Feasibility Of Continuous Positive Airway Pressure Research Articles

Feasibility of non-invasive mechanical ventilation during percutaneous coronary intervention in patients with myocardial infarction and acute decompensated heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive ventilation (NIV) is an established treatment for acute decompensated heart failure (ADHF). Purpose The aim of the present analysis was to evaluate the feasibility of continuous positive airway pressure (CPAP) in patients with myocardial infarction (MI) and ADHF, during percutaneous coronary intervention (PCI). Methods Consecutive patients admitted for MI, receiving CPAP for ADHF in the cath lab during PCI were retrospectively included. The main study outcome was the feasibility of CPAP, intended as well tolerated by the patient and exclusive cardiology staff management. Results Between December 2018 and October 2020, 15 patients were included; median age was 79 (40-87 IQR) years, 8 (53%) were males, 9 (60%) presented with STEMI and 10 (67%) in cardiogenic shock. At admission median ejection fraction was 35 (20-60 IQR) % and 6 (40%) patients had severe mitral regurgitation. Mean PaO2/ FiO2 was 188.1 ± 74.9 mmHg/%, mean lactate level was 2.6 ± 1.5 mmol/L and NTproBNP 7882 (3139-35000 IQR) ng/L. The CPAP was set with a median FiO2 of 50 (35-80 IQR) % with a PEEP of 7.5 (5-10 IQR) mmHg. CPAP was feasible in 14 (93%) patients, as in only one case it was interrupted for patient’s intolerance. CPAP was always managed by nurses of the cath lab, without the support of anesthetist. One patient suffered cardiac arrest that led to CPAP interruption for resuscitation maneuvers. No patients underwent intubation in the cath lab. Post-procedural PaO2/FiO2 ratio substantially improved to 259.4 ± 96.9 mmHg/% (p = 0.03) and lactate decreased to 1.5 ± 0.5 mmol/L (p = 0.01, 42% median reduction). One patient died in-hospital due to underlying disease, unrelated to study procedure. Conclusion CPAP during PCI in patients with MI and ADHF was feasible, well tolerated and easily manageable. Larger studies are warranted to confirm these results.

Feasibility of Continuous Positive Airway Pressure by Primary Care Paramedics

Introduction. Continuous positive airway pressure (CPAP) has been used effectively in the prehospital environment for a wide range of respiratory emergencies. The feasibility of CPAP when used by primary care paramedics (PCPs) has not been established. Objective. We sought to study the feasibility of prehospital CPAP when used by paramedics trained to the primary care paramedic (PCP) level compared with those trained to the advanced care paramedic (ACP) level. Our hypothesis was that the feasibility of CPAP use by paramedics trained to the PCP level is similar to that of paramedics trained to the ACP level. Methods. We conducted an observational study of 302 consecutive cases of CPAP use over one year beginning June 25, 2009. We defined compliant use as 100% adherence to the provincial CPAP medical directive. The criteria for compliance included specifics of patient presentation, vital signs, and appropriate documentation by the paramedic, as well as proper use, titration, and discontinuation of CPAP equipment according to protocol. Data were abstracted from ambulance call reports. Results. Using the criteria set out for compliant CPAP use, the highest level of compliance among the ACPs and the PCPs was 98.6% and 98.9%, respectively, for documenting indication for CPAP use. The lowest level of compliance among the ACPs was 84.4% for titration of CPAP during treatment, and the lowest level of compliance among the PCPs was 90% for adherence to criteria for CPAP application according to patients’ vital signs. Overall, the criteria for compliant use of CPAP were met for 76.8% (232/302) of the call reports examined. The rate of compliant use of CPAP was 75.9% (161/212) for ACP calls and 78.9% (71/90) for PCP calls. The difference between rates of compliant use for ACP calls versus PCP calls was not statistically significant (χ2 [1 df] = 0.31, p = 0.66). Conclusions. This study found no significant difference in the compliant use of prehospital CPAP between paramedics trained to the PCP level and those trained to the ACP level. This study suggests that CPAP use by PCP-level paramedics may be feasible. Further study is required to determine whether compliance translates to safe use of prehospital CPAP by PCP-level paramedics.

Continuous positive airway pressure with modified helmet for treatment of hypoxemic acute respiratory failure in infants and a preschool population: A feasibility study*

To analyze the feasibility of using continuous positive airway pressure (CPAP) delivered via a modified helmet to treat children with hypoxemic acute respiratory failure. A single-center, prospective, clinical study. Pediatric intensive care unit in a university hospital. Fifteen consecutive children (from 1 month to 5 yrs of age) with hypoxemic acute respiratory failure (defined as Pao2/Fio2 <300). CPAP was delivered via a modified helmet (CaStar, Starmed, Italy) of reduced size, fastened by a device we call a "baby-body." The feasibility of CPAP with the helmet was the primary end point. The improvement of gas exchange was the secondary one. Ten of 15 children had multiple organ failure. Nine of 15 children were </=1 yr old. The helmet was well tolerated by all the children. Additional sedation was provided to four patients. No children developed significant complications (skin lesion, gastric distension, conjunctivitis, epistaxis, or loss of invasive devices) or lethal, helmet-related events. Oxygenation improved above baseline after 2 hrs of CPAP with the helmet; no significant variation of hemodynamic variables was detected. The helmet is a suitable device for delivery of CPAP to infants and preschool children with hypoxemic acute respiratory failure. It was well tolerated and improved oxygenation.