Pressure Ventilation In Respiratory Failure Research Articles

Clinical update in non-invasive positive pressure ventilation for respiratory failure in 2022

In this article, we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure(ARF)/chronic respiratory failure(CRF) between 1st October 2021 and 30th September 2022 through Medline, and reviewed the important advances. Three prospective randomized controlled studies related to the efficacy and safety of NPPV and/or high-flow nasal cannula oxygen therapy (HFNC) on patients with COVID-19 with ARF were reported, showing that NPPV (including continuous positive airway pressure and bilevel positive airway pressure) was able to reduce the intubation rate, but the efficacy of HFNC was contradictory. In addition, progress has been made in outcome prediction models for ARF treated with NPPV, NPPV-related cardiac arrest, and the impact of human-machine interface on NPPV treatment outcomes. The effects of NPPV as preoxygenation method before intubation was reported to be able to reduce severe desaturation during intubation, especially in obese population. The use of NPPV in extubated patients resulting in reduced reintubation rate was also studied. With regard to long-term home application of NPPV, five indicators of successful initiation were proposed, but the success rate was low in clinical practice. Some reports showed that psychological support could improve the adherence to NPPV. The results of these studies contributed to the rational selection and optimal application of NPPV in clinical practice.

Noninvasive positive pressure ventilation for respiratory failure secondary to acute exacerbations of COPD: a clinical analysis of 46 cases

Objective To evaluate the efficacy of noninvasive positive pressure ventilation for respiratory failure secondary to acute exacerbations of COPD. Methods From January 2007 to December 2009, 92 patients were randomly assigned to receive conventional therapy alone (control group, 46 patients) or the same therapy plus noninvasive positive pressure ventilation (study group, 46 patients). The efficacy was compared between the two groups. Results After treatment, observe groups have better therapeutic efficacy than control groups in degrading PaCO2, degrading respiratory frequency, and elevating PaO2. Conclusions Noninvasive positive pressure ventilation for respiratory failure secondary to exacerbations of COPD can effectively decrease PaCO2 level and respiratory rate and increase PaO2 level. It has a better efficacy. Key words: Noninvasive positive pressure ventilation; Chronic obstructive pulmonary disease; Acute exacerbation; Respiratory failur

Noninvasive positive pressure ventilation for respiratory failure caused by exacerbations of chronic obstructive pulmonary disease: a standard of care?

This editorial comments on a meta-analysis of the use of noninvasive positive pressure ventilation to treat patients with acute respiratory failure caused by chronic obstructive pulmonary disease (COPD) exacerbations published in the British Medical Journal earlier this year. Based on its analysis of seven randomized controlled trials that met pre-specified criteria, the meta-analysis demonstrated highly significant benefits of noninvasive positive pressure ventilation in COPD patients, including a reduction in a combined end-point consisting of death and endotracheal intubation. The editorial argues that, based on the strength of this and other evidence, noninvasive positive pressure ventilation to treat selected patients with acute respiratory failure due to COPD exacerbations should now be considered a standard of care.

Noninvasive Positive Pressure Ventilation To Treat Respiratory Failure

To review the clinical use of noninvasive positive pressure ventilation, including its efficacy with acute and chronic forms of respiratory failure, its mechanism of action, and its implementation. Studies were identified through a MEDLINE search using the key words respiratory failure and mechanical ventilation and through a manual review of reference lists of published articles. All original studies relating to the use of noninvasive positive pressure ventilation in respiratory failure were included. Because of the paucity of controlled trials, cohort studies were not excluded. Study design, numbers and diagnoses of patients, ventilator modes, and success and complication rates were extracted and compiled. For acute respiratory failure, studies report improved gas exchange and avoidance of intubation in 60% to 80% of patients with chronic obstructive pulmonary disease, restrictive thoracic disease, congestive heart failure, pneumonia, or postoperative extubation failure. However, the patients were highly selected, and relatively few studies have been published, only one of which was a randomized controlled trial. For chronic respiratory failure due to restrictive thoracic disease, all studies report improved gas exchange and symptoms of hypoventilation after prolonged nocturnal use, although no study was controlled. Some cohort studies of patients with severe chronic obstructive pulmonary disease yielded favorable results, but longer-term, randomized, controlled studies showed minimal, if any, benefit. Noninvasive positive pressure ventilation is effective in the treatment of chronic respiratory failure due to restrictive thoracic diseases. The routine use of such treatment for chronic respiratory failure due to chronic obstructive pulmonary disease and for acute respiratory failure needs to be studied in randomized controlled trials in better-defined patient subsets.

Continuous positive airway pressure ventilation for respiratory failure associated with Pneumocystis carinii pneumonia

The value of continuous positive airway pressure (CPAP) ventilation via a tight fitting face mask was assessed in eight HIV-1 antibody-positive patients with Pneumocystis carinii pneumonia who were in hypoxaemic respiratory failure. All patients were conscious, able to protect their airway and not hypercapnic. Treatment was effective in seven patients. Prior to CPAP, mean (range) arterial oxygen tension was 6.7 (4.7-10.5) kPa in seven patients breathing oxygen via a face mask (FiO2 = 0.6), 6.1 kPa in one patient breathing room air and rose to 9.9 (6.8-12.8) kPa with CPAP (FiO2 = 0.6 and PEEP = 1.3 kPa in six patients and 2.6 kPa in one patient); the mean increase in PaO2 was 3.1 kPa (P less than 0.02). These seven patients experienced a rapid reduction in dyspnoea and their respiratory rate fell from a mean of 40 breaths min-1 to 32 breaths min-1 (P less than 0.001). One patient deteriorated rapidly on CPAP and died: no other complications were seen with this technique. CPAP was continued for a mean of 4.5 days and the seven responders all survived the episode of P. carinii pneumonia. We conclude that mask CPAP provides an effective means of improving oxygenation in severely hypoxaemic patients with P. carinii pneumonia.

The effect of mechanical ventilation after open-heart surgery.

The effect of mechanical ventilation after open-heart surgery.

Chest physiotherapy: a physiological assessment during intermittent positive pressure ventilation in respiratory failure.

Six patients in respiratory failure who were receiving intermittent positive pressure ventilation were studied to determine the efficacy of chest physiotherapy and the nature of the accompanying cardiovascular changes. Arterial to alveolar tension gradients for both oxygen and carbon dioxide were measured before and after chest physiotherapy, as was cardiac output. In addition, serial cardiac output measurements were made during physiotherapy. No overall change in pulmonary gas exchange was demonstrated. Cardiovascular response varied in different patients; a rise or a fall by as much as 50 per cent of the initial cardiac output was observed. The results are discussed and it is suggested that further study is needed to define which of those procedures used during chest physiotherapy are effective and safe.