Noninvasive Ventilation Research Articles

Prediction of Non Invasive Ventilation Failure in Critically Ill COVID 19 Patients

Background: Non-invasive ventilation (NIV) is recognized as a practical and effective method for assisting selected patients with respiratory issues. The HACOR scoring system evaluates heart rate, acidosis, consciousness, oxygenation, and respiratory rate and has proven to be predictive of NIV failure in critically ill patients like COVID-19 patinets. Aim: To determine the predictibility of HACOR score to identify NIV failure early in patients with respiratory failure linked to COVID-19. Methods: This cross-sectional study was carried out at the ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital over a one-year period. It involved 40 patients who were administered NIV via a conventional ventilator in spontaneous mode and selected based on specific inclusion and exclusion criteria. Informed written consent was obtained from each patient’s guardians. Upon admission to the ICU, the HACOR score of each patient was measured after one hour of NIV treatment, assessing factors such as heart rate, pH levels for acidosis, and oxygenation through the PaO2/FiO2 ratio, along with respiratory rate. Analysis was performed with both manual methods and software SPSS version 24. Results: NIV failure occurred in 33 (82.5%) patients with only 7 (17.5%) achieving psuccessful NIV. Older patients experienced NIV failure significanly higher compared to those with successful outcomes (average ages 61.79±17.28 vs. 47.57±11.92 years, p=0.045), and male patients were predominant (66.66%). The predominating comorbidities were diabetes mellitus (57.5%). The HACOR scores were significantly higher in patients who failed NIV compared to those who succeeded (8.18±2.18 vs. 4.71±1.5, p=0.002). Receiver operating characteristic (ROC) curve analysis established a HACOR score cutoff value of 5 after one hour of NIV treatment for predicting NIV failure in the study population, demonstrating a sensitivity of 93.9% and a specificity of 57.1% (AUC: 0.905). Conclusion: Despite the study's limited sample size, findings suggest that the HACOR score may serve as an early indicator of NIV failure in critically ill patients with COVID-19-related respiratory failure. Future research on a larger scale is anticipated to validate and expand upon these important insights.

Comparison of oronasal and nasal masks in home mechanical ventilation: an observational cohort and bench study

BackgroundIn patients with chronic respiratory failure, home non-invasive ventilation (NIV) is delivered through oronasal or nasal masks. Masks are a cornerstone for NIV success but can be associated with side-effects. However, the type, frequency and consequences of these side-effects are unknown. Here, we aimed to study the prevalence, nature and impact of mask-related adverse events in a cohort of stable patients. We then investigated differences between oronasal and nasal masks both in our cohort and in a bench study.MethodsThis was a prospective observational cohort including patients established on long-term NIV admitted for their elective review. Data regarding mask-related side-effects were assessed using a structured questionnaire. Our bench study was performed using a three-dimensional printed head connected to an artificial lung.Results800 patients were included, of whom 84% had an oronasal mask. Moderate to very severe mask-related side-effects occurred in 47% of patients and severe to very severe side-effects occurred in 18% of patients. Side-effects were associated with poorer daytime arterial partial pressure of carbon dioxide (p=0.005), poorer subjective sleep quality (p=0.003) and poorer quality of life (p<0.001). Mask-related side-effects were more frequently reported with the use of oronasal masks compared to nasal masks (p=0.023). Our bench study showed that nasal masks were more stable than oronasal masks (p<0.001).ConclusionsMask-related side-effects are frequent and associated with poorer outcomes. Our data suggest that nasal masks may have a better tolerance profile and should be used as a first-line interface.

A Meta-Analysis on the Efficacy of Noninvasive Positive Pressure Ventilation Combined With Pressure Support Ventilation in Treating Chronic Heart Failure.

To evaluate the clinical efficacy and safety of noninvasive positive pressure ventilation combined with pressure support ventilation (NPPV-PSV) in the treatment of chronic heart failure (CHF) through a meta-analysis. A systematic search was conducted using PubMed, Embase, Web of Science, Cochrane Library, CNKI and Wanfang databases to find randomized controlled trials and cohort studies on NPPV-PSV treatment for CHF. The period of search was set from inception until 2024. Eligible studies were included in a systematic review and meta-analysis. A total of 8 studies with 568 patients were included in this meta-analysis. The meta-analysis revealed that compared with conventional treatment, NPPV-PSV treatment had significant advantages in several aspects: clinical efficacy rate (total effect Z = 5.10, OR = 3.12, 95% confidence interval (CI) [2.01, 4.83], p = 0.000), heart rate (HR) (total effect Z = 16.26, MD = -10.50, 95% CI [-11.76, -9.23], p = 0.000), respiratory rate (RR) (total effect Z = 16.50, MD = -6.44, 95% CI [-7.20, -5.67], p = 0.000) and oxygen saturation (total effect Z = 12.40, MD = 0.09, 95% CI [0.08, 0.11], p = 0.000). Noninvasive positive pressure ventilation combined with PSV treatment significantly improves clinical symptoms, reduces HR and RR and increases oxygen saturation in patients with CHF, showing superior effects compared with conventional treatment.

Evaluation of factors affecting the success of non invasive mechanical ventilation in acute cardiogenic pulmonary edema in the emergency department.

The aim of this study was to evaluate the factors associated with non-invasive mechanical ventilation (NIMV) failure in acute cardiogenic pulmonary edema (ACPE) diagnosed in the emergency department. This study was prospectively conducted at the Ege University Faculty of Medicine ED between February 19, 2021 and December 01, 2021. Patients who received NIMV with ACPE were included. Patients' clinical and laboratory parameters, treatments, NIMV mode, and settings were recorded. The primary endpoint was NIMV failure (intubation within 24 h). Secondary endpoints were early NIMV failure, early mortality (within 24 h), and in-hospital mortality. Early NIMV failure was defined as follows: if the patient had a respiratory rate of more than 25 per minute, oxygen saturation below 90%, PaCO2 >50 mmHg in blood gas, and pH <7.35, 1 h after starting NIMV. Out of 347 patients in this study, 34 (10.7%) of them intubated within 24 h. Female sex percentage was 48.7%. Median age was 73 years. Risk factors for NIMV failure were respiratory rate >40.5, systolic blood pressure <122.5 mmHg, Glasgow Coma Score <14, pH <7.21, lactate level >5.2 mmol/L, base excess <-4.5 mmol/L, B-type natriuretic peptide level >3007 pg/mL (respectively area under the curve values; 0.723, 0.693, 0.739, 0.721, 0.690, 0.698, and 0.616). Signs of hypoperfusion such as low systolic blood pressure (<122.5 mmHg) and high lactate (lactate level >5.2 mmol/L) are risk factors for NIMV failure. Evaluation of initial vital signs and arterial blood gas parameters is significantly important for prediction of NIMV success in ED.

Association between prophylactic intermittent non-invasive positive pressure ventilation and incidence of pneumonia in patients with cervical spinal cord injury: a retrospective single-center cohort study

BackgroundPatients with cervical spinal cord injuries (CSCIs) have a high incidence of respiratory complications. The effectiveness of non-invasive positive pressure ventilation (NPPV) in preventing respiratory complications such as pneumonia in...

Is longer really better? Results of a retrospective real-life cohort study evaluating the benefit of adding a weekly educational session to a traditional 8-week home-based pulmonary rehabilitation programme in people with COPD

ObjectivesTo evaluate the short-term and long-term benefits of adding a weekly educational session to a traditional 8-week home-based pulmonary rehabilitation (PR) programme in people with chronic obstructive pulmonary disease (COPD)....

Heterogeneity of Intermediate Care Organization Within a Single Healthcare System.

Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.

Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.

Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022. We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project. We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions. A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.

Noninvasive Ventilation and Mortality During COVID-19: What Could Have Been Wrong?

Noninvasive Ventilation and Mortality During COVID-19: What Could Have Been Wrong?

Efficacy of Noninvasive Ventilation With Expiratory Washout in Stable COPD Patients

Efficacy of Noninvasive Ventilation With Expiratory Washout in Stable COPD Patients

Predictors of Non-Invasive Ventilation failure in Acute Hypoxemic Respiratory Failure

Predictors of Non-Invasive Ventilation failure in Acute Hypoxemic Respiratory Failure

Comment on “Ultrasound-assisted Neuraxial Anaesthesia and Intra-operative Non-invasive Ventilation for Emergency Caesarean Section in a Parturient with Profound Respiratory Failure: A Case Report”

Comment on “Ultrasound-assisted Neuraxial Anaesthesia and Intra-operative Non-invasive Ventilation for Emergency Caesarean Section in a Parturient with Profound Respiratory Failure: A Case Report”

Prevalence and Clinical Outcomes of Eosinophilic COPD in a Saudi Population: A Retrospective Study

Abstract Objective: This study assessed the prevalence of eosinophilic chronic obstructive pulmonary disease (COPD) among a selected Saudi population and examined its correlation with baseline characteristics, clinical outcomes, exacerbation risk, and current management. Materials and Methods: This retrospective single-center study was conducted over a 2-year period. The patients were divided into two groups based on the blood eosinophil count at the time of diagnosis: eosinophilic COPD (≥300 cells/μl) and non-eosinophilic COPD (&lt;300 cells/μl) groups. Results: Overall, 156 patients were included, of which 76 (48.7%) and 80 (51.3%) patients belonged to the eosinophilic and non-eosinophilic COPD groups, respectively. There were no significant differences between both groups regarding age, gender, smoking status, coexisting morbidities, FEV1, FEV1/FVC, and COPD severity (for all, P &gt;0.05). Besides, there were no significant differences between both groups regarding the frequency and numbers of exacerbations, emergency room visits, in-patient hospitalizations, and intensive care unit admissions (for all, P &gt;0.05). Among patients with eosinophilic COPD, 64 patients (84.2%) were correctly receiving the triple therapy of long-acting β2 agonists + long-acting muscarinic antagonist + inhaled corticosteroids, whereas 4 patients (5.26%) were incorrectly receiving the dual therapy of long-acting β2 agonists + inhaled corticosteroids. Univariate regression analyses revealed that heart failure, GOLD 3 severity, use of triple therapy, and use of non-invasive ventilation were significantly correlated with a higher risk of COPD exacerbation. Conversely, higher FEV1 was significantly correlated with lower risk of COPD exacerbation. The eosinophilic COPD phenotype was not found to be a significant independent variable of COPD exacerbation. Conclusion: This study found that among Saudi patients with COPD, there was no clinically important relationship between baseline blood eosinophil count and the rate of exacerbation.

Effect of Early Vs Late Intubation on Outcomes in Critically ill Patients with COVID-19 A Protocolised Approach

Introduction: COVID-19 related ARDS (CARDS) is associated with high mortality. Optimal timing of intubation in these patients is still under research. Early intubation could avoid alternate means of oxygenation like High Frequency Nasal Canula (HFNC) or Non Invasive Ventilation(NIV), which prevents Self Inflicting Lung Injury (SILI) in patients breathing spontaneously. At the same time intubation itself may generate aerosols and delaying of intubation may mean patient could be managed with other means of oxygenation thus preventing Ventilator Induced Lung Injury (VILI). Moreover, the concept of SILI is not supported by scientific data. This study investigated the effect of timing of intubation on 28-day mortality in CARDS patients. Methodology: A retrospective observational study was performed in patients admitted in COVID ICU, between January 1st and August 31st 2021, requiring ventilation. Following data collection patients were categorised into two groups. ‘Delayed ’intubation group consisted of patients receiving Non Re-Breathing Mask (NRBM) /HFNC /NIV initially and got intubated after 24 hrs of ICU admission. The remaining patients who were intubated within 24 hrs comprised the ‘early’ intubation group. The decision for early intubation was made by following the institution protocol for ventilatory management. Results: Among 114 ventilated patients 56 were intubated within 24 hours and 58 were intubated after 24 hours. The 28-day mortality in early and delayed intubation group were 39.7% and 60.3% respectively (p = 0.01). In early intubation group duration of mechanical ventilation (5±1.4), length of ICU stay (7.3±2.1) and hospital stay (9.4±4) were significantly less compared to delayed intubation group (p value &lt;0.05). Conclusion: Decision for intubation is complex and multifactorial which is usually individualized depending on the clinical condition. Early intubation is associated with improved survival rates and reduced duration of mechanical ventilation, length of ICU stay &amp; length of hospital stay in severe CARDS patients.

Clinical Characteristics of Patients Initiated on Long-Term Noninvasive Ventilation Support: A Single-Center Experience

Clinical Characteristics of Patients Initiated on Long-Term Noninvasive Ventilation Support: A Single-Center Experience

Guidelines for safe extubation and respiratory rehabilitation in the intensive care unit

Safe extubation and effective respiratory rehabilitation are pivotal in the recovery of critically ill patients in the intensive care unit (ICU). Extubation readiness is determined by assessing respiratory function, airway patency, neurological status, and hemodynamic stability. Tools such as spontaneous breathing trials (SBTs) and the cuff leak test provide valuable insights, while neurological and hemodynamic evaluations further guide decision-making. Ensuring the resolution of the primary illness is critical to minimize the risk of extubation failure and its associated complications. The process of extubation involves meticulous preparation and technique to ensure a smooth transition from mechanical ventilation. Pre-extubation interventions, including secretion management and corticosteroid administration for high-risk patients, are vital. Techniques like gradual cuff deflation and tube removal during peak inspiration, coupled with positioning strategies, reduce complications such as aspiration and airway obstruction. Post-extubation respiratory support, including high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV), plays a crucial role in stabilizing high-risk patients and preventing reintubation. Rehabilitation strategies focus on early mobilization, inspiratory muscle training, and pulmonary physiotherapy to enhance recovery and prevent long-term sequelae. Nutritional optimization is emphasized to counteract muscle weakness and promote tissue repair. Continuous monitoring for respiratory distress and addressing psychological impacts, such as post-intensive care syndrome (PICS), are integral to comprehensive care. Evidence-based protocols, individualized care plans, and multidisciplinary collaboration are essential to improving patient outcomes and reducing ICU-related morbidity and mortality.

Respiratory Severity Score (RSS): A Predictive Tool for Successful Extubation in Preterm Neonates

Introduction: The coexistence of immature lungs, poor respiratory drive, overly compliant chest wall, and surfactant deficiency in preterm neonates, leads to dependency on mechanical ventilation during the first days of life. Respiratory Severity Score (RSS) is a readily available, simple and non-invasive extubation failure prediction tool. Objective This study aims to evaluate the utility of pre-extubation RSS as a tool for predicting successful extubation among preterms. Methods and Analysis: This was a retrospective study with a duration of two years started after obtaining clearance from the Institutional Ethics Committee. All preterm neonates ventilated in NICU were included in the study. The hospital unit number was noted and the respective patient records were procured from the hospital records department. Demographic data were recorded from the files. Pre-extubation RSS was calculated. Other findings related to clinical review such as duration of invasive and non-invasive ventilation, surfactant requirement, intraventricular hemorrhage (IVH), early and late-onset sepsis, length of hospital stay (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) mortality data etc. were also recorded. The age, time of extubation and weight of those babies who underwent planned extubation were also recorded. Results: The RSS and RSS/kg were significantly higher among the neonates who failed extubation ( P &lt; .001). The Area under curve (AUC) for RSS and RSS/kg was 0.921 and 0.85, respectively. There was a significantly higher proportion of morbidities such as late-onset sepsis ( P = .046), grade ≥3 IVH ( P = .004) and ROP ( P = .043) observed among the neonates with extubation failure. The prevalence of in-hospital mortality was observed only among neonates with extubation failure which was statistically significant ( P &lt; .001). Conclusion: This study shows that pre-extubation RSS is an excellent tool for predicting successful extubation and is more accurate than RSS/kg. RSS could be a useful tool for clinicians to assess readiness of extubation. However, more prospective, multicentric studies are necessary to validate the generalizability of RSS.

Effect of balloon pulmonary angioplasty on chronic thromboembolic pulmonary hypertension: an assessment of the learning curve in a Japanese university hospital

Abstract Balloon pulmonary angioplasty (BPA) is an innovative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We retrospectively examined the clinical outcomes and complications of BPA at Yokohama City University Hospital (YCUH) between 2012 and 2018. In 2012, we began to conduct BPA sessions in 46 patients with inoperable CTEPH; 34 completed the BPA scheme and the follow-up plan. A longitudinal sub-analysis was performed with cohorts 1 and 2 receiving BPA before and after April 2015. Significant improvements in the mean pulmonary arterial pressure, pulmonary vascular resistance, and other parameters were detected after BPA. The total rate of thoracic complications was 25%. Specifically, the increase in SaO2 and home oxygen therapy discontinuation rate, and oral riociguat discontinuation rate was significantly higher in cohort 2 (+ 7.7, 75, and 59%) compared to cohort 1 (+ 3.1, 27, and 10%) (P &lt; 0.05). Moreover, the need for non-invasive positive pressure ventilation was significantly lower: 0% (cohort 2) vs. 7% (cohort 1) (P &lt; 0.05). The BPA sessions conducted at the YCUH resulted in significant improvements in patients with CTEPH. This study demonstrates a clear learning curve regarding the effectiveness of BPA both in normalizing SaO2 and facilitating the cessation of home oxygen therapy, as well as in reducing the incidence of severe complications. Graphical abstract

Fat embolism syndrome caused by fracture or liposuction: a retrospective case series of nine patients

Background Fat embolism syndrome (FES) is a rare and potentially fatal complication commonly observed after liposuction or fractures. Patients with FES often have an acute onset and a rapid course of disease. However, there is a paucity of research summarizing the clinical features of FES caused by simultaneous fracture or liposuction. Methods A comprehensive analysis was conducted to enhance understanding of patients with FES associated with either fractures or liposuction procedures. Results Nine patients who were diagnosed with FES were included in our study, of whom two were male. Six patients underwent liposuction, while three sustained multiple orthopaedic fractures. Postoperative liposuction complications occurred rapidly (average 1.8 h) after surgery, whereas patients with fractures experienced symptoms approximately 24 h after injury. All patients presented with respiratory insufficiency, six patients had cerebral involvement, and four patients had petechial haemorrhage. Laboratory tests revealed that six patients had leucocytosis, five patients had elevated neutrophil counts and eight patients had increased D-dimer concentrations. Seven patients exhibited decreased partial pressure of oxygen (7/9), six presented with decreased haemoglobin (6/9) and four had thrombocytopenia (4/9). Chest computed tomography (CT) revealed pneumonia with symmetrically diffuse ground glass opacities and patchy exudates in both lungs, which are the most common radiographic findings (8/9). Brain CT of five patients revealed multiple cerebral infarctions, and CT angiograms of the head and neck demonstrated corresponding vessel occlusions in one patient. All patients received supportive care, including six who received noninvasive ventilation and three who received mechanical ventilation. Additionally, seven patients were treated with corticosteroids. Eight patients survived, while one died of sustained cerebral embolism and ischaemia during treatment. Conclusions A patient’s medical history is critical for the diagnosis of FES. Early diagnosis and timely treatment can reduce mortality, while supportive care is important, and corticosteroid therapy may be effective for early treatment.

Respiratory support of patients with pneumonia in the context of the COVID-19 pandemic

The purpose of this study is to evaluate and analyse existing methods of supporting individuals suffering from pneumonia due to the coronavirus infection, as well as to find new ones. The following methods were used in a randomised controlled trial: artificial lung ventilation (ALV), non-invasive ventilation, oxygen therapy using oxygen masks and nasal cannulas, penetrating ventilation with high oxygen flow, high-flow nasal oxygen therapy; advantages and disadvantages of such methods. The analysis of a sample of 200 patients aged 18-80 years, among whom there were both women and men with different levels of severity of the disease, was carried out. The study showed that the use of penetrating ventilation with high oxygen flow significantly improves blood oxygenation and reduces the requirement for lung intubation and ALV. However, minimally invasive respiratory support and oxygen treatment have also proven to be effective methods of respiratory support. When using non-invasive ventilation and penetrating ventilation with high oxygen flow, higher survival rates and shorter hospital stay were observed in patients with pneumonia caused by coronavirus infection, compared with the use of ALV. The study revealed that the use of artificial respiration may result in more severe adverse effects, such as lung barotrauma, so it is recommended to use it only in the absence of other effective methods of respiratory support. Thus, the results of the study emphasise the need for an individual approach when choosing a method of respiratory support in patients with pneumonia caused by coronavirus infection, and also confirm the effectiveness of minimally invasive respiratory aid and high-flow oxygen penetrating ventilation in the treatment of this pathology.