Non-invasive Continuous Positive Pressure Ventilation Research Articles

899: COMPARISON OF CORTICOSTEROID DOSING IN NONINVASIVE POSITIVE PRESSURE VENTILATION COVID-19 PATIENTS

Introduction: High dose corticosteroids decrease ventilator free days in mechanically ventilated COVID-19 patients, however there is limited data on the benefit of higher doses in patients receiving non-invasive positive pressure ventilation. The purpose of this study was to compare high versus low dose corticosteroids’ impact on ventilator free days for COVID-19 patients who received continuous non-invasive positive pressure respiratory support. Methods: This retrospective study included COVID-19 positive patients diagnosed within 14 days of hospital admission, aged 18 years or older, and those who received at least 48 hours of corticosteroids while on continuous non-invasive positive pressure ventilation. Patients were excluded if they were pregnant, had active malignancy, transferred from an on outside facility, used oral corticosteroids within 10 days of hospitalization, and those who died or had comfort care orders placed within 24 hours of admission. The primary objective of this study compared ventilator free days between high dose (dexamethasone 20 mg or methylprednisolone ≥ 120 mg per day) and low dose (dexamethasone 6 mg per day) corticosteroids for patients who received continuous non-invasive positive pressure ventilation. Secondary objectives compared mortality, intensive care unit (ICU) length of stay, and hyperglycemia rates between groups. Results: A total of 72 patients were included in this study with 36 patients in each group. There was a statistically significant difference of 3 ventilator free days between the high and low dose corticosteroid groups (median [IQR], 12 days [8-16] vs 9 days [7-12], p=0.047). No difference was found between groups for ICU length of stay or inpatient mortality. There was an increased incidence of hyperglycemia in the high dose group compared to the low dose group (n [%], 32 patients [89] vs 24 patients [67], p=0.023). Conclusions: Initiating high dose corticosteroids for COVID-19 patients on non-invasive positive pressure ventilation is associated with an increase in ventilator-free days. The use of high dose corticosteroids in this patient population could help to delay or prevent intubation and the complications associated with mechanical ventilation. Future studies should evaluate duration of therapy and additional therapies for COVID-19 patients.

Possible role of Non-invasive Continuous Positive Pressure Ventilation In Patients With Overlap Syndrome: Obstructive Sleep Apnea And Chronic Obstructive Pulmonary Disease

Background: Overlap syndrome (OS), describes the association and simultaneous presence of OSA and COPD, Overlap syndrome has poor clinical prognosis , including increased risk for cardiovascular morbidity, hospitalization due to COPD acute exacerbation, and all-cause mortality. Efficient CPAP treatment has been related to improved survival and decreased hospitalizations. Patients and methods: This study was carried out at sleep lab of Chest Department on 24 patients splitted into two groups Group 1: patients with overlap syndrome (OS) under medical treatment plus CPAP. Group 2: patients with (OS) under medical treatment only. All patients in the study were subjected to full medical history taking, Quality of sleep by Epworth sleepiness scale (ESS). Clinical examination; (general and local), Spirometry, complete lab investigation, polysomnography and Echocardiography.Results: Statistically significant difference was observed between the two groups as regard AHI, nocturnal desaturation, mean pulmonary artery pressure, number of exacerbations per year and frequency of hospital admissions.Conclusion: Patients with CPAP-treated overlap syndrome for a period of one year experienced improving in nocturnal desaturation, mean pulmonary artery pressure and number of exacerbations.

UNUSUAL ETIOLOGY OF DIAPHRAGM WEAKNESS: NIVOLUMAB-INDUCED MYOPATHY

SESSION TITLE: Pulmonary SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Nivolumab is programmed death-1 (PD-1) inhibitors. It has been used for various cancers, including melanoma, non-small cell lung carcinoma, and renal cell carcinoma since 2015. PD-1 is expressed on activated T cells, B cells, natural killer cells and monocytes, therefore, use of nivolumab results in an enhanced immune response to both tumor cells and normal host tissues. The known adverse effects include hepatitis, pneumonitis, acute renal failure and other immune-related adverse events, such as myositis or rhabdomyolysis. We here report a case of bilateral diaphragm weakness secondary to inflammatory myopathy induced by nivolumab. CASE PRESENTATION: A 78-year-old male with recent history of stage 3 melanoma presented with few weeks duration of progressive dyspnea, orthopnea. Melanoma was removed surgically and he was recently started on adjuvant therapy with nivolumab. After 2 doses of nivolumab, he developed shortness of breath, orthopnea and required hospitalization. He was diagnosed with pneumonitis, thought to be induced by nivolumab, and received high dose steroid with clinical improvement. The CK level was high and improved after taking steroid. He was discharged on stable condition. However, he continued to have progressive respiratory symptoms and required second admission. He had acute hypercapnic respiratory failure and continuous noninvasive positive pressure ventilation (NIPPV) was placed. Image studies of the chest revealed elevation of both hemidiaphragms with compressive atelectatic changes. Diaphragm fluoroscopy showed markedly diminished excursion with free breathing and rapid inspiratory maneuvers, consistent with bilateral diaphragmatic paresis. There were no other neurologic deficits or signs suggesting neuromuscular disease. CT of cervical spine was negative for any lesions. Electromyography revealed necrotizing features in the low cervical paraspinal muscle, compatible with a proximal myopathy. Work-up for other necrotizing autoimmune myopathies was negative. As he required NIPPV continuously without improvement, aggressive treatment including methylprednisolone 1g/day and IVIG started. Unfortunately, he didn’t respond to treatment and transition to hospice care. DISCUSSION: Based on clinical feature following the use of nivolumab, negativity for autoantibodies and exclusion of other diagnoses, we diagnosed this patient with nivolumab induced myopathy, leading to diaphragms weakness. Although myopathy is rare among the patients treated with PD-1 inhibitor, it is potentially fatal in those who have necrotizing myopathy. Unfortunately patients with necrotizing myopathy can be refractory to aggressive immunotherapy and the most appropriate treatment has not been determined. CONCLUSIONS: This report highlights the importance of awareness of this rare adverse effect and considering not only pneumonitis but also myopathy in the patient with dyspnea after use of nivolumab. Reference #1: Liewluck T, Kao JC, Mauermann ML. PD-1 Inhibitor-associated Myopathies: Emerging Immune-mediated Myopathies. Journal of Immunotherapy 2017 Dec 1. Reference #2: Topalian SL, Hodi FS, Brahmer JR et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 2012 Reference #3: McDermott DF, Atkins MB. PD-1 as a potential target in cancer therapy. Cancer Med 2013 DISCLOSURES: No relevant relationships by Sungryong Noh, source=Web Response

Effect comparison of different aerosol inhalation methods of continuous non-invasive positive pressure ventilation in patients with AECOPD combined withII type respiratory failure

Objective To compare the application effects of different aerosol inhalation methods of continuous non-invasive positive pressure ventilation (NIPPV) in the treatment of the patients with AECOPD combined withⅡ type respiratory failure and offer reference for the appropriate choice of patients' aerosol inhalation methods. Methods With the convenience sampling method, totals of 150 continuous NIPPV patients with AECOPD combined withⅡ type respiratory failure were divided into the observation group and the control group according to the hospitalization time (75 patients in each group) . The patients in the control group used NIPPV and the standard oral spray driven by the atomizing pump. In the observation group the aerosol inhalation device was connected between the nasal face mask/nasal mask and the pipeline of the breathing machine. The patients in the observation group used NIPPV combined with the inhalation of atomizing drugs. Patients' oxygen saturation, heart rate, respiratory rate, dyspnea, dry mouth and sore throat, expectoration difficulties and comfort level in the two groups were compared between before and after the aerosol inhalation. Results After the aerosol inhalation, the heart rate and the respiratory rate in the observation group were (98.32±3.39) times/min and (23.16±1.30) times/min respectively, which were significantly lower compared with the control group [heart rate: (100.18±3.16) times/min, t=3.476, P<0.05; respiration rate: (25.67±1.21) times/min, t=12.240, P<0.05].The scores of dry mouth and sore throat, expectoration difficulties, and the comfort level in the observation group were (17.53±2.73) , (20.49±3.71) and (17.81±4.47) , which were significantly higher compared with the control group [dry mouth and sore throat: (16.48±3.07) , t=2.213, P<0.05; expectoration difficulties: (14.43±2.18) , t=12.196, P<0.05; comfort level: (16.37±3.74) , t=2.140, P<0.05]. Conclusions In the process of the continuous NIPPV, the aerosol inhalation device and nasal face mask are connected in the pipeline of the non-invasive breathing machine for the aerosol inhalation treatment, which can improve the therapy effect and the comfort level for patients and decrease the adverse effect level due to the use of the breathing machine. Key words: Pulmonary disease, chronic obstructive; Aerosol inhalation; Non-invasive positive pressure ventilation

Effect of hydrogel dressing on ocular in patients with continuous non-invasive positive pressure ventilation

Objective To observe the effects of hydrogel dressing on ocular in patients with continuous non-invasive positive pressure ventilation. Methods A total of 47 patients with continuous noninvasive ventilation were divided into observation group(n=22) and control group(n=25) randomly. Patients in observation group were putting the hydrogel dressing on ocular when using non-invasive ventilation, while control group received normal nursing. Then, clinical effects were observed and compared. Results The comfort level scores of observation group was significantly higher than that of control group at 7 days after using non-invasive positive pressure ventilation [(76.91±3.02)vs(72.56±2.86); t=5.067, P<0.01)]. The number of patients with foreign body sensation(3 vs 11) and ocular dryness(1 vs 9) in observation group was significantly lower than that in control group (χ2=5.159, 5.162, respectively; P<0.05). Conclusions Putting the hydrogel dressing on ocular of patients with non-invasive ventilation may increase patient′s comfort and reduce the incidence of ocular discomfort. Key words: Hydrogel dressing; Non-invasive positive pressure ventilation; Ocular; Comfort level

Nocturnal mouthpiece ventilation and medical hypnosis to treat severe obstructive sleep apnea in a child with cherubism

A 4-year old boy presented severe obstructive sleep apnoea due to complete nasal obstruction secondary to cherubism. Because of anticipatory anxiety due to numerous surgical interventions, medical hypnosis was proposed to facilitate non-invasive continuous positive pressure ventilation (CPAP) acceptance. CPAP by means of an oral interface was completely accepted after three hypnosis sessions and resulted in the correction of his obstructive sleep apnea (OSA) syndrome. This report highlights the benefit of medical hypnosis in facilitating CPAP acceptance as well as the efficacy of mouthpiece ventilation in a severe form of cherubism with complete nasal obstruction.

Occurrence of pneumothorax during noninvasive positive pressure ventilation through a helmet

A 79-year-old woman presented with hypoxemic acute respiratory failure secondary to pneumonia and was started on continuous noninvasive positive pressure ventilation (NPPV) by helmet. Patient improved over first two days of NPPV, but worsened suddenly on the third day because of development of a pneumothorax. Pneumothorax may have been caused by barotrauma from desynchronization between patient and ventilator.

Continuous NIPPV in Pneumocystis carinii pneumonia with acute severe hypoxaemic respiratory failure in an immunocompromised cancer patient: A case report

Pneumocystis carinii pneumonia (PCP) is very common cause of acute respiratory failure in patients with hematological malignancy. The role of non-invasive ventilation in moderate to severe respiratory failure due to PCP is controversial. We report a case of PCP with acute severe hypoxaemic respiratory failure well managed with prolonged continuous non-invasive positive pressure ventilation (NIPPV) and other specific treatment in a patient with acute lymphoblastic leukemia (ALL), on consolidation chemotherapy.