Rate Of Noninvasive Ventilation Research Articles

Pharmacoeconomic Aspects of Treating Childhood Pneumonia - Cost of Illness Study Based on Data from Serbia

Abstract The pharmacoeconomic aspect of the treatment of pneumonia in the pediatric population is scarce analyzed in the countries of the Balkan region. This research aimed to determine the value of total hospital costs of treating childhood pneumonia from the Republic Fund of Health Insurance perspective. This retrospective cost of illness study was performed using the “from the bottom to the top” approach. It included 82 patients with childhood pneumonia who were treated at Clinical for pediatrics at Clinical Centre Kragujevac. The total costs of hospital treatment of pneumonia for the examined population were 4,095,293.73 RSD. The largest share in total hospital costs has the length of patient hospitalization (22%). The median total hospital costs per patient per year amounted to 40,249.91 RSD (4,793.10 - 142,149.63 RSD). Since the main determinants of overall costs of treating childhood pneumonia are the length of stay and noninvasive ventilation rate, therapeutic strategies should provide not only efficient treatment in compliance with current guidelines as also decreasing these determinants to offer a better pharmacoeconomic profile of childhood pneumonia.

Outcome of Non-Invasive Ventilation in Patients of Acute Respiratory Failure.

Introduction: Non-invasive ventilation (NIV) is a method of ventilator support or delivery of positive pressure into the lungs usually through a face mask, mostly initiated before severe acidosis occurs. NIV failure requiring invasive mechanical ventilation in decompensated chronic obstructive pulmonary disease (COPD) patients is low, but, in critical patients, it is as high as 60%. Acute respiratory failure (ARF) is the common reason for admission to the intensive care unit. This study assesses the outcome of NIV among patients with acute respiratory failure, the duration of use, stay in ICU, and failure rate of NIV. Such type of study result is scarce in our country. Methods: Arterial blood gases were assessed prior, after, and at discontinuation of NIV. NIV was delivered by ventilator via face mask. All patients above age 15 years who presented to the hospital, diagnosed to have ARF by ABG were included and admitted to Medical Intensive Care Unit (MICU). . Appropriate statistical tests (Chi-square) were performed and the statistical significance of the results was assessed. Results: 35 patients with the median age of 73 years (range: 39- 89 years), of 60.0 % females among which 74.3 % were current smokers. Arterial blood pH prior to admission ranged from 7.11-7.39 and 7.06-7.41 among NIV success and failure, respectively. Similarly, PCo2 ranged from 54.0-127.5 and 29.5-105.9 among them, respectively. Two hours after ventilation pH ranged from 7.12-7.43 and 7.05-7.30 respectively in the success and failure group. The most common disease condition requiring NIV was 77.1% COPD. Out of NIV failure group (n=19) ,57.8 % were intubated and 42.1% patients left the intervention. Conclusions: Usage of NIV among ARF patients was associated with lower intubation and ICU mortality rate. COPD patients showed the most benefit with NIV, whereas patients suffering from interstitial lung disease, lung cancer had less benefit.

The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients

BackgroundDuring the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED).MethodsA retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality.ResultsA total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29–0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period.ConclusionDuring the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made.

Dexmedetomidine versus haloperidol for prevention of delirium during non-invasive mechanical ventilation

BackgroundDelirium is a common problem among intensive care patients and can contribute to non-invasive ventilation (NIV) failure. Prevention of delirium may improve the outcome and success rate of NIV. The aim of the current study was to compare the effects of using dexmedetomidine and haloperidol for prevention of delirium during NIV.Patients and methodsNinety adult intensive care patients of ASA physical status III and IV on NIV were randomly allocated to three equal groups. Group D (30 patients) received dexmedetomidine continuous intravenous infusion of 0.2–0.7 μg/kg/h preceded by a loading dose of 1.0 μg/kg intravenously over 10 min if needed, group H (30 patients) received haloperidol continuous intravenous infusion of 0.5–2 mg/h preceded by a loading dose of 2.5 mg intravenously if needed and group P (30 patients) received normal saline infusion. Supplementary sedation or analgesia was given when needed. Our primary outcome measure was the incidence of delirium. Duration of non-invasive mechanical ventilation, incidence of endotracheal intubation during NIV, length of ICU stay, and length of hospital stay, adverse events and mortality were recorded. Delirium was diagnosed using the Confusion Assessment Method for the ICU (CAM-ICU). Hemodynamic parameters and respiratory rate were recorded.ResultsThe incidence of delirium was significantly lower in dexmedetomidine group 3/30 (10%) than haloperidol 10/30 (33.3%) and placebo groups 13/30 (43.3%) groups. Duration of NIV was significantly shorter in dexmedetomidine group than in placebo group and shorter than haloperidol group. The incidence of endotracheal intubation was significantly less in dexmedetomidine group compared to placebo and haloperidol groups. The length of ICU and hospital stay was significantly shorter in dexmedetomidine group compared to haloperidol and placebo groups Bradycardia occurred significantly more in dexmedetomidine group while prolonged corrected QT (QTc) interval occurred only in haloperidol group (2 patients). A significantly lower incidence of respiratory tract infections was noted in dexmedetomidine group. The need for supplementary sedatives and analgesic was significantly less in dexmedetomidine group compared to haloperidol and placebo groups.ConclusionDexmedetomidine is more effective than haloperidol for prevention of delirium during NIV with lower incidence of endotracheal intubation and shorter ICU and hospital stay. Bradycardia is more frequent with dexmedetomidine use.

Polysomnography Improves the Success Rate of Noninvasive Ventilation in Obesity Hypoventilation Syndrome Complicated With Respiratory Failure and Heart Failure

Polysomnography Improves the Success Rate of Noninvasive Ventilation in Obesity Hypoventilation Syndrome Complicated With Respiratory Failure and Heart Failure

Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial

Duration of weaning from mechanical ventilation is decreased with the use of written protocols in adults. In children, the use of written protocols has not had such an impact. We conducted a single-center trial to assess the feasibility of conducting a multicenter randomized clinical trial comparing the duration of weaning from mechanical ventilation in those managed by a computer-driven explicit protocol versus usual care. Mechanically ventilated children aged between 2 and 17 years on pressure support and not receiving inotropes were included. After randomization, children were weaned either by usual care (n = 15) that was characterized by no protocolized decisions by attending physicians, or by a computer-driven protocol (Smartcare/PS™, Drager Medical) (n = 15). Weaning duration until first extubation was the primary outcome. For comparison, a Mann-Whitney U test was employed (p < 0.05). Patients characteristics at inclusion were similar. The median duration of weaning was 21 h (range 3-142 h) in the SmartCare/PS™ group and 90 h (range 4-552 h) in the usual care group, p = 0.007. The rate of reintubation within 48 h after extubation and the rate of noninvasive ventilation after extubation in the SmartCare/PS™ and usual care groups were 2/15 versus 1/15 and 2/15 versus 2/15, respectively. A pediatric randomized trial on mechanical ventilation with a computerized protocol in North America is feasible. A computer-driven protocol that also manages children younger than 2 years old would help to decrease the number of PICU admissions screened in a multicentre trial on this topic.

A Preliminary Randomized Controlled Trial to Assess Effectiveness of Nasal High-Flow Oxygen in Intensive Care Patients

In a cardiothoracic and vascular intensive care unit, to compare nasal high-flow (NHF) oxygen therapy and standard high-flow face mask (HFFM) oxygen therapy in patients with mild to moderate hypoxemic respiratory failure. In a prospective randomized comparative study, 60 patients with mild to moderate hypoxemic respiratory failure were randomized to receive NHF or HFFM. We analyzed the success of allocated therapy, noninvasive ventilation rate, and oxygenation. Significantly more NHF patients succeeded with their allocated therapy (P = .006). The rate of noninvasive ventilation in the NHF group was 3/29 (10%), compared with 8/27 (30%) in the HFFM group (P = .10). The NHF patients also had significantly fewer desaturations (P = .009). NHF oxygen therapy may be more effective than HFFM in treating mild to moderate hypoxemic respiratory failure.

Noninvasive Ventilation in Adults with Acute Respiratory Distress: A Primer for the Clinician

Noninvasive ventilation (NIV) has become an integral part of critical care management. Despite > 2 decades of experience, it is relatively underused, with general utilization reported as a little over 10% in a recent international survey. Lack of training, knowledge, equipment, and experience with NIV may account for its slow adoption. Patient selection, staff training and experience, and prompt recognition of ineffective NIV are important components to successful application of NIV. Noninvasive ventilation does have a learning curve that may be steep for some institutions but must be mastered if the procedure is to become a successful institutional component of care. Patients with acute respiratory failure due to chronic obstructive pulmonary disease or congestive heart failure are ideal candidates for NIV, and optimal efficacy in associated conditions is often linked to these 2 conditions. Technical issues and written guidelines are addressed, including details of an adequate trial of therapy as well as criteria for intubation. Attention to these elements should increase the success rate of NIV, which in turn should increase its general use.

Comparison of the usefulness of non-invasive ventilation between acute ventilatory failure and oxygenation failure

Objective: To compare the applicability and effect of non-invasive ventilation (NIV) between acute ventilatory failure and oxygenation failure, and to describe variables that may be related with successful outcome of NIV in each type of respiratory failure. Design: Prospective clinical study in two distinct types of respiratory failure. Setting: Medical intensive care unit of a university-affiliated hospital. Patients: Twenty-six episodes of respiratory failure managed using NIV from a total of 106 episodes in 102 patients. Respiratory failure was defined as acute ventilatory failure (VF: PaCO2 ≥43 mmHg [5.7 kPa] with pH <7.35, n=19) or acute oxygenation failure (OF: PaO2/FiO2 <300 mmHg [40 kPa] with pH ≥7.35, n=87) necessitating mechanical ventilation. Interventions: The subjects were managed by NIV via face mask if they fulfilled the minimal requirement for NIV application. Respiratory pattern, arterial blood gases, complications and success rate of NIV were analysed in each group. Results: Eleven...