Noninvasive Ventilation System Research Articles

Home Noninvasive Ventilation for COPD.

Patients with hypercapnic COPD appear to represent a phenotype driven by specific physiology including air trapping and mechanical disadvantage, sleep hypoventilation, and sleep apnea. Such individuals appear to be at high risk for adverse health outcomes. Home noninvasive ventilation (NIV) has been shown to have the potential to help compensate for physiological issues underlying hypercapnia. In contrast to older literature, contemporary clinical trials of home NIV have been shown to improve patient-oriented outcomes including quality of life, hospitalizations, and mortality. Advancements in the use of NIV, including the use of higher inspiratory pressures, may account for recent success. Successful practical application of home NIV thus requires an adequate understanding of patient selection, devices and modes, and strategies for titration. The emergence of telemonitoring holds promise for further improvements in patient care by facilitating titration, promoting adherence, troubleshooting issues, and possibly predicting exacerbations. Given the complexity of home NIV, clinicians and health systems might consider establishment of dedicated home ventilation programs to provide such care. In addition, incorporation of respiratory therapist expertise is likely to improve success. Traditional fee-for-service structures have been a challenge for financing such programs, but ongoing changes toward value-based care are likely to make home NIV programs more feasible.

Prehospital Noninvasive Ventilation: An NAEMSP Position Statement and Resource Document

Noninvasive ventilation (NIV), including bilevel positive airway pressure and continuous positive airway pressure, is a safe and important therapeutic option in the management of prehospital respiratory distress. NAEMSP recommends: NIV should be used in the management of prehospital patients with respiratory failure, such as those with chronic obstructive pulmonary disease, asthma, and pulmonary edema. NIV is a safe intervention for use by Emergency Medical Technicians. Medical directors must assure adequate training in NIV, including appropriate patient selection, NIV system operation, administration of adjunctive medications, and assessment of clinical response. Medical directors must implement quality assessment and improvement programs to assure optimal application of and outcomes from NIV. Novel NIV methods such as high-flow nasal cannula and helmet ventilation may have a role in prehospital care.

Alternative to traditional noninvasive ventilation using a modified snorkel mask in a patient with SARS-COV2: A case report.

IntroductionThe lack of mechanical ventilators for patients with COVID-19 has necessitated the use of other noninvasive ventilation (NIV) systems. One of these NIV systems is the use of an adapted snorkel mask with inspiration valves and pressure valve (PEEP).Case and outcomesA 48-year-old man with no previous history of lung disease was admitted to the emergency room with a diagnosis of acute respiratory failure due to SARS-COV2. The patient did not improve saturation with the use of the reservoir mask. Oxygenation was started using an adapted snorkel mask with a PEEP valve with an alveolar recruitment function and double oxygen flow. The patient presented clinical and radiological improvement after 2 days of use and was discharged 16 days later.DiscussionThe use of a snorkel mask is an important, viable, and simpler NIV modality for the management of patients with COVID-19 with respiratory failure who fail to use a reservoir mask, and it can be an alternative before the use of a mechanical ventilator.ConclusionThe use of the adapted snorkel mask with Charlotte valve and PEEP is a feasible alternative for the treatment of patients with COVID-19.

Improving home oxygen therapy in patients with interstitial lung diseases: application of a noninvasive ventilation device.

Background:Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in patients with interstitial lung disease (ILD) requiring long-term oxygen therapy is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may not be enough. As demonstrated previously in patients with chronic obstructive pulmonary disease, the use of a noninvasive ventilation (NIV) device combined with oxygen therapy may prevent the falling of oxygen saturation during exercise, due to an improvement of the ventilation–perfusion ratio and a reduction of the respiratory work, thus enhancing exercise tolerance. We sought to assess in patients diagnosed with ILD who are in need of oxygen therapy, the effect of associating an NIV to improve oxygen parameters and the distance covered during the 6 min walking test (6MWT).Methods:We conducted a prospective observational study in patients with ILDs. After a clinical characterization, we performed a 6MWT in two different situations: using a portable oxygen concentrator with the regular flow used by the patient during their daily life activities and afterwards adding the additional support of a NIV. The oxygen saturation parameters were registered with a portable oximeter.Results:We included 16 patients with different ILDs who have oxygen therapy prescribed. The use of NIV associated with oxygen therapy in comparison with the use of oxygen therapy alone showed an increase of the average SaO2 [91% (88–93) versus 88% (86–90%); p = 0.0005] and a decrease in the percentage of time with oxygen saturation <90%: 36% (6–56%) versus 58% (36–77%); p < 0.0001. There were no changes in the 6MWT distance: 307 m (222–419 m) versus 316 m (228–425 m); p = 0.10.Conclusions:In our study the use of a NIV system associated with long-term oxygen therapy during exercise showed beneficial effects, especially improvement of oxygen saturation.The reviews of this paper are available via the supplemental material section.

Improving Pharmaceutical Aerosol Delivery During Noninvasive Ventilation: Effects of Streamlined Components

Aerosol delivery efficiency during noninvasive ventilation (NIV) is known to be low (~10%) and is associated with poor outcomes of aerosol therapy. The objective of this study was to demonstrate the benefit of redesigning ventilation circuit components using a streamlining approach to improve aerosol delivery during nasal high flow therapy in adults with a conventional-sized aerosol from a mesh nebulizer. The ventilation circuit consisted of a humidifier, mesh nebulizer, mixing T-connector (with 90° angle), 10 mm tubing, and nasal cannula interface. In vitro experiments and computational fluid dynamics analyses were used to evaluate depositional losses in a system of existing components and a newly proposed streamlined T-connector and cannula at flow rates of 30 and 45 LPM. Streamlined designs reduced deposition in the T-connector by a factor of 4. In the nasal cannula, the streamlined designs reduced depositional losses by factors of 1.25-2.0. With the streamlined designs, the highest emitted dose achieved was >40% for a conventional-sized aerosol at 30 LPM. Streamlined geometries offer an effective method to significantly improve the delivery of aerosols through components of NIV systems. This increase in delivery efficiency is important for new inhaled medications with narrow therapeutic windows, increased costs, or long delivery times.

Home Noninvasive Ventilation

Treatment of chronic respiratory failure with noninvasive ventilation (NIV) is standard pediatric practice, and NIV systems are commonly used in the home setting. Although practice guidelines on the perioperative management of children supported with home NIV systems have yet to be published, increasingly these patients are referred for consultation regarding perioperative management. Just as knowledge of pharmacology underlies the safe prescription of medication, so too knowledge of biomedical design is necessary for the safe prescription of NIV therapy. The medical device design requirements developed by the Organization for International Standardization provide a framework to rationalize the safe prescription of NIV for hospitalized patients supported at home with NIV systems. This review article provides an overview of the indications for home NIV therapy, an overview of the medical devices currently available to deliver it, and a specific discussion of the management conundrums confronting anesthesiologists.