Effect Of Noninvasive Mechanical Ventilation Research Articles

Use of non-invasive mechanical ventilation in the Emergency Department, clinical outcomes and correlates of failure

Background: Despite several studies having been carried in this organizational context, there is an absence of information about the effectiveness of non-invasive mechanical ventilation (NIV) in Emergency Departments (ED), based on a number of suitable patients with acute respiratory failure (ARF) of different aetiology. In particular, it has not yet been defined as to whether the context of the ED suits the necessary requirement of quality for the correct application of the method and if the obtained results are different from those taken in other studies in general or respiratory intensive care unit. Finally there are few data related to the predictive factors to NIV failure (endotracheal intubation, in-hospital mortality) when applied in the emergency setting. Methods: To answer these questions we have retrospectively studied a population of 210 patients (95 with COPD exsacerbation ; 92 with acute cardiogenic pulmonary oedema; 23 with severe community acquired pneumonia) treated for ARF in the “critical area” of four Italian level II Emergency Departments. For all patients demographic data; some comorbidities (diabetes, dementia, sopraventricular arrhythmias, obesity); the physiological scores (Kelly, SAPS II, Apache II); the need for pharmacological sedation; vital and blood gas parameters (evaluated at entry, after one hour of treatment and before its suspension); the ventilatory modality applied (CPAP or PSV + PEEP) and some parameters of in-hospital stay (duration of the hospitalization in the critical area, duration of ventilation, compliance to the treatment, patient's refusal to continue it, development of skin necrosis, need for endotracheal intubation, in-hospital mortality) were considered. Finally demographic, event of death with Cox regression or to the need for ETI through linear regression analysis. Results: Globally, in-hospital mortality reached 13,3%, the percentage of failure with consequent endotracheal intubation amounted to 10,4% . Considering the single aetiologic groups in the patients with COPD, exsacerbation mortality and ETI percentage were 12,6% and 13,7% respectively; in ACPO patients these data respectively amounted to 3,3% and 4,3%; while for patients with severe CAP they respectively reached 34,7% and 21,7%. The following factors were independently correlated with in-hospital mortality: SAPS II > 35, presence of dementia for COPD patients; SAPS II > 35; presence of dementia, presence of sopraventricular arrhythmias for ACPO patients; SAPS II > 35, presence of sopraventricular arrhythmias, presence of dementia for CAP patients. Considering the whole population of 210 patients, the predictive factors of in-hospital mortality were the following: SAPS II > 35; presence of dementia; presence of sopraventricular arrhythmias; maintenance of a respiratory rate above 24 bpm during tratment. The following were factors independently correlated with the need for endotracheal intubation: male gender, pH < 7,32, respiratory rate > 24 bpm, mean arterial pressure > 96 mmHg, all measured at one hour of treatment, for COPD patients; male gender sex, pH < 7,32 , respiratory rate > 24 bpm, PaCO2> 54,5 mm Hg all measured after one hour treatment for ACPO patients. Given the low number of patients, it was not possible to perform the logistic regression and to calculate the matrix of covariance of the parameter for the CAP group. Considering the whole series of patients, the factors independently correlated to ETI resulting in the following: male gender; diagnosis of COPD; pH < 7,32, respiratory rate > 24 bpm, mean arterial pressure > 96 mm Hg, PaCO2 > 54,5 mm Hg, all measured after one hour treatment. Conclusions: In conclusion, our study shows that NIV is racticable in the ED with safety and clinical results I T A L I A N J O U R N A L O F P U B L I C H E A L T H JPH - Year 6, Volume 5, Number 3, 2008 T H E M E P A P E R S 1 9 9

Effect of Non-Invasive Mechanical Ventilation with Average Volume Assured Pressure Support (AVAPS) in Patients with Chronic Obstructive Pulmonary Disease with Acute Exacerbation

Background: Patients with acute respiratory failure have traditionally been evaluated for non-invasive mechanical ventilation (NIV) based on clinical evaluation and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adapts to a patient's needs. Objective: To see the effective of non-invasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease with acute exacerbation. Materials and Methods: This single-center prospective study was carried out at the Gazi Medical College (GMC), Khulna, Bangladesh, in the department of medicine. The research's participants were all admitted between December 1, 2021, and January 1, 2023. The trial included all patients with acute exacerbations of chronic obstructive pulmonary disease. Age, gender, and disease severity were determined using the APACHE II scoring system. A structured proforma was used to collect data. The percentage and absolute number were used to express all category data. All numerical continuous data were reported as mean standard deviation. SPSS version 23 was used to analyze the data. All tests were evaluated using a 95% confidence interval, and a P value of 0.05 was deemed significant. Results: The mean MBS, NRS, dyspnea/comfort scale, respiration rates, systolic blood pressure, and diastolic blood pressure- post treatment were statistically significant (p <0.05) when compared to pretreatment in the BiPAP S/T with AVAPS group. Mean PaCO2, MBS, NRS, dyspnea/comfort scale, heart rate, respiration rates, and systolic blood pressure- post treatment were statistically significant (p <0.05) when compared to pretreatment in the BiPAP S/T group. Conclusion: BiPAP S/T with AVAPS promotes a quicker return to awareness in patients with chronic .......

Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary diseaseon general respiratory wards

Background- Chronic Obstructive Pulmonary disease (COPD) as defined by Global Initiative for Obstructive Lung Disease (GOLD) is a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Objectives-To evaluate outcome of NIV in terms ofTime for reversion of pH to normal, Duration of NIV, Hospital stay, Failure of NIV, Mortality and to compare the effect of noninvasive mechanical ventilation (NIV) in severelyacidotic (pH < 7.25) with mildly acidotic (pH 7.25–7.35) patients with acute hypercapnic chronic obstructive lung disease (COPD) Methods-This is a prospective observational study of COPD patients with acute Type 2 respiratory failure initiated on NIV conducted in Christian Medical College, Vellore, Tamil Nadu. The study was conducted in the Department of Pulmonary Medicine, Christian Medical College, Vellore.Assuming the mean as 12h (SD=6h), the sample size is Hence it is decided to sample 25 mild acidosis and 25 severe acidosis cases for this study. In the present study, 53 patients were recruited from April 2017 to June 2018.

The Effect of Non-Invasive Mechanical Ventilation on Respiratory and Inflammatory Parameters in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is an airway obstructive disease that is often caused by smoking. The disease is currently the third leading cause of death worldwide. The current therapeutic approach is based on Non-Invasive Ventilation (NIV) therapy, which can reduce mortality, the need for hospitalization in the intensive care unit, and to some extent therapeutic complications. Therefore, this study was performed to determine the effect of non-invasive ventilation along with routine treatments on respiratory markers, inflammation, and clinical status of patients with COPD. Methods: A total of 30 patients with COPD referred to Masih Daneshvari Hospital were divided into control and intervention groups. In the intervention group, 15 patients underwent non-invasive ventilation in addition to the usual treatments, and in the control group, the patients underwent only the usual treatments. After completing the mMRC (Modified Medical Research Council) questionnaire and evaluating FEV1 (Forced Expiratory Value in one score), 5 ml of blood samples were taken from these patients at the beginning of the study, on the seventh to tenth day, and also in the third month, and the results of this evaluation were compared between the two groups. Results: Based on the results of this study, the mMRC score of the intervention group was significantly lower than the control group in the first week (p=0.043) and three months after treatment (p=0.049). However, indices such as FEV1, and IL-8(Interleukin-8) did not change significantly in both groups. Conclusion: The use of non-invasive mechanical ventilation along with standard treatments can play a relative role in improving patient outcomes.

Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure.

IntroductionThe effectiveness of non‐invasive mechanical ventilation (NIV) in the management of COPD patients suffering from acute respiratory failure (ARF) as a consequence of exacerbation of the disease, is well established. However, data on long‐term outcomes and their predictors, including the individual response to NIV, are scarce.ObjectivesTo investigate predictors for short‐ and long‐term mortality in this study population.MethodsA retrospective cohort study was performed including all patients admitted to the Medium Respiratory Care Unit of Maastricht University Medical Center in Maastricht, the Netherlands, with hospitalized exacerbation of COPD (H‐ECOPD) with ARF requiring NIV for the first time between January 2009 and December 2011. An extensive number of potential predictors of outcomes, including the response to NIV, were determined on admission and during hospitalization. Univariate and multivariate logistic regression was used for statistical analysis.ResultsSeventy‐eight consecutive patients with moderate to severe COPD (mean age 71.0 ± 10.7 years; 48.7% males) were included; In‐hospital, 1‐year and 2‐year mortality rates were 14.1%, 43.6% and 56.4%, respectively. Independent risk factors for 2‐year mortality were: advanced age (odds ratio(OR) 1.025; confidence interval (CI) 1.002‐1.049; P = 0.037), prolonged NIV use more than 8 days (OR:1.054;CI:1.006‐1.104; P = 0.027) and no successful response to NIV (OR:2.392;CI:1.297‐4.413; P = 0.005).ConclusionPatients with an H‐ECOPD requiring NIV for the first time, constitute a severely ill patient group with high in‐hospital and 2‐year mortality. This study identified advanced age, NIV use more than 8 days and unsuccessful response to NIV as clinical important independent predictors for long‐term mortality.

The effects of non-invasive mechanical ventilation on cardiac autonomic dysfunction in spinal muscular atrophy

In patients with spinal muscular atrophy (SMA), obstructive sleep apnea syndrome (OSAS) constitutes an important cause of cardiovascular morbidity and mortality. We investigated heart rate variability (HRV) to evaluate the effects of non-invasive mechanical ventilation on cardiac autonomic dysfunction in patients with SMA and OSAS. Six patients with SMA (type 1 and 2) and six age- and sex-matched healthy children were consecutively enrolled. A whole-night diagnostic polysomnography was performed, and SMA patients with OSAS were given non-invasive mechanical ventilation therapy. HRV analysis was performed on the basis of whole-night electrocardiography recordings via a computer-base program. Apnea-hypopnea index (AHI) was 9.2 ± 6.2/hr in SMA patients, while it was 0.4 ± 0.5/hr in controls (p = 0.036). All SMA patients had OSAS, while none of the controls had OSAS (p = 0.012). Mean percentage of successive R wave of QRS complex (R-R) intervals>50 ms was significantly lower in SMA patients than those in controls (p = 0.031). Significant correlations were found between AHI and high-frequency power, low/high-frequency ratio in wakefulness and in sleep (p<0.05). Repeated HRV analysis in SMA patients following OSAS therapy showed significant reductions in average R-R duration (p = 0.028) and percentage of successive R-R intervals>50 ms (p = 0.043). Our study demonstrates the beneficial effects of non-invasive mechanical ventilation on cardiac autonomic dysfunction in SMA patients with OSAS.

Do Cheyne and Stokes have an important message for modern‐day patients with heart failure? Yes, they do

Do <scp>C</scp>heyne and <scp>S</scp>tokes have an important message for modern‐day patients with heart failure? <scp>Y</scp>es, they do

Effect of non-invasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease with acute exacerbation: A randomized pilot trial

Objectives: The primary goal of this study was to compare patient satisfaction betweenbi-level positive airway pressure-spontaneous/timed with average volume assured pressuresupport (BiPAP S/T with AVAPS) and BiPAP S/T alone in patients with acute exacerbationsof chronic obstructive pulmonary disease (AECOPD) using self-reported intensity of dyspneameasured with the modified Borg scale (MBS) and a numeric rating scale (NRS) and comfortlevel measured with a dyspnea and comfort scale.Methods: This pilot randomized clinical study was conducted in patients who presentedwith acute respiratory distress due to AECOPD to the Siriraj Hospital Emergency Department.Included patients were randomized in a 1:1 ratio to receive either BiPAP S/T with AVAPS(intervention) or BiPAP S/T (control). MBS, NRS, dyspnea and comfort scale, clinical information,and laboratory results were recorded and analyzed.Results: Twenty-two patients were enrolled (11 in each group). The average decrease inthe MBS, the NRS, and the dyspnea and comfort scale were higher in the group than the controlgroup (4.09 ± 1.81 vs. 2.91 ± 1.64; 4.09 ± 1.76 vs. 2.91 ± 1.92; 3.27 ± 2.45 vs. 3.00 ± 1.90,respectively). The average increase of patient satisfaction with overall comfort was higher inthe AVAPS group (1.64 ± 2.77 vs. 1.09 ± 3.02). However, none of these differences reachedstatistical significance.Conclusion: There was no statistically significant improvement in patient comfort usingAVAPS as an adjunct to standard BiPAP S/T therapy in this pilot study.

无创机械通气对非计划性拔管患者再插管情况的影响

无创机械通气对非计划性拔管患者再插管情况的影响

Observation on the effect of noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease with respiratory failure

Objective To analyze the therapeutic effect of noninvasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Methods Sixty patients with COPD respiratory failure were randomly divided into two groups.30 cases in the conventional treatment group used conventional comprehensive therapy.30 cases in the noninvasive mechanical ventilation group were given noninvasive mechanical ventilation based on conventional treatment.The total effective rate, time to correct the abnormal breathing, hospitalization time were compared between the two groups.Before and after treatment, the arterial blood gas analysis indicators and heart rate, respiratory rate, probability, mortality for ventilator ventilation were compared in the two groups. Results The total effective rate of the noninvasive mechanical ventilation group was 96.67%, which was higher than 73.33% of the conventional treatment group(χ2=6.405, P 0.05). After treatment, the frequency of PaCO2, PaO2, heart rate and respiratory rate in the conventional treatment group were (60.45±3.94)mmHg, (60.24±4.12)mmHg, (92.58±0.61)times/min, (22.45±3.14)times/min, respectively, which in the noninvasive mechanical ventilation group were (52.24±1.23)mmHg, (76.24±5.26)mmHg, (83.92±0.62)times/min, (17.26±2.23)times/min, respectively, the differences between the two groups were statistically significant(t=5.133, 3.734, 5.166, 6.360, all P<0.05). The invasive rate of invasive ventilator and mortality of noninvasive mechanical ventilation group were 3.33% and 0.00%, respectively, which were lower than 20.00%, 13.33% of the conventional treatment group (χ2=7.214, 6.247, all P<0.05). Conclusion Noninvasive mechanical ventilation is effective in treatment of patients with COPD respiratory failure, which can effectively improve the indicators of arterial blood gas and heart rate and respiratory rate, improve the prognosis of patients, improve the ventilation probability of invasive ventilator. Key words: Respiration, artificial; Pulmonary disease, chronic obstructive; Respiratory insufficiency

Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis.

BackgroundTo determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted.ResultsThirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay.ConclusionsThe overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0289-y) contains supplementary material, which is available to authorized users.

Efficacy, safety and side effects of noninvasive mechanical ventilation (NIV) in an internal medicine ward

Over the last two decades, NIV has become the cornerstone in the management of acute respiratory failure (ARF) in ICU. Benefits from NIV have been reported from RCTs and meta-analyses in selected patients admitted to centers with extensive experience. The generalizability of these benefits in non referral centers and in elderly patients with co-morbidities has to be demonstrated.

Effects of non-invasive ventilation on reintubation rate: a systematic review and meta-analysis of randomised studies of patients undergoing cardiothoracic surgery

Objective: To estimate the effect of non-invasive mechanical ventilation (NIV) on the rate of reintubation among patients undergoing cardiothoracic surgery.Design: A meta-analysis of randomised trials.Data sources: Medline, Embase, and the Cochrane Central Register of clinical trials were searched (April 2012) for pertinent studies by two trained investigators. International experts were contacted.Data extraction: Articles were assessed by two trained investigators, with divergences resolved by consensus. Inclusion criterion was random allocation to NIV versus standard treatment without restrictions on duration or modalities of the treatment delivered.Data synthesis: Fourteen studies enrolling 1211 patients were included in the meta-analysis. NIV reduced the reintubation rate (risk ratio [RR], 0.29; 95% CI, 0.16–0.53; P for efficacy < 0.0001; I2 = 0), hospital length of stay and mortality. Subgroup analyses suggested that the benefits of NIV are more important in patients with ongoing acute respiratory failure (RR, 0.25; 95% CI, 0.07–0.89) and in those at high risk of developing postoperative pulmonary complications (RR, 0.19; 95% CI, 0.04–0.84). Analyses including prophylactic studies in patients at low risk did not show a significant effect of NIV on reintubation rate (RR = 0.42; 95% CI, 0.12–1.48) and on any of the outcomes considered except for oxygenation.Conclusions: NIV seems to be effective in reducing reintubation rate after cardiothoracic surgery. The results of this meta-analysis should be confirmed by large randomised controlled studies.

Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial

Despite best-possible medical management, many patients with end-stage cancer experience breathlessness, especially towards the end of their lives. We assessed the acceptability and effectiveness of non-invasive mechanical ventilation (NIV) versus oxygen therapy in decreasing dyspnoea and the amount of opiates needed. In this randomised feasibility study, we recruited patients from seven centres in Italy, Spain, and Taiwan, who had solid tumours and acute respiratory failure and had a life expectancy of less than 6 months. We randomly allocated patients to receive either NIV (using the Pressure Support mode and scheduled on patients' request and mask comfort) or oxygen therapy (using a Venturi or a reservoir mask). We used a computer-generated sequence for randomisation, stratified on the basis of patients' hypercapnic status (PaCO2 >45 mm Hg or PaCO2 ≤45 mm Hg), and assigned treatment allocation using opaque, sealed envelopes. Patients in both groups were given sufficient subcutaneous morphine to reduce their dyspnoea score by at least one point on the Borg scale. Our primary endpoints were to assess the acceptability of NIV used solely as a palliative measure and to assess its effectiveness in reducing dyspnoea and the amount of opiates needed compared with oxygen therapy. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00533143. We recruited patients between Jan 15, 2008, and March 9, 2011. Of 234 patients eligible for recruitment, we randomly allocated 200 (85%) to treatment: 99 to NIV and 101 to oxygen. 11 (11%) patients in the NIV group discontinued treatment; no patients in the oxygen group discontinued treatment. Dyspnoea decreased more rapidly in the NIV group compared with the oxygen group (average change in Borg scale -0·58, 95% CI -0·92 to -0·23, p=0·0012), with most benefit seen after the first hour of treatment and in hypercapnic patients. The total dose of morphine during the first 48 h was lower in the NIV group than it was in the oxygen group (26·9 mg [37·3] for NIV vs 59·4 mg [SD 67·1] for oxygen; mean difference -32·4 mg, 95% CI -47·5 to -17·4). Adverse events leading to NIV discontinuation were mainly related to mask intolerance and anxiety. Morphine was suspended because of severe vomiting and nausea (one patient in each group), sudden respiratory arrest (one patient in the NIV group), and myocardial infarction (one patient in the oxygen group). Our findings suggest that NIV is more effective compared with oxygen in reducing dyspnoea and decreasing the doses of morphine needed in patients with end-stage cancer. Further studies are needed to confirm our findings and to assess the effectiveness of NIV on other outcomes such as survival. The use of NIV is, however, restricted to centres with NIV equipment, our findings are not generalisable to all cancer or palliative care units. None.

The effect of non-invasive mechanical ventilation in postoperative respiratory failure

Postoperative respiratory failure is related with the highest mortality and morbidity among all perioperative complications. The most common underlying mechanism of postoperative respiratory failure is the development of atelectasis. Anaesthesia, medications which cause respiratory depression, high FiO2 use, postoperative pain and disruption of muscle forces due to surgery leads to decrease in functional residual capacity and results in atelectasis formation. Atelectasis causes severe hypoxemia due to ventilation, perfusion mismatch, shunt and increased peripheral vascular resistance. Intrathoracic positive pressure is an effective therapeutic option in both prevention and treatment of atelectasis. Non-invasive mechanical ventilation is related with a lower mortality and morbidity rate due to lack of any potential complication risks of endotracheal intubation. Non-invasive mechanical ventilation can be applied as prophylactic or curative. Both of these techniques are related with lower reintubation rates, nosocomial infections, duration of hospitalization and mortality in patients with postoperative respiratory failure. The differences of this therapy from standard application and potential complications should be well known in order to improve prognosis in these group of patients. The primary aim of this review is to underline the pathogenesis of postoperative respiratory failure. The secondary aim is to clarify the optimum method, effect and complications of non-invasive mechanical ventilation therapy under the light of the studies which was performed in specific patient groups.

A pilot study of the effects of non-invasive mechanical ventilation on the prognosis of ischemic cerebrovascular events in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for ischemic cerebrovascular diseases, and results in worse prognosis and higher mortality. We aimed to investigate the effects of early treatment of OSAS on the prognosis of ischemic stroke. We prospectively evaluated patients with acute supratentorial ischemic stroke and OSAS on admission (acute stage), at second week (subacute stage) and at second month (chronic stage); 11 (73.3%) out of 15 patients put on the non-invasive mechanical ventilation treatment within 48 h of stroke constituted the treatment group, and 13 patients constituted the control group. Patients with OSAS treatment showed significantly better prognosis and better functioning in activities of daily living in both subacute and chronic stages. The rate of shrinkage of the ischemic lesion was higher in the treatment group, though not significant. The early and effective treatment of OSAS provides a better clinical prognosis in ischemic stroke. The beneficial effects on radiological parameters need to be further studied.

Noninvasive mechanical ventilation in severe pneumonia due to H1N1 virus

ObjectiveThe use of noninvasive mechanical ventilation was evaluated in our series of patients admitted to our ICU with pneumonia due to influenza A virus H1N1, assessing the need for intubation, arterial blood gases and clinical improvement, the development of complications and ICU and hospital stay. DesignRetrospective and observational study. SettingICU of Castellón University General Hospital (Castellón, Spain). PopulationPatients admitted to ICU with pneumonia due to influenza A virus H1N1 and acute hypoxemic respiratory failure. InterventionsBoussignac CPAP, Helmet system and BiPAP Vision® were used. ResultsFive of 10 patients with pneumonia and hypoxemia were analyzed, showing 100% effectiveness of noninvasive mechanical ventilation in terms of clinical and arterial blood gas improvement, and avoiding intubation in all cases. There were no patient deaths in ICU or in hospital. The duration (median) of ventilation was 6 (4–11) days, with an ICU stay of 9 (7–11) days. The number of complications was low (except for urinary tract infection due to Pseudomonas aeruginosa), and only the noise produced by CPAP was underscored. There were no infections among the staff. ConclusionsBased on our results, increased use of noninvasive mechanical ventilation in future epidemics could be proposed.

Utilización de la ventilación mecánica no invasiva en neumonía grave por virus H1N1

Objective The use of noninvasive mechanical ventilation was evaluated in our series of patients admitted to our ICU with pneumonia due to influenza A virus H1N1, assessing the need for intubation, arterial blood gases and clinical improvement, the development of complications and ICU and hospital stay. Design Retrospective and observational study. Setting ICU of Castellón University General Hospital (Castellón, Spain). Population Patients admitted to ICU with pneumonia due to influenza A virus H1N1 and acute hypoxemic respiratory failure. Interventions Boussignac CPAP, Helmet system and BiPAP Vision ® were used. Results Five of 10 patients with pneumonia and hypoxemia were analyzed, showing 100% effectiveness of noninvasive mechanical ventilation in terms of clinical and arterial blood gas improvement, and avoiding intubation in all cases. There were no patient deaths in ICU or in hospital. The duration (median) of ventilation was 6 (4-11) days, with an ICU stay of 9 (7-11) days. The number of complications was low (except for urinary tract infection due to Pseudomonas aeruginosa), and only the noise produced by CPAP was underscored. There were no infections among the staff. Conclusions Based on our results, increased use of noninvasive mechanical ventilation in future epidemics coujld be proposed.

Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial

older patients usually receive less invasive and costly hospital care, even if they meet the criteria for Intensive Care Unit admission or have a 'do not intubate'(DNI) order. The aim of this randomised, controlled trial was to assess the effectiveness of non-invasive mechanical ventilation (NIV) versus the standard medical therapy (SMT) in reducing the need of intubation, improving survival and reducing respiratory distress in very old patients with acute hypercapnic respiratory failure (AHRF). eighty-two patients aged >75 years (mean age 81.3 ± 3.5 years) were randomised to receive NIV or SMT. three respiratory units. the primary outcome was the rate of meeting the endotracheal intubation (ETI) criteria. Secondary outcomes were the mortality rate, the respiratory rate, dyspnoea score, arterial blood gases. the rate of meeting the ETI criteria was lower in the NIV group compared with the SMT group (7.3 versus 63.4%, respectively; P < 0.001), as was the mortality rate [(odds ratios) OR = 0.40; 95% CI: 0.19-0.83; P = 0.014]. Twenty-two of 41 SMT patients with DNI orders received NIV as a rescue therapy. The mortality rate in this subgroup was comparable with the NIV group and significantly lower compared with patients receiving ETI (OR = 0.60, 95% CI: 0.18-1.92 versus 4.03, 95% CI: 2.35-6.94, respectively; P = 0.009). Arterial blood gases, respiratory rate and dyspnoea improved significantly faster with NIV than with SMT. compared with SMT, NIV decreased the rate of meeting the ETI criteria and the mortality rate of very old patients with AHRF. NIV should be offered as an alternative to patients considered poor candidates for intubation and those with a DNI order.

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.