Noninvasive Positive Airway Pressure Research Articles

Effect of High-Flow Nasal Oxygen on Pulmonary Complications and Outcomes After Adult Cardiothoracic Surgery: A Qualitative Review.

IGH-FLOW NASAL OXYGEN (HFNO) therapy delivers low-level, flow-dependent positive airway pressure and may be tolerated better than continuous positive airway pressure (CPAP) or noninvasive bi-level positive airway pressure (BiPAP) and enhance washout of nasopharyngeal deadspace, thus improving oxygenation. 1,2 The apparatus is composed of an air/oxygen blender, an active heated humidifier, a single heated circuit, and a nasal cannula. At the air/ oxygen blender, the inspiratory fraction of oxygen (FIO2) is set from 0.21 to 1.0 at a flow of up to 60 L/min. The gas is heated and humidified with the active humidifier and delivered through the heated circuit. Theoretically, HFNO has a number of advantages over other respiratory support systems, including conventional nasal cannulae, face masks, or CPAP/BiPAP. First, because gas generally is warmed to 371C and completely humidified in HFNO circuits, mucociliary function remains intact and patients report minimal discomfort. Mechanical splinting of the nasopharynx prevents supraglottic collapse and decreases nasopharyngeal resistance, and at 60 L/min HFNO can generate positive end-expiratory pressure (PEEP) of 4 to 7.4 cmH2O, which may counterbalance auto-PEEP and reduce the work of breathing. 3,4 HFNO therapy has been gaining attention as an innovative form of respiratory support in various clinical settings. It is being used increasingly in critically ill patients and gaining favor in the perioperative period. HFNO has been used for multiple indications, including hypoxemic respiratory failure and cardiogenic pulmonary edema, to counterbalance autoPEEP in patients with chronic obstructive airway disease and as prophylactic therapy or treatment of respiratory failure after surgery and extubation. 5 It has been shown to be both safe and noninferior to conventional CPAP in providing prophylactic support to very preterm neonates after extubation. 6 In this same study, the incidence of nasal trauma also was significantly lower in the nasal cannulae group than in the CPAP group. Little clinical experience has been reported on the use of HFNO in the cardiothoracic surgical patient population. Patients undergoing cardiothoracic surgery are at significant risk of postoperative pulmonary complications, and these complications may increase morbidity and mortality and lead to prolonged intensive care unit and hospital length of stay. 7 The incidence of pulmonary complications ranges from 8% to 79% after cardiac surgery and has been reported to be as high as 50% after lung resection surgery. 8 Postoperative pulmonary complications manifest early as arterial hypoxemia, during the later course as pneumonia, and in rare cases also as acute respiratory distress syndrome. 9 The pathogenesis of

Domiciliary noninvasive positive airway pressure therapy in children.

There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.

High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial

High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial

Treatment of sleep-disordered breathing with positive airway pressure devices: technology update.

Many types of positive airway pressure (PAP) devices are used to treat sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. These include continuous PAP, autoadjusting CPAP, bilevel PAP, adaptive servoventilation, and volume-assured pressure support. Noninvasive PAP has significant leak by design, which these devices adjust for in different manners. Algorithms to provide pressure, detect events, and respond to events vary greatly between the types of devices, and vary among the same category between companies and different models by the same company. Many devices include features designed to improve effectiveness and patient comfort. Data collection systems can track compliance, pressure, leak, and efficacy. Understanding how each device works allows the clinician to better select the best device and settings for a given patient. This paper reviews PAP devices, including their algorithms, settings, and features.

Acute neuromuscular respiratory failure

Purpose of review Neurologists working in the hospital are often called to evaluate patients with severe muscle weakness. Some of these patients can develop ventilatory compromise and require admission to the intensive care unit (ICU). This article reviews the general evaluation of neuromuscular respiratory failure, discusses its differential diagnosis, and provides practical advice on the management of its most common causes. Recent findings Determining the cause of acute neuromuscular respiratory failure is crucial because functional prognosis is poor in patients for whom the cause cannot be defined. The differential diagnosis is extensive, but the first step is to discriminate between cases related to a primary neurologic disease (primary neuromuscular respiratory failure) and those provoked by systemic disease, most often critical illness from sepsis and multiorgan failure (secondary neuromuscular respiratory failure). Guillain-Barre syndrome (GBS) and myasthenic crisis are the two most frequent causes of primary neuromuscular respiratory failure. Although they are both autoimmune conditions that benefit from the administration of plasma exchange or IV immunoglobulin (IVIg), they are otherwise very different disorders with unique features and distinct complications. Optimal strategies for mechanical ventilation also differ between these two conditions; while myasthenic crisis is ideally managed with noninvasive bilevel positive airway pressure (BiPAP) ventilation, GBS demands early intubation. Summary Prompt recognition of neuromuscular respiratory failure can be lifesaving, and identification of its cause has substantial prognostic implications. Adequate management of these patients requires a multidisciplinary team with the neurologist at its center, not only to guide the diagnostic evaluation but often also to prescribe the optimal management.

Acute Neuromuscular Respiratory Failure.

Neurologists working in the hospital are often called to evaluate patients with severe muscle weakness. Some of these patients can develop ventilatory compromise and require admission to the intensive care unit (ICU). This article reviews the general evaluation of neuromuscular respiratory failure, discusses its differential diagnosis, and provides practical advice on the management of its most common causes. Determining the cause of acute neuromuscular respiratory failure is crucial because functional prognosis is poor in patients for whom the cause cannot be defined. The differential diagnosis is extensive, but the first step is to discriminate between cases related to a primary neurologic disease (primary neuromuscular respiratory failure) and those provoked by systemic disease, most often critical illness from sepsis and multiorgan failure (secondary neuromuscular respiratory failure). Guillain-Barré syndrome (GBS) and myasthenic crisis are the two most frequent causes of primary neuromuscular respiratory failure. Although they are both autoimmune conditions that benefit from the administration of plasma exchange or IV immunoglobulin (IVIg), they are otherwise very different disorders with unique features and distinct complications. Optimal strategies for mechanical ventilation also differ between these two conditions; while myasthenic crisis is ideally managed with noninvasive bilevel positive airway pressure (BiPAP) ventilation, GBS demands early intubation. Prompt recognition of neuromuscular respiratory failure can be lifesaving, and identification of its cause has substantial prognostic implications. Adequate management of these patients requires a multidisciplinary team with the neurologist at its center, not only to guide the diagnostic evaluation but often also to prescribe the optimal management.

The effect of non-invasive positive airway pressure therapy following thoracic surgical procedures: protocol for a systematic review.

BackgroundThoracic surgical procedures impair respiratory function, decreasing ventilation and oxygenation and increasing the risk of acute respiratory failure and pulmonary complications. To prevent these clinical repercussions, positive airway pressure therapy is widely used to increase pulmonary ventilation, decrease muscle overload, and ensure adequate oxygenation; however, the benefit of this therapy remains unclear.Methods/designA systematic search of the literature including PubMed, CINAHL, AMED, PsycINFO, LILACS, Scielo, Scopus, PEDro, and the Cochrane Library will identify the randomized and quasi-randomized trials that used CPAP, Bilevel, or IPPB compared with a control without intervention, a sham treatment or other lung expansion techniques following thoracic surgical procedures. From these trials, we will extract data on a predefined list of outcomes, including oxygenation, ventilation, respiratory failure, pulmonary complications, and time of resolution of the clinical condition. The methodological quality of each trial included will be assessed using the PEDro scale. The strength of the recommendations will be summarized using the GRADE scale. Meta-analyses will be performed, if appropriate.DiscussionThis review aims to promote greater knowledge regarding the efficiency of the use of non-invasive positive airway pressure on recovery of respiratory function and on prevention of pulmonary complications following thoracic surgical procedures. This review could help health professionals improve the care for patients undergoing thoracic surgical procedures.Systematic review registrationPROSPERO CRD42015019004Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0073-8) contains supplementary material, which is available to authorized users.

Obesity Hypoventilation Syndrome.

Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleep-disordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include non-invasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesity-hypoventilation syndromes.

Noninvasive Respirarory Treatment (Noninvasive Positive Pressure Ventilation and Continuous Positive Airway Pressure)

Noninvasive Respirarory Treatment (Noninvasive Positive Pressure Ventilation and Continuous Positive Airway Pressure)

PC.49 Assessment of Myocardial Function in Preterm Infants with Chronic Lung Disease using Tissue Doppler Imaging

BackgroundChronic lung disease (CLD), defined as oxygen requirement at 36 weeks corrected gestational age (CGA) is a significant neonatal morbidity which can have adverse effects on cardiac function until at...

G353 Impact of Echocardiogram in the assessment of babies with chronic lung disease

BackgroundChronic lung disease (CLD) defined as oxygen requirement at 36 weeks corrected gestational age (CGA) is a significant neonatal morbidity. Pulmonary hypertension (PH) is a recognized complication of CLD and...

Noninvasive Ventilation Practice in Cardiac Surgery Patients: Insights From a European Survey

Noninvasive Ventilation Practice in Cardiac Surgery Patients: Insights From a European Survey

A System Controller Designed for Bi-PAP Noninvasive Ventilator with an ARM MCU

Being aim at designing a system controller used in the Noninvasive Bidirectional Positive Airway Pressure Ventilation (N-Bi-PAPV) and advancing this medical device to serve the respiratory patients who suffer from the OSAHS, COPD and etc, by using an embed ARM Microcomputer LM3S9B92, the system controller including its circuit diagram and embed software was designed in accordance with the request of Bi-PAP medical ventilator. And the ventilators critical parameters were clearly defined and ranged for this system. After testing in a spontaneously breathing simulator, this system controller may be used to control the ventilator performing function well.

Effect of non-invasive bi-level positive airway pressure ventilation combined with naloxone in the treatment of AECOPD complicated with pulmonary encephalopathy: a meta-analysis

Objective To review the effect of non-invasive bi-level positive airway pressure ventilation combined with naloxone in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy (PE). Methods Related published studies involving BiPAP combined with naloxone in the treatment of AECOPD complicated with PE were recruited and identified from Pubmed, ISI Web of knowledge, CBM Disc, CNKI, Wanfang Data, and randomized controlled trails(RCTs) primarily collected were screened according to inclusive criteria and exclusive criteria.Valid data were extracted after quality evaluation for meta-analysis utilizing RevMan 5.2. Results A total of 10 Chinese RCTs were enrolled, including 697 patients (353 patients in experimental group while 343 patients in control group). The results of meta-analysis indicated that BiPAP combined with naloxone improved PaO2(WMD=4.10, 95%CI(2.83, 5.38), P<0.00001), PH value(WMD=0.04, 95%CI(0.02, 0.05), P<0.00001) and clinical efficiency rate(OR=3.58, 95% CI((2.22, 5.76), P<0.00001), and reduced PaCO2(WMD=-5.78, 95%CI(-6.87, 4.69), P<0.00001), re-endotracheal intubation rate (OR=0.19, 95%CI(0.11, 0.35), P<0.00001), but failed to decrease mortality(OR=0.38, 95%CI(0.11, 1.34), P=0.13) of patients with AECOPD complicated with PE. Conclusions BiPAP combined with naloxone play a protective role in enhancing arterial blood gas indexes, improving clinical efficiency rate and limiting re-endotracheal intubation rate.However, the mortality of patients cannot be reduced. Key words: BiPAP; Naloxone; AECOPD; Pulmonary encephalopathy; Meta-analysis

A Case of Successful Management for Pulmonary Edema by Three Kinds of Non-invasive Positive Airway Pressure Device in Heart Failure

A 79-year-old man was admitted to our hospital owing to broad-anterior acute myocardial infarction with cardiogenic shock. Although percutaneous coronary intervention and intra aorta balloon pumping were performed immediately, he presented severe left ventricular systolic dysfunction and acute pulmonary edema. Therefore, non-invasive positive pressure ventilation (NIPPV) was initiated. His hemodynamic status was gradually improved, but positive airway pressure (PAP) treatment was needed to prevent for exacerbation of heart failure.

Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity, daytime hypoventilation, and sleep-disordered breathing without an alternative neuromuscular, mechanical, or metabolic cause of hypoventilation. It is a disease entity distinct from simple obesity and obstructive sleep apnea. OHS is often undiagnosed but its prevalence is estimated to be 10-20% in obese patients with obstructive sleep apnea and 0.15-0.3% in the general adult population. Compared with eucapnic obese patients, those with OHS present with severe upper airway obstruction, restrictive chest physiology, blunted central respiratory drive, pulmonary hypertension, and increased mortality. The mainstay of therapy is noninvasive positive airway pressure. Currently, information regarding OHS is extremely limited in the anesthesiology literature. This review will examine the epidemiology, pathophysiology, clinical characteristics, screening, and treatment of OHS. Perioperative management of OHS will be discussed last.

Characteristics of Patients With the “Malignant Obesity Hypoventilation Syndrome” Admitted to an ICU

The incidence of obesity in westernized nations is increasing at an alarming rate. We have noted an increasing number of patients admitted to our intensive care unit (ICU) with hypercapnic respiratory failure and multisystem organ dysfunction related to obesity. We have coined the term the malignant obesity hypoventilation syndrome (MOHS) to describe this entity. We reviewed the hospital records of all patients who were admitted to our ICU over an 8-month period, with a body mass index (BMI) greater than 40 kg/m² and a PaCO₂ greater than 45 mm Hg. We excluded patients with musculoskeletal disease, intrinsic lung disease, and those with >20 pack-year smoking history. Sixty-one patients (8% of all admissions) met the inclusion criteria for our study. The patients' mean BMI was 48.9 ± 8.6 kg/m². The patients' mean age was 59 ± 11; 47 (77%) were female and 56 (92%) were black. All patients were admitted to the ICU with hypercapnic respiratory failure. The patients had been admitted to our hospital on average 6 times over the previous 2 years; 75% had been erroneously diagnosed and treated for chronic obstructive pulmonary disease (COPD)/asthma and 86% had been treated with diuretics for congestive cardiac failure. All patients had type 2 diabetes and the metabolic syndrome. Three patients had a tracheotomy in place at admission and required mechanical ventilation. All of the remaining patients were treated with noninvasive bilevel positive airway pressure (BiPAP), with 23 patients failing BiPAP and requiring mechanical ventilation. Seven patients had a tracheotomy performed. On the basis of unexplained abnormalities of liver function tests, 39 patients (64%) were presumptively diagnosed with nonalcoholic steatohepatitis (NASH). Pulmonary function tests were suggestive of a restrictive pattern in all patients tested. By echocardiography 43 (71%) patients had left ventricular hypertrophy and 37 (61%) patients had features of left ventricular diastolic dysfunction. Forty-seven (77%) patients had pulmonary hypertension, which was moderate to severe (pulmonary systolic pressure >45 mm Hg) in 25 cases. All patients had an elevated C-reactive protein (9.4 ± 6.9 mg/dL), and all but 1 were vitamin D deficient (13.5 ± 8.5 ng/mL). Eleven patients (18%) died during the index hospitalization. MOHS is a serious multisystem disorder with a high mortality that appears to be relatively common, frequently misdiagnosed, and inadequately treated.

EZ - PAP in the Postoperative Period: A Pilot Study

Induction of general anesthesia impairs gas exchange in the lungs, persists postoperatively, and may contribute to significant postoperative morbidity and health care cost. Laparoscopic surgery has been associated with an increased incidence of ventilatory complications. Multiple factors, including cardiac and respiratory comorbidities, surgical procedure and incision site, and body habitus contribute to these risks. The purpose of this study is to compare the effect of EZ PAP (a noninvasive positive airway pressure device) versus passive oxygen delivery via nasal cannula (conventional postoperative care) on postoperative ventilator status in patients scheduled to undergo laparoscopic surgery. A theoretical framework for ventilatory status with an emphasis on assessment of the patient with potential postoperative gas exchange impairment guided this study. Patients with body mass index (BMI) ≥ 35 having non-emergent laparoscopic abdominal surgery were recruited and randomly assigned to either the EZ PAP or the control group. Noninvasive pulse oximetry, capnography, oxygen liter flow, EZ PAP pressure, vital signs, and post operative opioids use were recorded at baseline, initiation of EZ PAP, 1 hour, 2 hours and 4 hours postoperatively.

Does Self-Titrating CPAP Therapy Improve Postoperative Outcome in Patients at Risk for Obstructive Sleep Apnea Syndrome? A Randomized Controlled Clinical Trial

PURPOSE: Obstructive Sleep Apnea (OSA) is thought to increase postoperative morbidity and mortality, however the efficacy of post-operative intervention with non-invasive positive airway pressure is unproven. The aim of our study was to evaluate the effect on post-operative outcome of treating orthopedic patients, identified as high-risk for OSA, with post-operative auto-titrating positive airway pressure (APAP). Length of stay and occurrence of post-operative complications were examined. We also aimed to assess the accuracy of the OSA risk assessment in an orthopaedic population.

Adjunctive tadalafil therapy for managing pulmonary hypertension in a patient with obesity hypoventilation syndrome

Obesity hypoventilation syndrome (OHS) is often associated with pulmonary hypertension (PH), and noninvasive bi-level positive airway pressure therapy is indicated as first-line treatment. However, its effect in reducing pulmonary arterial pressure is insufficient in many cases, thus adjunctive therapies should be evaluated. In this report, we present a patient with OHS-associated PH who was successfully treated by tadalafil in conjunction with weight reduction and bi-level positive airway pressure therapy.