NIV In Acute Respiratory Failure Research Articles

To study indication’s outcomes and complications of non-invasive ventilation in acute respiratory failure

Failure of respiratory system in one or both of its gas-exchanging functions- oxygenation of pulmonary arterial blood and carbon-dioxide elimination from mixed venous blood. Non-Invasive Ventilation is an alternative to invasive ventilation in many conditions it is a valuable component in patient management. Its use in acute respiratory failure is widely accepted and well known. To Study the indications, outcomes, and complications of NIV. This is a prospective observational study conducted on 100 patients admitted with either Type-I or Type -II respiratory failure. Various common indications for use of NIV in acute Respiratory Failure are COPD, ILD, Bronchiectasis, Pneumonia, Pulmonary Thromboembolism, Kyphoscoliosis, and Pulmonary Tuberculosis in that order. The overall success rate of NIV is 84%. NIV helps in improving gas exchange in acute respiratory failure irrespective of its type, reduces intubation and length of hospital stay hence, its use as the first modality of treatment in patients without overt contraindications is recommended. Overall, NIV is safe and effective in patients with acute respiratory failure as there are no major complications associated with its use.

TO STUDY PARAMETERS CO-RELATING OUTCOME OF NON-INVASIVE VENTILATION IN ACUTE RESPIRATORY FAILURE

Background: Respiratory failure is a condition in which the respiratory system fails in one or both of its gas-exchanging functions- oxygenation of pulmonary arterial blood and carbon dioxide elimination from mixed venous blood. NIV is used as a replacement for invasive ventilation in a few conditions, and its exibility also allows it to be a valuable component in patient management. Its use in acute respiratory failure is well accepted and widespread. AIM: This study was conducted to study various parameters such as baseline PCO2 levels, pH, PO2 levels, Heart rate, respiratory rate, and their correlation with the outcome of Non-invasive Ventilation. This is a prospective observational studyMethods: conducted on 100 patients admitted with either Type-I or Type -II respiratory failure. Results: Respiratory rate <30, Heart rate <130, PCO2 45-70 are associated with good outcomes of Non-invasive ventilation. Type of respiratory failure, sputum aerobic culture are not predictors of NIV outcomes. NIV in acute respiratory failure, irrespective of the type of respiratoryConclusion: failure helps in improving gas exchange, reduces intubation and length of hospital stay hence, its use as the rst modality of treatment in patients without overt contraindications is recommended. Overall, NIV is safe and effective in patients with acute respiratory failure as there are no major complications associated with its use.

NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection

ABSTRACTIntroduction: Hospital mortality among chronic obstructive pulmonary disease (COPD) patients receiving NIV for acute respiratory failure has shown to be significantly higher in clinical settings than in the randomized trials (RCTs) which clinical guidelines are based on. This may be due to the quality of care of NIV or patient selection. In daily clinical practice, we include patients with terminal pulmonary disease with a do-not-intubate (DNI) or a do-not-resuscitate (DNR) order with a high mortality risk compared to highly selected patients in RCTs. The aim of this study was to determine the role of patient selection for in-hospital mortality among patients receiving NIV for acute respiratory failure of COPD.Methods: We conducted a retrospective study including all patients receiving acute NIV due to acute respiratory failure at the respiratory wards in 2012–2013 at two hospitals in Greater Copenhagen.Results: Overall in-hospital mortality rate was 30%. In patients with a DNI/DNR order, mortality was 59% and in patients with no limitations in treatment 2%. Patients who fulfilled the exclusion criteria of the RCT by Plant et al. had a mortality of 41% compared to 25% in the remaining population.Conclusions: High overall in-hospital mortality reflects that patient selection in clinical practice is very different from RCT. Quality of acute NIV treatment seems acceptable in clinical practice for patients with less severe COPD and no limitations in treatment. Higher mortality in patients with DNI/DNR order may be due to inefficient NIV treatment for these patients with more severe COPD.

Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study

Background and objectiveNon-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. MethodsProspective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. ResultsAmong the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37] vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. ConclusionsOutside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.

Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

BackgroundNoninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required.MethodsA retrospective cohort study was carried out in an academic pediatric intensive care unit (PICU). Dexmedetomidine (DEX) was infused as unique sedative in 40 consecutive pediatric patients (median age 16 months) previously showing intolerance and agitation during NIV application.ResultsDuring NIV clinical application both COMFORT-B Score and Richmond Agitation-Sedation Scale (RASS) were serially evaluated. Four patients experiencing NIV failure, all due to pulmonary condition worsening, required intubation and invasive ventilation. 36 patients were successfully weaned from NIV under DEX sedation and discharged from PICU. All patients survived until home discharge.ConclusionOur data suggest that DEX may represent an effective sedative agent in infants and children showing agitation during NIV. Early use of DEX in infants/children receiving NIV for acute respiratory failure (ARF) should be considered safe and capable of improving NIV, thus permitting both lung recruitment and patient-ventilator synchronization.

Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis

PurposeWe systematically reviewed the effects of NIV for acute respiratory failure (ARF) in low- and low-middle income countries. Materials and methodsWe searched MEDLINE, CENTRAL, and EMBASE (to January 2016) for observational studies and trials of NIV for ARF or in the peri-extubation period in adults and post-neonatal children. We abstracted outcomes data and assessed quality. Meta-analyses used random-effect models. ResultsFifty-four studies (ten pediatric/n=1099; 44 adult/n=2904), mostly South Asian, were included. Common diagnoses were pneumonia and chronic obstructive pulmonary disease (COPD). Considering observational studies and the NIV arm of trials, NIV was associated with moderate risks of mortality (pooled risk 9.5%, 95% confidence interval (CI) 4.6–14.5% in children; 16.2% [11.2–21.2%] in adults); NIV failure (10.5% [4.6–16.5%] in children; 28.5% [22.4–34.6%] in adults); and intubation (5.3% [0.8–9.7%] in children; 28.8% [21.9–35.8%] in adults). The risk of mortality was greater (p=0.035) in adults with hypoxemic (25.7% [15.2–36.1%]) vs. hypercapneic (12.8% [7.0–18.6%]) ARF. NIV reduced mortality in COPD (relative risk [RR] 0.47 [0.27–0.79]) and in patients weaning from ventilation (RR 0.48 [0.28–0.80]). The pooled pneumothorax risk was 2.4% (0.8–3.9%) in children and 5.2% (1.0–9.4%) in adults. Meta-analyses had high heterogeneity. ConclusionsNIV for ARF in these settings appears to be effective.

Epidemiology of noninvasive mechanical ventilation in acute respiratory failure - a retrospective population-based study

BackgroundNoninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study.MethodsWe conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (≥18 years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded.ResultsOut of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60–84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment.ConclusionsOur results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment.

Noninvasive positive-pressure ventilation in acute respiratory distress syndrome: preliminary results

The NIV in acute respiratory failure of a previously healthy lung is not much widespread but much discussed. We report the first data about four patients, who have been accepted in our ICU due to acute respiratory failure post-trauma and treated with ventilatory support via face mask like NIV. All patients were negative to pre-existing lung disease and got thoracic trauma with multiple costal fractures and bony fractures. We used the mechanical ventilator Adult Star (Infrasonic, Inc., San Diego USA). All the patients were co-operating and without neurological deficiency. The NIV has been applied for 2 days and alternated with spontaneous ventilation through Venturi mask after 24 h.