Chronic Respiratory Failure Patients Research Articles

Low-intensity noninvasive ventilation: Lower pressure, more exacerbations of chronic respiratory failure.

BACKGROUND:For patients with chronic respiratory failure (CRF) who are treated with noninvasive positive pressure ventilation (NPPV), a little is known regarding the effects of low-intensity NPPV (LI-NPPV) on the clinical course of CRF and the frequency of adjustments in these patients.OBJECTIVES:This study investigated the effects of LI-NPPV on the clinical course of patients with CRF as compared with patients who were treated with conventional NPPV (C-NPPV) and determined how frequently NPPV was adjusted during therapy.METHODS:Clinical data from 21 patients who received long-term NPPV were retrospectively analyzed. Patients were categorized into two groups based on the level of initial pressure support (PS): C-NPPV group (PS ≥ 10 cm H2O) and LI-NPPV group (PS < 10 cm H2O).RESULTS:Patients in the LI-NPPV group had significantly more exacerbations of CRF (P < 0.05). There was no significant difference in the number of patients who required adjustments of NPPV settings between the two groups. There was no significant difference in PaCO2 levels 1 month after the start of NPPV between the two groups; however, PaCO2 levels were significantly lower after 1 year in the C-group (P < 0.001). Seventy-one percent of LI-NPPV patients and 43% of C-NPPV patients needed NPPV adjustments.CONCLUSIONS:Attention should be paid to CRF patients who are initially administered LI-NPPV; they should be carefully observed because they can develop more exacerbations of CRF than patients undergoing C-NPPV. If possible, higher initial PS should be administered to prevent CRF exacerbations.

Randomized, dose-finding trial of ghrelin treatment for chronic respiratory failure.

Ghrelin, a growth hormone-releasing peptide, has shown efficacy in chronic obstructive pulmonary disease (COPD) patients in previous trials. This study was designed to evaluate the effective dose of ghrelin in chronic respiratory failure patients. In this randomized, double-blind, dose-finding, single-center study, 18 patients, including 16 with COPD, were randomly assigned to receive pulmonary rehabilitation (PR) with intravenous ghrelin at 1 μg/kg or 2 μg/kg, twice daily for 3 weeks. The primary outcome was the change in peak oxygen uptake ( V˙o2). Secondary outcomes included changes in plasma vascular endothelial growth factor (VEGF)-A levels, and exertional cardio-respiratory functions with blood gas analysis. With incremental exercise, there was no significant differences in the mean difference (high-dose ghrelin minus low-dose ghrelin) of peak V˙o2 (1.0 mL/kg/min, 95% CI: -0.6 to 2.6 mL/kg/min, between-group, P = 0.193). However, there were significant differences in the mean difference of (i) O2 -pulse (0.6 mL/beats, 95% CI: 0.0 to 1.1 mL/beats, between-group, P = 0.035) at iso-time; and ii) PaO2 (4.2 mmHg, 95% CI: 0.2 to 8.2 mmHg, between-group, P = 0.041) and PaCO2 (-3.1 mmHg, 95% CI: -6.0 to -0.3 mmHg, between-group, P = 0.034) at peak exercise. The mean difference in the plasma VEGF-A level was significantly inhibited by high dose-ghrelin with PR (-125.4 pg/mL, 95% CI: -235.2 to -15.5 pg/mL, between-group, P = 0.028). Although the primary outcome of the study was not met, high-dose ghrelin with PR improved exertional cardiac function and blood gas values, and inhibited circulating VEGF-A levels.

Improvement in process of care and outcome in patients requiring intensive care unit admission for community acquired pneumonia

BackgroundThe present study was performed to assess the prognosis of patients admitted to the intensive care unit (ICU) for community acquired pneumonia (CAP) after implementation of new processes of care.MethodsTwo groups of patients with CAP were admitted to a 16-bed multidisciplinary ICU in an urban teaching hospital during two different periods: the years 1995–2000, corresponding to the historical group; and 2005–2010, corresponding to the intervention group. New therapeutic procedures were implemented during the period 2005–2010. These procedures included a sepsis management bundle derived from the Surviving Sepsis Campaign, use of a third-generation cephalosporin and levofloxacin as the initial empirical antimicrobial regimen, and noninvasive mechanical ventilation following extubation.ResultsA total of 317 patients were studied: 142 (44.8%) during the historical period and 175 (55.2%) during the intervention period. Sequential Organ Failure Assessment scores were higher in patients in the intervention group (7.2 ± 3.7 vs 6.2 ± 2.8; p=0.008). Mortality changed significantly between the two studied periods, decreasing from 43.6% in the historical group to 30.9% in the intervention group (p < 0.02). A restrictive transfusion strategy, use of systematic postextubation noninvasive mechanical ventilation in patients with severe chronic respiratory or cardiac failure patients, less frequent use of dobutamine and/or epinephrine in patients with sepsis or septic shock, and delivery of a third-generation cephalosporin associated with levofloxacin as empirical antimicrobial therapy were independently associated with better outcomes.ConclusionPositive outcomes in ICU patients with CAP have significantly increased in our ICU in recent years. Many new interventions have contributed to this improvement.

A study on sleep architecture in patients with chronic respiratory failure under long-term oxygen therapy—Focused on the influence of ventilatory failure (high CO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;) elements on the patient’s sleep architecture

Sleep disturbance related symptoms are common in patients with long-term oxygen therapy (LTOT). Essentially, there were only few previous reports about the sleep architecture in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD). This study aims to clarify the objective sleep state and the elements that affect sleep architecture in Chronic Respiratory Failure (CRF) patients with focus on clinical cases of chronic hypercapnia. 13 subjects with chronic respiratory failure were enrolled in the study. All the subjects were pre-evaluated by pulmonary function test and Arterial blood gas analysis (ABG) including exercise testing. Polysomnography (PSG) test was performed in each subject with supplemental oxygen. The estimated base line PaCO2 value that reflects overall PaCO2 including sleep period was calculated using equation of PaCO2[2.4×(HCOˉ3)-22]from obtained ABG value just before PSG test. 6 subjects were classified as hypercapnic group (base line PaCO2 ≥ 45 mmHg) and 7 subjects were non-hypercapnic group (base line PaCO2 2 were no significant difference. This study suggests that patients with estimated hypercapnia had more disturbed sleep architecture especially significant loss of sleep latency than non-hypercapnic patient with chronic respiratory failure under LTOT. Nocturnal PaCO2 level or ventilatory function may contribute to sleep disturbance in patients with estimated hypercapnia during LTOT.

Process of Attaining Self-care for Chronic Respiratory Failure Patients Receiving Home Noninvasive Positive Pressure Ventilation Therapy

Process of Attaining Self-care for Chronic Respiratory Failure Patients Receiving Home Noninvasive Positive Pressure Ventilation Therapy

Hypoxia and muscle maintenance regulation

Muscle wasting and impaired muscle oxidative metabolism are common extrapulmonary features of chronic respiratory failure (CRF) that significantly increase disease burden. This review aims to address the question whether hypoxia, an obvious consequence of this disease, actually plays a causal role in these muscle impairments. In experimental models, a causal role for hypoxia in muscle atrophy and metabolic impairments has clearly been shown. Although the hypoxia-inducible factors and nuclear factor kappa B are putative mediators of these hypoxia-induced alterations, their true involvement remains to be proven. Molecular signatures of disrupted regulation of muscle mass and oxidative metabolism observed in these experimental models also have been shown in muscles of patients suffering from CRF, suggestive of but not conclusive for a causal role of hypoxia. Therapies, including but not restricted to those aimed at alleviating hypoxia, have been shown to partially but not completely restore muscle mass and oxidative capacity in CRF patients, which may imply an additive effect of nutritional modulation of substrate metabolism. Although hypoxia clearly affects skeletal muscle maintenance, it remains to be confirmed whether and by which underlying molecular mechanisms hypoxia is causally involved in CRF-related muscle atrophy and impaired oxidative capacity.

Energy Expenditure at Rest and during Walking in Patients with Chronic Respiratory Failure: A Prospective Two-Phase Case-Control Study

BackgroundMeasurements of Energy Expenditure (EE) at rest (REE) and during physical activities are increasing in interest in chronic patients. In this study we aimed at evaluating the validity/reliability of the SenseWear®Armband (SWA) device in terms of REE and EE during assisted walking in Chronic Respiratory Failure (CRF) patients receiving long-term oxygen therapy (LTOT).Methodology/Principal FindingsIn a two-phase prospective protocol we studied 40 severe patients and 35 age-matched healthy controls. In phase-1 we determined the validity and repeatability of REE measured by SWA (REEa) in comparison with standard calorimetry (REEc). In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted (Aid) or unassisted (No-Aid) modalities. When compared with REEc, REEa was slightly lower in patients (1351±169 vs 1413±194 kcal/day respectively, p<0.05), and less repeatable than in healthy controls (0.14 and 0.43 coefficient respectively). COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked, perceived symptoms and EE.Conclusions/SignificanceSWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT, and it shows that aided walking results in a substantial energy saving in this population.

Potentially modifiable predictors of mortality in patients treated with long-term oxygen therapy

Anemia is considered a systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD); however, few studies have described its influence on chronic respiratory failure (CRF) prognosis. We aimed to test the hypotheses that anemia negatively influences survival and also to identify the cut-off points of hematocrit (Htc) and hemoglobin (Hb) associated with higher mortality in CRF patients using long-term oxygen therapy (LTOT). One-hundred forty two patients with CRF in use of LTOT were evaluated at baseline and followed for three years or until death. Baseline assessment included identification, diagnosis, body composition, dyspnea, health status (HS), spirometry, arterial blood gases, Hb and Htc. Univariate and Cox proportional hazard models were used to evaluate predictors of mortality. We performed ROC curve to identify the best cut-off point of the variables related to survival to construct the Kaplan-Meier curves. Eight-three patients (58%) died after three years. Baseline values of Hb and Htc were significantly lower in the non-survivors group and both, Htc (HR, 0.96; 95%CI 0.91-0.99; p = 0.04), Hb (HR, 0.86; 95%CI 0.76-0.98; p = 0.02) were selected as predictors of mortality after three years. The cut-off points determined were: the value of HB is < 11 g/dl (sensitivity 95% specificity 85%), Htc ≤ 33% (sensitivity 97% specificity 89%). Other prognostic factors were: male gender, low PaCO(2) and SpO(2), higher dyspnea perception and impairment of HS. Our study shows that anemia is a predictor of mortality in patients with CRF under LTOT treatment. Although anemia is potentially modifiable, the effects of raising hemoglobin on mortality remain undetermined.

Effects of long-term non-invasive home mechanical ventilation on chronic respiratory failure

Objective:Chronic respiratory failure (CRF) is a syndrome defined by certain disturbances in arterial blood gases. Non-invasive mechanical ventilation (NIMV) is an increasingly used treatment modality in respiratory failure. The aim of this study was to investigate the long-term effects of NIMV on pulmonary function and survival of patients with CRF.Methods:The study enrolled 170 CRF patients who it was decided should receive long-term home mechanical ventilation. Patients were stratified into two distinct groups – Group I (patients for whom NIMV was recommended and who had used it) and Group II (patients for whom NIMV was recommended at least 1 year ago but who had not used it for various reasons). Best arterial blood gas and pulmonary function test values in the year before the NIMV recommendation were obtained from patient records. The same tests were performed at least 1 year (1–5 years) after initiation of NIMV therapy in Group I patients and at least 1 year (1–5 years) after prescription of the device in Group II.Results:In the assessments performed 1 year after NIMV recommendation, no difference was found between groups in terms of hospital admissions. However, in Group I, intra-group analysis showed a reduction in the number of hospitalizations 1 year after NIMV. A marked reduction in PaCO2 level was found in Group I patients 1 year after NIMV therapy. Mean survival after NIMV recommendation was 40.27 ± 3.56 months in Group I, and 27.35 ± 3.68 months in Group II (log rank = 7.79; p = 0.005). It was found that survival time increased as duration of NIMV usage increased.Conclusion:NIMV therapy has some important and significant benefits in patients with hypercapnic chronic respiratory failure. This study has some limitations in terms of patient selection, power analysis and survival analysis. To assess the effects of NIMV on mortality and pulmonary functions, the authors believe that there is need for prospective, controlled, multicentre studies with longer follow-up periods, improved adherence and novel ventilator modes and settings.

Tele-Assistance in Chronic Respiratory Failure: Patients' Characterization and Staff Workload of 5-Year Activity

The issue of how to optimize the routine use of tele-assistance (TA) in the clinical care remains to be addressed. Skills and costs of human resources represent the major component to care for chronic patients with TA. We investigated (1) the change in patient population, mortality, and staff utilization/cost during the first 5-year activity of a TA program (24-h availability of a call center, pulse oxygen device, and second medical opinion) dedicated to chronic respiratory failure patients and (2) the staff time dedicated to each new patient admitted to the service. Three-hundred and ninety-six patients (age 64 +/- 17 years; 296 men) were reviewed across 5 years of activity. Patients followed/year increased over time, particularly for amyotrophic lateral sclerosis subjects. Calls/month dramatically increased from 60 to 290, with a 5-year number of calls equal to 12.952. The doctor's time dedicated to TA decreased over time, whereas the nurse's time increased allowing a cost saving of 39% when compared with budgeted salary costs. The number of home ventilated patients did not change, remaining over 78%. The mortality rate increased over time (from 6% to 11%). Both chronic obstructive pulmonary disease (COPD) and No-COPD patients used the TA service more frequently during the winter, and COPD used it also in the summer. A stable TA service dedicated to chronic respiratory failure may be reached after 4 years. Across years, (1) number of patients increased, with COPD and ventilated subjects being the most representative; (2) calls varied during seasons; (3) doctor's workload decreased, saving salary costs; and (4) each new enrolled patient may require 73 and 27 min/month of nurse and doctor, respectively.

Telemedicine to support end of life in severe chronic respiratory failure patients at home

Tele hospice has been demonstrated useful and cost saving for palliative care. The aim of the present study was to analyze the feasibility of impact of a telemedicine (TM) programme on severe chronic respiratory failure (CRF) patients discharged to home, their family and the healthcare team (HCT) in the terminal phase of life. TM consisted of scheduled phone calls, pulse-oximetry recording, 24h call centre, and specialised nurse and physician second opinion. 21 patients out of 118 died after 6±3.4 months of follow up. Compared to the 97 surviving subjects, the deceased patients presented a higher number of hospitalisations/month (0.36±0.33 vs. 0.09±0.14 p<0.005), ER visits/month (0.31±0.40 vs. 0.02±0.04 p<0.005), exacerbations/month (0.39±0.42 vs. 0.11±018 p<0.003) and urgent calls/month to the GP (0.22±0.34 vs. 0.19±0.05 p<0.02). The TM team was involved in counselling on hospital admissions, discussions and decisions reached in consensus, all care options to avoid a nihilistic position or aggressive and disproportional care choices, GP or home nurse consultations, sedative or morphine prescription, resolving problems with ventilators, the prescription of oxygen saturation monitoring, patient education regarding the severity of the illness, coordination with home nursing services and psychological and spiritual help. A nurse-centred TM programme for terminal patients may: (1) improve communication between hospital staff and the patients’ relatives; (2) optimise the management of pain and respiratory symptoms; (3) improve health care assistance; and (4) rationalise hospitalisations and the health care needs.

Muscle Blood Flow and Oxygen Utilization Measured by Near-Infrared Spectroscopy during Handgrip Exercise in Chronic Respiratory Patients

[Purpose] The purpose of this study was to evaluate tissue oxygen utilization and blood flow in patients with chronic respiratory failure (CRF). [Subjects] The subjects were divided into three groups: twelve subjects with chronic respiratory failure, twelve healthy older subjects, and thirteen healthy young subjects. [Method] A near infrared spectrometer was used to monitor tissue oxygenation, and the probe was placed over the flexor muscle. The subjects performed 3min rhythmic handgrip (HG) exercise at 10 and 30% of maximum voluntary contraction force in a random order. Forearm blood flow was estimated by the rate of increase in the sum of oxy-hemoglobin (OxyHb) and deoxy-hemoglobin (DeoxyHb) during venous occlusion, and muscle oxygen utilization by the rate of decrease in the difference between OxyHb and DeoxyHb during arterial occlusion. [Results] Forearm blood flow in the CRF group was significantly lower compared to the older group during 10% HG and the younger group in 30% HG. Muscle oxygen utilization in the CRF group was significantly higher than the older and young groups in 10% HG. [Conclusion]We conclude that the CRF patients desaturate their muscles more than normal control subjects at a lower work level due to insufficiency of blood flow to the exercising muscles.

Quantitative Analysis of Acid-Base Disorders in Patients with Acute on Chronic Respiratory Failure and Acute Respiratory Distress Syndrome. A Prospective, One Center Study

Background: With Stewart approach, pH depends on strong ion difference (SIDe), PaCO2 and non volatile weak acids (Atot). This approach might detect complex acid-base disorders undetected by conventional approach. We de- signed this study to describe acid-base disorders with both Stewart and conventional approaches and to compare the diagnostic performance in patients with chronic respiratory failure (CRF) in acute respiratory failure (ARF) or with acute respiratory distress syndrome (ARDS) because they are expected to have complex acid-base disorders. Conventional ap- proach was based on standardized base excess (SBE), bicarbonate (HCO3 - ) and anion gap (AG). Working hypotheses were that in CRF, metabolic alkalosis was associated with respiratory acidosis and in ARDS, Stewart approach was able to identify metabolic acidosis not detected with the conventional approach. Methods: Observational study in a medical ICU of a University hospital on 36 patients with obstructive CRF (CRFo), 36 with non obstructive CRF (CRFno) and 28 with ARDS prospectively included over 8 months. Measurements were per- formed on ICU admission, day 1 and day 2 after admission. Results: Metabolic alkalosis occurred in less than 5% of samples in CRF patients and in 0 ARDS patient. As compared to CRF patients, ARDS patients exhibited lower SBE, higher AG, lower SIDe and lower Atot. In ARDS, low SIDe was pri- marily due to elevated unidentified anions. Hypoalbuminemia was present in more than 75% of patients without dif- ference between groups. Normal values of SBE, HCO3 - and AG were very common. Stewart approach detected low SIDe in 13% of samples with normal SBE, in 13.8% of samples with normal HCO3 - , and in 11% of samples with normal AG corrected for abnormal albumin concentration, without difference between CRF and ARDS. Conclusions: In these selected critically ill patients, Stewart approach exceeded the diagnostic performance of the conven- tional approach even when AG corrected was taken into account. Further studies in CRF patients with chronic hypercap- nia and elevated bicarbonatemia are required to assess the incidence of associated metabolic alkalosis.

Tele-assistance in chronic respiratory failure patients: a randomised clinical trial

Chronic respiratory patients requiring oxygen or home mechanical ventilation experience frequent exacerbations and hospitalisations with related costs. Strict monitoring and care have been recommended. The aim of the present study was to primarily evaluate reduction in hospitalisations and, secondly, exacerbations, general practitioner (GP) calls and related cost-effectiveness of tele-assistance (TA) for these patients. A total of 240 patients (101 with chronic obstructive pulmonary disease (COPD)) were randomised to two groups: an intervention group entered a 1-yr TA programme while controls received traditional care. No anthropometric and clinical differences were found between groups both in baseline and in mortality (18% for TA, 23% for controls). Compared with controls, the TA group experienced significantly fewer hospitalisations (-36%), urgent GP calls (-65%) and acute exacerbations (-71%). Only COPD patients, as a separate group, had fewer hospitalisations, emergency room admissions, urgent GP calls or exacerbations. Each patient referred to staff a mean+/-sd 36+/-25 times. After deduction of TA costs, the average overall cost for each patient was 33% less than that for usual care. In chronic respiratory failure patients on oxygen or home mechanical ventilation, a nurse-centred tele-assistance prevents hospitalisations while it is cost-effective. The chronic obstructive pulmonary disease group seems to have a greater advantage from tele-assistance.

During exercise non-invasive ventilation in chronic restrictive respiratory failure

Exercise intolerance limits chronic restrictive respiratory failure (CRF) patients from participating in daily activities. The specific modalities that could improve exercise tolerance in these patients remain to be established. To investigate exercise endurance and associated physiological responses with non-invasive ventilation (NIV) during exercise in restrictive CRF patients. Eighteen patients (63+/-11 years, total lung capacity (TLC)=59+/-16% of predicted value) performed maximal exercise in spontaneous breathing conditions (MWLE) and during two constant workload exercise (CWLE) tests at 75% Pmax, with or without NIV in random order. "NIV Responders" were defined by an increase in CWLE duration of more than 50% when using NIV. For the whole group, CWLE duration when using NIV increased from 5.6+/-4.6 to 9.6+/-8.1 min. Increase in CWLE duration correlated with reduction in heart rate and oxygen desaturation, and dyspnea relief during exercise. NIV responders (n=9) showed more severe lung restriction (TLC: 2.6+/-0.7 versus 3.5+/-1.1L; forced vital capacity: 1.0+/-0.16 versus 1.46+/-0.38 L). At the end of MWLE, responders had a lower Vt (0.60+/-0.09 versus 0.89+/-0.34 L), a higher dead-space ratio (0.51+/-0.06 versus 0.38+/-0.12) and lower oxygen pulse (4.5+/-1.2 versus 7.4+/-3.9 ml/beat). In severely restrictive patients, NIV during exercise significantly improved exercise duration and tolerance and increased alveolar ventilation. The enrollment of the patients started before July 1, 2005.

Maugeri Respiratory Failure questionnaire reduced form: A method for improving the questionnaire using the Rasch model

Purpose. The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically developed for use with chronic respiratory failure (CRF) patients. The 28 items were selected using classical test theory. The purpose of the current analysis was to further refine the questionnaire using item response theory, specifically, the Rasch model analysis.Methods. Three hundred and seventeen CRF patients (mean aged 66.7 yrs; Male 219, Female 98) completed the MRF-28 health status measure. Data were collected through the self-report questionnaire and analyzed using 1-parameter logistic models by means of RUMM software.Results. The 28-item questionnaire has good psychometric properties in terms of discriminant power because the Person Separation Index is 0.896. However, the item-trait interaction was not good as shown by the total-item Chi-square (, p<0.001). Removing two items that did not fit the Rasch model well, produced a minor improvement in Person Separation Index to 0.899 and the item-trait interaction improved (, p = NS). In the preliminary analysis we identified 21 patients who were outliers; when they were excluded the distribution of the residuals, according to the Kolmogorov-Smirnov statistics, was normal and factor analysis of the item residuals showed that the components had similar eigenvalues and no strong correlation with items. These results suggest that the MRF-26 is a unidimensional measure of health-related quality of life impairment for chronic respiratory failure patients.Conclusions. A combination of classical psychometric tests and Rasch analysis produced an instrument of moderate size that covers a wide range of effects of CRF and has interval scaling properties.

Noninvasive positive pressure ventilation prevents postoperative pulmonary complications in chronic ventilators users

To evaluate the postoperative pulmonary complications and the long-term impact on pulmonary function of different surgical procedures with general anaesthesia in chronic respiratory failure (CRF) patients who were using noninvasive positive pressure ventilation (NPPV). We retrospectively studied 20 stable patients on NPPV for CRF secondary to: kyphoscoliosis (eight), morbid obesity (six), thoracoplasty (four), neuromuscular diseases (two), who underwent surgical procedures with general anaesthesia, between January 1998 and December 2003. The variables studied were: type of surgery, hours of orotracheal intubation, hours of stay in the postsurgical reanimation unit (PRU), postoperative pulmonary complications and days of hospital stay. These results were compared with those obtained in patients without respiratory pathology and who were submitted to the same type of surgical interventions during the study period. All patients were tested for: arterial blood gases, forced vital capacity (FVC) and forced expiratory volume in 1s (FVE1). These tests were carried out both prior to surgical intervention and 12 months after this intervention, and the use of medical assistance resources the year prior to and the year after the surgical intervention were also analysed. Sixteen patients were using NPPV at home at the time of the intervention and four patients were adapted to NPPV before surgery. The surgical procedures were: gastroplasty: six; mastectomy: five; septoplasty: three; hip prosthesis: two; cholecystectomy: one; Gasserian ganglion thermocoagulation: one; hysterectomy: one; and endoscopic retrograde cholangiopancreatography (ERCP): one. The mean postoperative intubation time was 3.8+/-3.2h, and only one patient remained intubated for more than 12h. The mean stay in the PRU was 19+/-9h (vs 19+/-6h in the general population, p>0.05). The days of hospital stay for the different pathologies were in the majority of cases greater than in the general population. We did not find significant differences on comparing the arterial blood gases, in pulmonary function or in use of assistance resources between the year previous to and the year following the surgical intervention. In high-risk patients with chronic respiratory failure as a consequence of a restrictive lung pathology, NPPV can play an important role to confront surgical procedure with general anaesthesia with greater security. To obtain these results, it was fundamental to coordinate between the Pulmonary Services and the Anaesthesia Services as well as to follow up jointly in the PRU.

Décisions de non admission et de limitation thérapeutique chez l'insuffisant respiratoire chronique en réanimation

Chronic respiratory failure (CRF) is one of the most common underlying illnesses in ICU patients in whom death is preceded by a decision of withdraw or withhold life support. The number of CRF patients is growing because the prevalence of chronic obstructive pulmonary disease (COPD), a major cause of chronic morbidity and mortality, is increasing. The following medical situations could lead to a decision of not admitting to the ICU: end-stage idiopathic pulmonary fibrosis (IPF) or cystic fibrosis (CF) in patients not included in a lung transplant program, amyotrophic lateral sclerosis (ALS) treated by home noninvasive ventilation in patients who did not want long term ventilation by tracheostomy, any form of CRF associated to another illness with poor short-term prognosis. In ICU, the reasons leading to a decision-making process of life support treatment withholding or withdrawing could be the futility of care (advanced IPF or CF patients receiving prolonged invasive mechanical ventilation without identified reversible cause of respiratory failure) or the future poor quality of life (ventilator-dependent patients with ALS or severe COPD who are not candidate for home ventilation by tracheostomy). The patients must be involved in the decision-making process as they are judged to be competent. In patients with end-stage lung disease, it is important to stimulate discussion about advance care planning before the onset of acute respiratory failure and a possible admission to the ICU.

Pulse oximetry saturation levels in chronic respiratory failure patients during unsedated trans-nasal gastroscopy

Pulse oximetry saturation levels in chronic respiratory failure patients during unsedated trans-nasal gastroscopy

Pulse oximetry saturation levels in chronic respiratory failure patients during unsedated trans-nasal gastroscopy

Pulse oximetry saturation levels in chronic respiratory failure patients during unsedated trans-nasal gastroscopy