating its effective use in severe cases of ARDS as well as dreadful concern about aerosol generation especially in patients having COVID-19 infection. Objective: To determine whether, NIPPV application is effective and safe in COVID-19 Patients. Methods: One hundred and thirty hemodynamically stable patients with severe CARDS as per Berlin definition (PaO2/FiO2 ratio ≤ 100mm Hg), having GCS &gt; 13, respiratory breathing index (RBI) &lt; 105, and without any systemic complication were selected. They were managed with NIPPV in Corona Intensive Care Unit of Mayo Hospital/King Edward Medical University Lahore. A little innovation was done with the application of a specific orofacial interface, fitted with heat and moist exchanger (HME) at the interface and viral/bacterial filters at the expiratory limb of ventilatory circuit. Favorable outcome has been observed in 64% of treated cases in terms of improvement in PaO2/FiO2 ratio, thus abating severity of ARDS from severe to mild category, in an average time span of 6 days. Remaining 36% of patients progressed to IPPV with definitive airway. During study period, 4.2% of healthcare workers (HCW) got infected with COVID-19. Associated complications of NIPPV application were claustrophobia (13.8%), nasal crusting (6.9%), aspiration (6.1%) and barotrauma (0.7%). Conclusion: In carefully selected patients, use of noninvasive positive pressure ventilation with the application of HME and viral/bacterial filters is an effective, preferable and safe modality of choice to provide respiratory support, thus obviating the need for IPPV. However further larger studies are needed to confirm our recommendations.

Noninvasive positive pressure ventilator deteriorates the outcome of pneumomediastinum in anti-MDA5 antibody-positive clinically amyopathic dermatomyositis

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive clinically amyopathic dermatomyositis (CADM) with pneumomediastinum (PNM) is a life-threatening condition. We aim to determine the prognostic factors affecting survival of patients with anti-MDA5 Ab-positive CADM complicated with PNM. We retrospectively established a cohort of patients with anti-MDA5 Ab-positive CADM complicated with PNM from April 2013 to July 2019. Demographic data and clinical characteristics from medical records were analyzed and variables were compared between survivors and nonsurvivors. We performed univariate and multivariate survival analyses by Cox regression. Survival curves were depicted by the Kaplan-Meier method. Among 133 patients with anti-MDA5 Ab-positive CADM, 20 were diagnosed with PNM. The cumulative estimated Kaplan-Meier survival rate was 85% at 1week, 55% at 1month, and 40% at 1year. Univariate analysis indicated several factors associated with survival. Worse liver function (AST, p = 0.043; LDH, p = 0.002; TBIL, p = 0.038), higher CRP level (p = 0.044), higher HRCT score (p = 0.022), and using noninvasive positive pressure ventilation (NPPV) (p < 0.01) were associated with poor prognosis. In a multivariate Cox regression model, AST level and using NPPV were indicated to be independent predictors of poor prognosis. In this research, we found that the incidence rate of PNM in anti-MDA5 Ab-positive CADM was 15.5%, obviously higher than in classical DM. The application of noninvasive positive pressure ventilator (NPPV) and higher AST level were independent risk factors for survival.Key Points• Anti-MDA5 Ab-positive CADM complicated with PNM is a life-threatening condition with an incidence rate of 15.5%.• The application of NPPV and worse liver function were independent risk factors for survival of anti-MDA5 Ab-positive CADM patients complicated with PNM.

Efficacy of protocol-based non-invasive positive pressure ventilation for acute respiratory distress syndrome: a retrospective observational study.

AimThe efficacy of non‐invasive positive pressure ventilation (NPPV) in acute respiratory distress syndrome (ARDS) remains unclear. Variation in both the etiology of ARDS and patient factors has resulted in inconsistent application of NPPV. We have developed a protocol‐based NPPV strategy as a first‐line intervention for ARDS. The aim of this observational study was to determine if protocol‐based NPPV improves the outcome in patients with ARDS.MethodsWe identified patients with ARDS treated by protocol‐based NPPV at our institution between March 2006 and March 2010 and categorized them according to NPPV success or failure. Success was defined as avoidance of intubation and remaining alive during NPPV.ResultsEighty‐eight of 169 patients diagnosed with ARDS during the study period were treated using the protocol. Fifty‐two (76%) of 68 patients who were eligible for the study were successfully treated and did not require endotracheal intubation. The overall mortality rate at 28 days after initiation of NPPV was 12%. The mortality rate was significantly lower in the success group than in the failure group (P < 0.01). The PaO2/FiO2 ratio after 12–24 h of NPPV was significantly higher in the success group than in the failure group (202 ± 63 versus 145 ± 46; P < 0.01).ConclusionsThe success rate was higher and the mortality was lower in patients than in historical controls. Protocol‐based NPPV could be effective in patients with ARDS.

Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema.

Non-invasive positive pressure ventilation (NPPV) has been used to treat respiratory distress due to acute cardiogenic pulmonary oedema (ACPE). We performed a systematic review and meta-analysis update on NPPV for adults presenting with ACPE. To evaluate the safety and effectiveness of NPPV compared to standard medical care (SMC) for adults with ACPE. The primary outcome was hospital mortality. Important secondary outcomes were endotracheal intubation, treatment intolerance, hospital and intensive care unit length of stay, rates of acute myocardial infarction, and adverse event rates. We searched CENTRAL (CRS Web, 20 September 2018), MEDLINE (Ovid, 1946 to 19 September 2018), Embase (Ovid, 1974 to 19 September 2018), CINAHL Plus (EBSCO, 1937 to 19 September 2018), LILACS, WHO ICTRP, and clinicaltrials.gov. We also reviewed reference lists of included studies. We applied no language restrictions. We included blinded or unblinded randomised controlled trials in adults with ACPE. Participants had to be randomised to NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care (SMC) compared with SMC alone. Two review authors independently screened and selected articles for inclusion. We extracted data with a standardised data collection form. We evaluated the risks of bias of each study using the Cochrane 'Risk of bias' tool. We assessed evidence quality for each outcome using the GRADE recommendations. We included 24 studies (2664 participants) of adult participants (older than 18 years of age) with respiratory distress due to ACPE, not requiring immediate mechanical ventilation. People with ACPE presented either to an Emergency Department or were inpatients. ACPE treatment was provided in an intensive care or Emergency Department setting. There was a median follow-up of 13 days for hospital mortality, one day for endotracheal intubation, and three days for acute myocardial infarction. Compared with SMC, NPPV may reduce hospital mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; participants = 2484; studies = 21; I2 = 6%; low quality of evidence) with a number needed to treat for an additional beneficial outcome (NNTB) of 17 (NNTB 12 to 32). NPPV probably reduces endotracheal intubation rates (RR 0.49, 95% CI 0.38 to 0.62; participants = 2449; studies = 20; I2 = 0%; moderate quality of evidence) with a NNTB of 13 (NNTB 11 to 18). There is probably little or no difference in acute myocardial infarction (AMI) incidence with NPPV compared to SMC for ACPE (RR 1.03, 95% CI 0.91 to 1.16; participants = 1313; studies = 5; I2 = 0%; moderate quality of evidence). We are uncertain as to whether NPPV increases hospital length of stay (mean difference (MD) -0.31 days, 95% CI -1.23 to 0.61; participants = 1714; studies = 11; I2 = 55%; very low quality of evidence). Adverse events were generally similar between NPPV and SMC groups, but evidence was of low quality. Our review provides support for continued clinical application of NPPV for ACPE, to improve outcomes such as hospital mortality and intubation rates. NPPV is a safe intervention with similar adverse event rates to SMC alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.

Clinical characteristics of pediatric pneumothorax during a noninvasive positive pressure ventilation

Purpose: Noninvasive positive pressure ventilation (NIPPV) is one of the ventilation-supporting methods by providing adequate ex ogenous pressure without intubation or tracheostomy. We aimed to assess the frequency and clinical factors for pneumothorax oc curring during NIPPV application in a tertiary children’s hospital. Methods: We selected cases of pneumothorax related to NIPPV by keyword searching in our institution''s clinical data warehouse, and their medical records were retrospectively reviewed. Results: During a period of 17 years, 15 cases undergoing NIPPV developed pneumothorax, which was an incidence of 0.64% (15 of 2,343). There were 9 neonates and 6 adolescents. In 9 neonates, pneumothorax was caused by the continuous positive airway pres sure (CPAP) ventilator, and occurred on 2 days after birth (median, range 1-3 days). In neonates, pneumothorax developed within 36 hours after CPAP application. One neonate underwent tracheal intubation and 3 neonates underwent chest tube insertion. In the postteenager group, pneumothorax developed 23 months (median, range 5 days to 47 months) after NIPPV application with a mask. All of the 6 patients had underlying neuromuscular disorders and one had superimposed interstitial lung disease. One of the 7 cases underwent surgical treatment and 4 cases were intubated. One case died from the deterioration of underlying interstitial lung disease. Conclusion: Although it rarely happens, the NIPPV can result in pneumothorax. In most cases, it can be resolved by supportive cares with oxygen or chest tube with or without tracheostomy. The prognosis is related to the type of underlying disease and its progres sion. (Allergy Asthma Respir Dis 2019;7:51-56)

Noninvasive Positive-Pressure Ventilation: A Cross Sectional Descriptive Study of Our First Experience in Iran

Background: Noninvasive positive-pressure ventilation (NIPPV) has been safely used in selected patient populations. The purpose of this study was to determine the safety and efficacy of NIPPV outside the intensive care unit (ICU) in a tertiary hospital. This descriptive, cross sectional study was performed at Masih Daneshvari Hospital, Tehran, Iran during 2011 - 2015. Methods: Between March 2011 and June 2015, patients requiring NIPPV were enrolled in the study. The study population included all eligible patients. Census sampling was applied in this study. The patients’ medical history (including comorbidities), age, sex, and hospital ward in which NIPPV was delivered were assessed retrospectively. Moreover, venous pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3-) were analyzed before and after the intervention (NIPPV application). Results: A total of 946 patients, including 598 (63.2%) men and 348 (36.8%) women, received NIPPV for inpatient hospital care. The mean age of the patients was 61.92 ± 15.5 years (range, 3 - 102 years). Indications for NIPPV included exacerbation of chronic obstructive pulmonary disease (COPD; 55.4%), obstructive sleep apnea (OSA; 6%), bronchiectasis (7.8%), concurrence of COPD and OSA (4.8%), neuromuscular disorders (1.7%), congestive heart failure (4%), postthoracotomy pain (0.6%), thoracic malignancy (2.1%), pulmonary thromboembolism (1.1%), pneumonia (7.3%), asthma (1.5%), interstitial lung disease (2.5%), tuberculosis (4%), and cystic fibrosis (1.3%). We found significant improvements in venous pH and PCO2 with no significant changes in HCO3- (P > 0.05). Conclusions: NIPPV could be safely used under the supervision of trained pulmonologists in non-ICU settings. This method was effective in treating acute abnormalities in venous blood gas, including pH and PCO2.

EARLY EFFECTIVENESS OF NONINVASIVE POSITIVE PRESSURE VENTILATION ON RIGHT VENTRICULAR FUNCTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE SUBJECTS WITH ACUTE HYPERCAPNIC RESPIRATORY FAILURE

Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF. Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV. Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively). Conclusion: As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease NT-proBNP levels and PAP.

Therapeutic effect of long-term noninvasive positive pressure ventilation on stable chronic obstructive pulmonary disease: a systematic review

To determine the efficacy of long-term noninvasive positive pressure ventilation (NPPV) on stable chronic obstructive pulmonary disease (COPD). Information was collected from the database of China National Knowledge Infrastructure (CNKI), WanFang, WeiPu, PubMed, EMbase, CBM (from the begining to October 2014). Statistical analysis was performed with the Cochrane Collaboration's software RevMan 5.2. A total of 23 trials involving 1 200 patients were included. RESULTS showed that NPPV can reduce PaCO2 and improve PaO2 in patients with stable COPD; two years of NPPV can delay the decline in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), increase six-minutes walk distance (6MWD) and reduce mortality in patients with stable COPD (OR=0.62, 95% CI 0.47 to 0.82). NPPV can improve the arterial blood gas in patients, and the longer the application of NPPV, the better effect; NPPV can increase exercise endurance and improve the quality of life for the patients; long application of NPPV can delay the decline in FEV1and FVC (2 years or longer); NPPV can reduce the mortality of COPD patients.

Evaluation of noninvasive positive pressure ventilation after extubation from moderate positive end-expiratory pressure level in patients undergoing cardiovascular surgery: a prospective observational study.

BackgroundIt remains to be clarified if the application of noninvasive positive pressure ventilation (NPPV) is effective after extubation in patients with hypoxemic respiratory failure who require the sufficient level of positive end-expiratory pressure (PEEP). This study was aimed at examining the effect and the safety of NPPV application following extubation in patients requiring moderate PEEP level for sufficient oxygenation after cardiovascular surgery.MethodsWith institutional ethic committee approval, the patients ventilated invasively for over 48 h after cardiovascular surgery were enrolled in this study. The patients who failed the first spontaneous breathing trial (SBT) at 5 cmH2O of PEEP, but passed the second SBT at 8 cmH2O of PEEP, received NPPV immediately after extubation following our weaning protocol. Respiratory parameters (partial pressure of arterial oxygen tension to inspiratory oxygen fraction ratio: P/F ratio, respiratory ratio, and partial pressure of arterial carbon dioxide: PaCO2) 2 h after extubation were evaluated with those just before extubation as the primary outcome. The rate of re-intubation, the frequency of respiratory failure and intolerance of NPPV, the duration of NPPV, and the length of intensive care unit (ICU) stay were also recorded.ResultsWhile 51 postcardiovascular surgery patients were screened, 6 patients who met the criteria received NPPV after extubation. P/F ratio was increased significantly after extubation compared with that before extubation (325 ± 85 versus 245 ± 55 mmHg, p < 0.05). The other respiratory parameters did not change significantly. Re-intubation, respiratory failure, and intolerance of NPPV never occurred. The duration of NPPV and the length of ICU stay were 2.7 ± 0.7 (SD) and 7.5 (6 to 10) (interquartile range) days, respectively.ConclusionsWhile further investigation should be warranted, NPPV could be applied effectively and safely after extubation in patients requiring the moderate PEEP level after cardiovascular surgery.

Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure

Noninvasive positive-pressure ventilation (NPPV) provides ventilatory support without the need for an invasive airway. Interest has emerged in using NPPV to facilitate earlier removal of an endotracheal tube and to decrease complications associated with prolonged intubation. We evaluated studies in which invasively ventilated adults with respiratory failure of any cause (chronic obstructive pulmonary disease (COPD), non-COPD, postoperative, nonoperative) were weaned by means of early extubation followed by immediate application of NPPV or continued IPPV weaning. The primary objective was to determine whether the noninvasive positive-pressure ventilation (NPPV) strategy reduced all-cause mortality compared with invasive positive-pressure ventilation (IPPV) weaning. Secondary objectives were to ascertain differences between strategies in proportions of weaning failure and ventilator-associated pneumonia (VAP), intensive care unit (ICU) and hospital length of stay (LOS), total duration of mechanical ventilation, duration of mechanical support related to weaning, duration of endotracheal mechanical ventilation (ETMV), frequency of adverse events (related to weaning) and overall quality of life. We planned sensitivity and subgroup analyses to assess (1) the influence on mortality and VAP of excluding quasi-randomized trials, and (2) effects on mortality and weaning failure associated with different causes of respiratory failure (COPD vs. mixed populations). We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 5, 2013), MEDLINE (January 1966 to May 2013), EMBASE (January 1980 to May 2013), proceedings from four conferences, trial registration websites and personal files; we contacted authors to identify trials comparing NPPV versus conventional IPPV weaning. Randomized and quasi-randomized trials comparing early extubation with immediate application of NPPV versus IPPV weaning in intubated adults with respiratory failure. Two review authors independently assessed trial quality and abstracted data according to prespecified criteria. Sensitivity and subgroup analyses assessed (1) the impact of excluding quasi-randomized trials, and (2) the effects on selected outcomes noted with different causes of respiratory failure. We identified 16 trials, predominantly of moderate to good quality, involving 994 participants, most with chronic obstructive pulmonary disease (COPD). Compared with IPPV weaning, NPPV weaning significantly decreased mortality. The benefits for mortality were significantly greater in trials enrolling exclusively participants with COPD (risk ratio (RR) 0.36, 95% confidence interval (CI) 0.24 to 0.56) versus mixed populations (RR 0.81, 95% CI 0.47 to 1.40). NPPV significantly reduced weaning failure (RR 0.63, 95% CI 0.42 to 0.96) and ventilator-associated pneumonia (RR 0.25, 95% CI 0.15 to 0.43); shortened length of stay in an intensive care unit (mean difference (MD) -5.59 days, 95% CI -7.90 to -3.28) and in hospital (MD -6.04 days, 95% CI -9.22 to -2.87); and decreased the total duration of ventilation (MD -5.64 days, 95% CI -9.50 to -1.77) and the duration of endotracheal mechanical ventilation (MD - 7.44 days, 95% CI -10.34 to -4.55) amidst significant heterogeneity. Noninvasive weaning also significantly reduced tracheostomy (RR 0.19, 95% CI 0.08 to 0.47) and reintubation (RR 0.65, 95% CI 0.44 to 0.97) rates. Noninvasive weaning had no effect on the duration of ventilation related to weaning. Exclusion of a single quasi-randomized trial did not alter these results. Subgroup analyses suggest that the benefits for mortality were significantly greater in trials enrolling exclusively participants with COPD versus mixed populations. Summary estimates from 16 trials of moderate to good quality that included predominantly participants with COPD suggest that a weaning strategy that includes NPPV may reduce rates of mortality and ventilator-associated pneumonia without increasing the risk of weaning failure or reintubation.

Clinical research on application of acute noninvasive positive pressure ventilation in treatment of acute respiratory failure

Objective To explore the clinical application effect and value of acute noninvasive positive pressure ventilation (NPPV) in treatment of acute respiratory failure (ARF) in the emergency department.Methods 47 patients with ARF by all causes were divided into two groups,according to the order and whether they were willing to breathing machine treatment.24 patients in NPPV group,and standard therapy group with 23 cases,standard treatment group used the routine treatment,based on routine therapy in the breathing machine,NPPV group was treated with index of the mask breathing machine under connection assisted ventilation treatment.We observed both groups before and after treatment the heart rate (HR),respiratory rate (RR),carbon dioxide points pressure (PaCO2),oxygen and index (PaO2/FO2),pH value change,the treatment outcome.Results HR,RR,PaCO2,PaO2/FO2,and pH value examination results before treatment standard treatment group and group compared with those of NPPV there was no statistical difference (P＞0.05),two groups' HR,RR,PaCO2 2 h,treatment within 24 h before testing results and the treatment was down,PaO2/FO2,pH value rised,NPPV group above index before and after treatment there was statistical differences (P＜0.05),standard treatment group within 24 h PaCO2 only treatment,PaO2/FO2,pH value and treatment before there was statistical difference (P＜0.05).Standard treatment group had survival rate by 60.87％,the death rate 39.13％,and the average hospitalization time (24.45 ± 12.13) d,NPPV group survival rate by 87.50％,the death rate 22.50％,and the average hospitalization time (16.64 ± 9.87)d,two groups in the length of time and the survival rate of the patients,there was statistical significant difference (P＜0.05).Conclusion The acute NPPV application in treatment of ARF can quickly improve patients' ventilation condition,and increase their survival rate. Key words: Acute respiratory failure (ARF); Noninvasive positive pressure ventilation (NPPV); Emergency

A study of patients with type II respiratory failure put on non-invasive positive pressure ventilation

Non-invasive ventilation as an alternative to the endotracheal intubation is associated with less infectious complications and injury to the airways. In a study cohort that included 50 patients with type II respiratory failure with the commonest diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation with or without associated co-morbidities, mechanical ventilation with non-invasive positive pressure ventilation (NIPPV) was applied and the response was observed in terms of change in various clinical and laboratory parameters after 1 hour, at the time of weaning, and 6 hours after weaning. There was significant improvement with NIPPV in form of increase in pH and PaO 2 and decrease in PaCO2 and HCO3 after 1 hour of NIPPV application, which also persisted after successful weaning. The patients who failed NIPPV had significantly high respiratory rate, low pH value, and high PaCO 2 on admission.

Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

Asthma is a chronic respiratory condition causing inflammation and changes to the airways. Care of people with asthma includes routine and urgent management across primary and tertiary care; however, due to sub-optimal long-term care and delays in obtaining help during acute exacerbations, the mortality and morbidity related to asthma is still a major health concern. There is reason to believe that non-invasive positive pressure ventilation (NPPV) could be beneficial to patients with severe acute asthma; however, the evidence surrounding the efficacy of NPPV is unclear, despite its common use in clinical practice. To determine the efficacy of NPPV in adults with severe acute asthma in comparison to usual medical care with respect to mortality, tracheal intubation, changes in blood gases and hospital length of stay. We carried out a search in the Cochrane Airways Group Specialised Register of trials (July 2012). Following this, the bibliographies of included studies and review articles were searched for additional studies (July 2012). We included randomised controlled trials of adults with severe acute asthma as the primary reason for presentation to the emergency department or for admission to hospital. Asthma diagnosis was defined by internationally accepted criteria. Studies were included if the intervention was usual medical care for the management of severe acute asthma plus NPPV applied through a nasal or facemask compared to usual medical care alone. Studies including patients with features of chronic obstructive pulmonary disease (COPD) were excluded unless data were provided separately for patients with asthma in studies recruiting both COPD and asthmatic patients. A combination of two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information where required. All data were analysed using RevMan 5.1. For continuous variables, a mean difference and 95% confidence interval were used and for dichotomous variables, risk ratio with 95% confidence interval were calculated. We identified six trials for inclusion. Five studies on 206 participants contributed data, while one study was available in abstract form only and was not fully incorporated into this review. For the primary outcome of endotracheal intubation there were two studies that contributed data: two intubations were needed in 45 participants on NPPV and no intubations in 41 control patients (risk ratio 4.48; 95% CI 0.23 to 89.13). There were no deaths in either of these studies. Length of hospital stay was reported in two studies, though meta-analysis was not possible. Hospitalisation was reported in one small study, in which there were three admissions out of 17 on NPPV and 10 admissions out of 16 in control patients (RR 0.28, 95% CI 0.09, 0.84). This review of studies has highlighted the paucity of data that exist to support the use of NPPV in patients in status asthmaticus. As such this course of treatment remains controversial despite its continued use in current clinical practice. Larger, prospective randomised controlled trials of rigorous methodological design are needed to determine the role of NPPV in patients with asthma.