Experience Of Non-invasive Ventilation Research Articles

NIV@Home: a pilot randomized controlled trial of in-home noninvasive ventilation initiation compared to a single-day admission model.

Objective: Noninvasive ventilation (NIV) is the primary treatment for respiratory insufficiency in neuromuscular disease. NIV implementation is usually conducted within hospitals; however, in-home implementation with intensive follow-up is an effective alternative. This pilot study aimed to assess model feasibility, acceptability, and NIV usage at 12-weeks after a single visit in-home implementation of NIV with remote monitoring follow-up (NIV@Home) compared to an in-hospital day admission NIV initiation plus planned polysomnography (Usual care). Methods: A single-blinded randomized controlled trial (www.anzctr.org.au ACTRN12620000682943) of adults with neuromuscular disease referred for NIV implementation. Participants were stratified by disease (MND or Other diagnoses) and bulbar symptoms before randomization to NIV@Home or Usual care, with follow-up at 12-weeks. The primary outcome was NIV usage. Secondary outcomes included feasibility, health-related quality of life, symptoms, carer burden, and NIV experience (semi-structured qualitative interviews). Results: Twenty-three participants (MND bulbar = 9, MND non-bulbar = 11, Other = 3) were randomized (NIV@Home = 9). No statistical differences were observed in the percentage of MND participants using NIV for >4 hours/day (NIV@Home = 33% vs. Usual care = 60%, p=0.370), average use (NIV@Home = 2.4 [1.5-9.3] vs. 5.3 [1.8-7.0] hours/day, p=0.568), or secondary outcomes. In-home NIV implementation was feasible and safe but took more therapist time (NIV@Home = 278 [270-305] vs. 172 [130-200] minutes, p<0.001). Participants in the NIV@Home group reported substantial advantages to receiving care in home. Conclusion: In-home NIV implementation is feasible and acceptable to people with MND but requires more therapist time. Larger studies are required to determine whether there are clinically important differences between this model of NIV initiation and a traditional hospital-based model.

Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy

Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy

Differences in training among prehospital emergency physicians in Germany.

BackgroundGermany has an interdisciplinary physician-based emergency medical service. Differences in training likely lead to different levels of expertise.ObjectivesWe assessed the number of manual procedures performed at the completion of training to determine level of experience of prehospital emergency physicians of different primary specialties.Materials and methodsImmediately after passing the board examination each examinee was asked to estimate the number of performed procedures for 26 manual skills. We compared the results with recommendations and data on learning manual skills. Results are presented as mean (standard deviation).ResultsEndotracheal intubation via direct laryngoscopy was performed 1032 (739) times by anesthesiologists. Surgeons and internists performed 89 (89) and 77 (65) intubations, respectively. Intubation via video laryngoscopy was performed 79 (81) times by anesthesiologists, 11 (17) times by surgeons and 6 (11) times by internists. Surgeons had little experience in non-invasive ventilation, with 9 (19) performed procedures and had rarely used external pacemaker therapy or electrical cardioversion. In comparison, among all participants non-invasive ventilation was performed 152 (197) times, electrical cardioversion was performed 41 (103) times and an external pacemaker was used 6 (15) times. For other procedures the numbers did not markedly differ between the different specialties.ConclusionThe number of performed procedures markedly differed for some skills between different primary specialties. Recommendations regarding a procedural volume were not always met, suggesting missing expertise for some skills. A defined number of procedures should therefore be a formal requirement to be eligible for board certification in prehospital emergency medicine.

Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis

BackgroundDescriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe...

Promoting NIV using ICEMAN methodology

One of the main reasons for children needing hospital admission is the need for respiratory support and monitoring. Intubation and ventilation has been the standard method of supporting patients in respiratory failure. With better ventilators and interfaces many of these children with respiratory failure could benefit from non-invasive ventilation (NIV). The main advantages of NIV over its invasive counterpart are reduced need for sedation, avoiding laryngeal and tracheal injuries, reducing nosocomial infections, and shorter length of stay.1,2 NIV can be used for acute conditions. Studies have shown that NIV is more successful in type 2 respiratory failure compared to type 1 respiratory failure as in type 2 respiratory failure, a failing pump is replaced by another pump i.e., NIV machine.3,4 With improvement in technology NIV has emerged as a core therapy in the management of patients with acute and chronic respiratory failure. Use of NIV has not spread worldwide. Even in the countries where they are being used, there is huge variability in the use of NIV. This reluctance in usage could be partly explained by the lack of adequate scientific literature in children concerning this technology.The first thing to do to overcome this barrier is to create an understanding and familiarity of this technology, resulting in more usage of NIV which has been shown to improve the quality of care and reduce cost of healthcare.A FAST-NIVT (Forwarding Advanced Simulation Training in Noninvasive Ventilation Therapy) project supported by the Respiratory group of ESPNIC (European Society of Pediatric and Neonatal Intensive Care) has developed blended courses (online and face to face) for attendees and for NIV trainers in order to promote the teaching and learning of NIV around the world.As an extension of this project we have developed a structured algorithm with the acronym ICEMAN (Figure 1) and used it to train our clinicians in the judicious selection of patients, contraindications and equipment used for NIV.2 This approach helps the teams to recognize failure of non-invasive ventilation, troubleshoot hypercapnia and hypoxemia, manage asynchrony and plan for weaning or escalation of care using algorithms.We have conducted workshops globally to provide clinicians with best practice recommendations and guidance about how to best deliver non-invasive ventilation to patients who sometimes need this lifesaving technology. By attending this workshop, delegates would be able to understand the various indications, NIV options, modes of delivery, effective monitoring, and analysing failures which will definitely go a long way in providing this care more effectively with less failure.All the workshops are led by trained educators who are experienced practicing paediatric intensivists, neonatologists, and pulmonologists with an extensive NIV experience. To make learning fun and to encourage participation, high-quality learning materials and skill stations have been tailored to the needs of each group. This methodology has been successfully used to train the next generation of clinical champions.

Respiratory morbidity in children with cerebral palsy: an overview

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

New non invasive ventilator strategy applied to COPD patients in acute ventilator failure

IntroductionThere is no evidence in the literature regarding the combined use of positive ventilation with negative ventilation. A recent study reported that the two techniques can be combined in patients with ARDS, who undergo ventilatory support for severe acute respiratory failure (ARF). There is experience of non-invasive ventilation in patients with chronic respiratory diseases and ARF.The aim of this study was to test the efficacy of a non-invasive ventilatory strategy based on the combined use of negative (N) and positive ventilation (P) in bi-level mode (PN). MethodsWe enrolled 8 patients with severe COPD exacerbations and exacerbated chronic respiratory failure admitted in a monitored setting of an intermediate-intensive respiratory Unit. ResultsPatients underwent combined positive/negative ventilation and at different times, in place of the two singular ventilation modes (P and N).After each cycle, in the combined P/N ventilatory mode, gas exchanges were significantly increased compared to the two singular P/N mode: pH (7.42 vs 7.40 and 7.40); PCO2 (85.01 vs 72.05 and 66.81 mmHg); FiO2/PO2 (488.75 vs 352.62 and 327.87).All patients well tolerated the application of the double ventilation mode. ConclusionsIn conclusion, the use of dual mode ventilation appears well tolerated and superior to the individual modes in patients with COPD exacerbations and ARF.

Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence.

Noninvasive ventilation (NIV) has been shown to be beneficial for patients with respiratory failure; however, many patients fail to tolerate it and require other interventions. The objective of this thematic synthesis was to describe the nature of NIV experiences in adults with hypercapnic respiratory failure. A systematic, computerised literature search of English-language databases was undertaken with no restriction on date of publication. A total of 99 papers was identified and screened for eligibility from databases including CINAHL, Medline and PsycINFO, and some were hand searched. 45 papers were critically appraised and 32 met our inclusion criteria. Thematic analysis identified six key themes: benefits of NIV; fear (of various categories, namely, fear of technology/mask, fear of death and dying, and fear of pain and suffering); adaptation to NIV machine; decision making; need for information; and relationship with healthcare professionals. For people using NIV treatment, the experience of being on the NIV machine is unexpected and can be stressful. Findings from this review offer healthcare professionals insights and understanding into the patient experience of NIV. Healthcare professionals may use these findings to implement new strategies in NIV provision and the exploration of the applicability of age-specific supportive care NIV guidelines.

Music-assisted relaxation during transition to non-invasive ventilation in people with motor neuron disease: A qualitative case series

For individuals with motor neuron disease, the transition to using non-invasive ventilation has a number of associated stressors, which can negatively impact adherence to ventilation and its benefits to quality of life. Music listening interventions have been linked with a reduction in anxiety and physiological stress responses in mechanically ventilated patients. This article presents four case studies from a feasibility study that investigated the experience and effect of a music-assisted relaxation intervention on anxiety, quality of life, and non-invasive ventilation use during the first 3 months of using non-invasive ventilation. The experiences of these four participants demonstrated how music-assisted relaxation served to distract from non-invasive ventilation and promote relaxation, indicating that for some, music-assisted relaxation could be a useful strategy to optimize their non-invasive ventilation experience. Early music therapy intervention in motor neuron disease progression could be beneficial to address obstacles faced by one participant in using music-assisted relaxation.

What can we learn from patients to improve their non-invasive ventilation experience? ‘It was unpleasant; if I was offered it again, I would do what I was told’

ObjectivesNon-invasive ventilation (NIV) is widely used as a lifesaving treatment in acute exacerbations of chronic obstructive pulmonary disease; however, little is known about the patients' experience of this treatment. This...

Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease

Noninvasive ventilation (NIV) is a common practice in acute hypercapnic respiratory failure (AHRF) because of exacerbation of chronic obstructive pulmonary disease (COPD). However, a recent study has shown that patients who require invasive mechanical ventilation (IMV) after failure of NIV experience high mortality rates (up to 30%). Therefore, the aim of this study is to determine the parameters, specifically for emergency department (ED) presentation, associated with the transition from NIV to IMV because of NIV failure. This is a 4-year retrospective cohort study in the EDs of two Dutch hospitals. International Classification of Disease codes were used to identify 139 COPD patients treated with NIV. Those with AHRF (pH limits: 7.25-7.35), a full resuscitation order, and those without a pneumonia were selected for the study (n=40 with 50 NIV episodes). Parameters in patients treated successfully with NIV were compared with those in patients requiring transition to IMV due to NIV failure. Univariable regression analysis was used and, if P-value less than 0.20, analyses were entered into a multivariable logistic regression analysis model. NIV was successful in 33 (66%) patients, 10 (20%) required transition to IMV, and seven (14%) died. Age over 65 years and a Glasgow Coma Score less than 15 were associated significantly with the transition from NIV to IMV in multivariable analysis (P<0.05). Older age and a low Glasgow Coma Score at ED presentation are factors associated with the transition from NIV to IMV in COPD patients with AHRF.

Experience of long-term use of non-invasive ventilation in motor neuron disease: an interpretative phenomenological analysis

ObjectiveAlthough non-invasive ventilation (NIV) can promote quality of life in motor neuron disease (MND), previous studies have disregarded the impact of progression of illness. This study explored how patients’ perceptions...

Bronchoscopic Lung Biopsy Using Noninvasive Ventilatory Support: Case Series and Review of Literature of NIV-Assisted Bronchoscopy

Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. To report the efficacy and safety of an innovative technique of NIV-assisted bronchoscopic lung biopsy in a small case-series of hypoxemic subjects with diffuse parenchymal infiltrates; also to systematically review the literature on NIV-assisted bronchoscopy. Subjects with bilateral diffuse parenchymal infiltrates and P(aO(2))/F(IO(2)) < 200 mm Hg underwent bronchoscopic lung biopsy under NIV support. NIV was initiated 10 min before the procedure and continued for 30 min after the procedure. The primary outcomes were performance of successful procedure and episodes of decline in S(pO(2)) < 90%. Secondary end points were the change in the respiratory and hemodynamic parameters during the procedure and occurrence of complications such as pneumothorax, hemorrhage, and endotracheal intubation. Six subjects, with a mean ± SD age of 44.5 ± 11.6 years, were included in the study. The median (interquartile range [IQR]) P(aO(2))/F(IO(2)) prior to lung biopsy was 164.5 mm Hg (146.3-176.3 mm Hg), and the median (IQR) inspiratory and expiratory positive airway pressures were 14 cm H(2)O (12-15 cm H(2)O) and 5 cm H(2)O. Fiberoptic bronchoscopy was well tolerated and all subjects maintained S(pO(2)) > 92% during the procedure. One subject required endotracheal intubation due to hemoptysis. A definite diagnosis was obtained in 5 of the 6 subjects. A repeat procedure was performed in one subject, which again yielded no diagnosis. No other periprocedural complications were encountered. NIV-assisted bronchoscopic lung biopsy is a novel method for obtaining diagnosis in hypoxemic patients with diffuse lung infiltrates. However, this approach should be reserved for centers with extensive experience in NIV. More studies are required to define the utility of this approach.

Notre expérience de ventilation non invasive chez l’enfant polyhandicapé

Non-invasive ventilation is still limited in children with total body involment or cerebral palsy. The aim of this study is to show our new experience in non-invasive ventilation. Six patients in the pediatric department of San-Salvadour hospital, with respiratory insufficiency and restrictive syndrome received non-invasive ventilation in order to improve their clinical status, their quality of life, and to delay acute respiratory failure and tracheotomy.

Postoperative Noninvasive Ventilation

Thesemodificationsoftherespiratoryfunctionoccur early after surgery and are more often transient andcould lead to ARF. The clinical result (severity of theARF) is the product of perioperative-related ventilatoryimpairment and severity of the preoperative pulmonarycondition. Maintenance of adequate oxygenation in thepostoperative period is of major importance, especiallywhen pulmonary complications such as ARF occur. Al-though invasive endotracheal mechanical ventilation hasremained the cornerstone of ventilatory strategy for manyyearsforsevereARF,severalstudieshaveshownthatmor-tality associated with pulmonary disease is largely relatedto complications of postoperative reintubation and me-chanicalventilation.Therefore,majorobjectivesforanes-thesiologists are first to prevent the occurrence of postop-erative complications and second to ensure oxygenadministration and carbon dioxide removal while avoid-ing intubation if ARF occurs. Noninvasive ventilation(NIV) does not require an artificial airway (endotrachealtube or tracheotomy), and its use is well established toprevent ARF occurrence (prophylactic treatment) or totreat ARF to avoid reintubation (curative treatment) (fig.1). Studies show that patient-related risk factors, such aschronic obstructive pulmonary disease, age older than 60yr, American Society of Anesthesiologists class of II orhigher, obesity, functional dependence, and congestiveheart failure, increase the risk for postoperative pulmo-nary complications.

Utilización de la ventilación no invasiva en la insuficiencia respiratoria aguda. Estudio multicéntrico en unidades de cuidados intensivos

Study the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in intensive care units (ICUs) in Spain. A questionnaire was sent to 254 ICUs, after which, they were invited to participate in a multicenter, retrospective study, providing detailed information on ventilated patients. Answers were received from 123 hospitals. Of these, 119 used NIV, although its use varied greatly. NIV is the treatment of choice in 89% of the units for chronic obstructive pulmonary disease (COPD), in 79% for acute pulmonary edema (APE), in 53% for postextubation failure, in 53% for pneumonia 53%, and in 17% for acute respiratory distress syndrome (ARDS). It was used occasionally in COPD in 11% of the units, and in 21% of the units for APE. Eighteen hospitals provided additional information on 432 ventilated patients, 232 (54%) of whom received NIV as first line therapy. Presence of pneumonia or acute respiratory distress syndrome (ARDS) was an independent predictive factor of NIV failure (ORa=5.71; CI 95%, 1.83-17.8; p=0.003). Admission in a unit with experience in NIV in >50 patients/year (ORa=0.22; CI 95%, 0.07-0.63; p=0.005) and a higher PaO2/FiO2 ratio after one hour of ventilation (ORa=0.98 per point; CI 95%, 0.97-0.99; p<0.001) were protector factors. In Spain, NIV is widely used but it may continue to be underused in COPD and APE. The diagnosis of pneumonia or ARDS was an independent predictive risk factor. Admission in an ICU with NIV in more than 50 patients/year also have higher PaO2/FiO2 ratio after one hour of ventilation were predictive factors of success.

Ventilación no invasiva en insuficiencia respiratoria aguda

Background: Non-invasive ventilation (NIV) has become a therapeutic tool for acute respiratory failure in pediatric patients. Objective: To describe NIV experience at a Pediatric Intensive Care Unit, identifying factors associated to modality failure. Methods: Patients cohort who received NIV in acute respiratory failure during 2005-2007. Recolection of clinical and gasometrical variables previous and subsequent to connection to NIV. Descriptive statistic and logistic regression analysis were performed. Results: 51 events of NIV, where 55%) cases were congenital cardiopathies. NIV main indication was respiratory distress post-extubation (31.4%). 15 patients (29.4%) required CMV. In univariate logistic regression for variables, an independent association was found between Fi02 pre-connection and Fi02 subsequent to NIV connection, with necessity of CMV. 9%> presented complications and mortality was not related to ventilatory modality. Conclusions: NIV is useful in pediatric patients with acute respiratory insufficiency, with low risk of complications. The variables associated with failure are easy to obtain and interpretate.

Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis

To report our experience of non-invasive ventilation (NIV) as primary ventilatory support strategy in infants admitted for severe bronchiolitis. Retrospective study in a paediatric intensive care unit of an university hospital. Infants aged less than 12 months, admitted for bronchiolitis during 2003-2004 and 2004-2005 winter epidemics. NIV was used as the primary ventilatory support during the second winter (NIV period), whereas invasive ventilation (IV) was the only support employed during the first winter (IV period). NIV consisted in either continuous positive airway pressure (CPAP from 5 to 10 cmH(2)O) or bilevel positive airway pressure (inspiratory pressure from 12 to 18 cmH(2)O) with a nasal mask. During the IV period, 53 infants were included, compared to 27 during the NIV period. The two groups did not differ in age or in number of premature births. Children in NIV group had less apnoea on admission. The intubation rate was reduced during NIV period (p < 0.001). No children had ventilator-associated pneumonia (VAP) during NIV period compared to nine during IV period (p < 0.05). In the NIV group, 10 infants (37%) required supplemental oxygen for more than 8 days compared to 33 children (65%) in IV group (p < 0.05). The length of hospital stay and the duration of ventilation were similar. In this retrospective study, the use of NIV decreased the rate of ventilator associated pneumonia and reduced the duration of oxygen requirement without prolonging the hospital stay.

Non-Invasive Ventilation: The Impact of a Home Health Support

Non-invasive ventilation seems to have gained in popularity in the past few years for pediatric patients with a variety of disease processes. Although it is infrequently used for acute respiratory failure, it is becoming a popular choice for ventilation assistance in a variety of chronic disease processes and not just limited to asthma, cystic fibrosis and other neurological disorders that impair breathing. As the medical team acquires more experience in non-invasive ventilation, a new frontier in the home setting is now being explored.

The role of noninvasive ventilation in cancer patients with acute respiratory failure

The poor prognosis of ventilated patients with cancers, especially hematological malignancies, has been a major incentive in the use non-invasive ventilation in such patients. With experience of more than a decade, a few recommendations can be made. While experience in non invasive ventilation is of prime importance, it is the early use especially in conditions requiring supplemental oxygen and a drop in SaO 2 of > 10% that the most benefit is expected. Use of the helmet to provide noninvasive ventilation (NIV) may improve patient compliance. With appropriate use during diagnostic bronchoscopy, NIV may prevent endotracheal intubation. NIV has also been shown to provide relief from dyspnoea to a select group of do-not-intubate patients. While outcome in this group of patients is poor, appropriate use of NIV has been shown to reduce mortality. The coming years and more experience will improve our understanding and refine the use of this modality in this critical condition.