Mask Ventilation In Patients Research Articles

Sedation and Non-Invasive Mask Ventilation in Patients with Delirium and Acute Respiratory Failure

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality.

The Predictive Values of Anatomical Parameters for Difficult Mask Ventilation in Patients who Underwent Elective Surgeries in Wolaita Sodo Town Hospitals, 2017

Background: Mask ventilation is the primary technique of ventilation before insertion of any airway device. Difficulties in mask ventilation have been associated with serious complications, such as death or hypoxic brain damage. If the anesthetist can predict which patients are likely to prove difficult to ventilate, he/she may reduce the risks of anesthesia considerably. The study was aimed to assess the incidence of and predictive values of anatomical parameters for difficult mask ventilation among patients who underwent elective surgeries at Wolaita Sodo University teaching and referral Hospital and Sodo Christian Hospital. Methods: Institutional based cross sectional study was conducted from July 1 to August 30, 2017 in two hospitals of wolaita zone. The study was conducted on 278 patients of which 101 (36.3%) were males and 177 (63.7%) were females. Patient demographics, incidence and predictive values of anatomical parameters for difficult mask ventilation were studied among elective patients who took general anesthesia. Result: The incidence of difficult mask ventilation (grade III) was 2.2%; whereas, impossible mask ventilation (grade IV) was 0.4%. Highest percent of difficult mask ventilation (grade III) was occurred in patients with obstructive sleep apnea, BMI?26 kg/m2 and Mandibular Protrusion Class C. Conclusion: Modified Mallampatti class III and IV and Mandibular protrusion class B and C are highly accurate parameters with high specificity, negative predictive value and positive predictive value to predict difficult mask ventilation.

Long-term Efficiency of Home Nasal Mask Ventilation in Patients With Diffuse Bronchiectasis and Severe Chronic Respiratory Failure: A Case-Control Study

The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Karnofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2 evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.

Noninvasive Face Mask Ventilation in Patients with Acute Respiratory Failure

Noninvasive face mask ventilation has been used successfully in patients with paralytic respiratory failure. This study evaluated whether noninvasive face mask ventilation can be used for patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia and four with hypoxemic acute respiratory failure met clinical and objective criteria for mechanical ventilation, which was delivered with pressure control and pressure support via a tightly strapped, clear face mask. No patient terminated the study because of inability to deliver adequate ventilation or to improve oxygen exchange; three eventually required endotracheal intubation. The mask was generally well tolerated. All patients had a nasogastric tube placed on suction, and none vomited or aspirated. The mean duration of treatment was 33 h (range, 3 to 88). The physiologic response was considered similar to that which would have been achieved with conventionally delivered ventilation. Noninvasive face mask ventilation may have a role in managing respiratory failure.