Role Of Noninvasive Ventilation Research Articles

Enhancing respiratory function in neuromuscular disease: the role of non-invasive ventilation. A narrative review.

Neuromuscular diseases (NMDs) comprise a heterogeneous group of conditions characterized by extreme progressive muscle weakness leading to respiratory failure. Noninvasive mechanical ventilation (NIV) has emerged as a cornerstone in the management of respiratory complications associated with NMDs. This review aims to elucidate the role of NMV in respiratory function, improving quality of life, and prolonging survival in individuals with NMD. The physiological basis of respiratory impairment in NMDs, principles of NMV application, evidence supporting its efficacy, patient selection criteria, and potential challenges in its application are discussed.

Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19.

The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Nationwide cohort of 17.023 cases (median/IQR age 71/61-80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

The role of non-invasive ventilation

The role of non-invasive ventilation

Noninvasive ventilation in children: A review for the pediatric anesthesiologist.

Preserving adequate respiratory function is essential in the perioperative period. Mechanical ventilation with endotracheal intubation is widely used for this purpose. In select patients, noninvasive ventilation (NIV) may be an alternative to invasive ventilation or may complement respiratory management. NIV is used to provide ventilatory support and increase gas exchange at the alveolar level without the use of an invasive artificial airway such as an endotracheal tube or tracheostomy. NIV includes both continuous positive airway pressure (CPAP) and noninvasive positive pressure ventilation. Indications for NIV range from acute hypoxic respiratory failure in the intensive care unit or the emergency department, to chronic respiratory failure in patients with neuromuscular disease with nocturnal hypoventilation. In the perioperative setting, NIV is commonly applied as CPAP, and bilevel positive airway pressure (BPAP). There are limited data on the role of NIV in children in the perioperative setting, and there are no clear guidelines regarding optimal timing of use and pressure settings of perioperative NIV. Contraindications to the use of NIV include reduced level of consciousness, apnea, severe respiratory distress, and inability to maintain upper airway patency or airway protective reflexes. Common problems encountered during NIV involve airway leaks and asynchrony with auto-triggering. High-flow nasal oxygen (HFNO) has emerged as an alternative to NIV when trying to decrease the work of breathing and improve oxygenation in children. HFNO delivers humidified and heated oxygen at rates between 2 and 70L/min using specific nasal cannulas, and flows are determined by the patient's weight and clinical needs. HFNO can be useful as a method for preoxygenation in infants and children by prolonging apnea time before desaturation, yet in children with decreased minute ventilation or apnea HFNO does not improve alveolar gas exchange. Clinicians experienced with these devices, such as pediatric intensivists and pulmonary medicine specialists, can be useful resources for the pediatric anesthesiologist caring for complex patients on NIV.

Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice.

Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, "(secretion OR secretions) AND (noninvasive ventilation OR NIV)" on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel's suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel's suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.

The role of noninvasive ventilation in the management of type II respiratory failure in patients with myotonic dystrophy.

Type 1 myotonic dystrophy (DM1) causes sleep disordered breathing and respiratory failure due to a combination of obstructive sleep apnoea, reduced central drive and respiratory muscle weakness. Noninvasive ventilation (NIV) is commonly used for treating respiratory failure in neuromuscular disease; however, there have been few studies assessing the role of NIV in DM1. The aim of this retrospective service evaluation was to investigate the impact of NIV adherence on hypercapnia and symptoms of hypoventilation in patients with DM1. Data on capillary carbon dioxide tension (PCO2), lung function, adherence to NIV and symptoms of hypoventilation were obtained from the records of 40 patients with DM1. Mean capillary PCO2 significantly reduced from 6.81±1.17 kPa during supervised inpatient set-up to 5.93±0.82 kPa after NIV set-up (p<0.001). NIV adherence reduced from 7.8 (range: 1.0–11.0) h per 24 h during supervised inpatient set-up to 2.9 (0–10.4) h per 24 h in the community. Overall 72% of patients used NIV <5 h per 24 h during follow-up, including 11% who discontinued NIV completely. There was no correlation between adherence to NIV and changes in capillary PCO2. Patients who reported symptomatic benefit (50%) had higher adherence than those who did not feel benefit (p<0.05). In conclusion, in patients with myotonic dystrophy with Type II respiratory failure maintaining adherence is challenging.

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic respiratory failure it caused did not appear to fit conveniently or consistently into our classification of ARDS. This not only re-ignited a half-century's long simmering debate over taxonomy, but also fueled similar debates over how PEEP and lung-protective ventilation should be titrated, as well as the appropriate role of noninvasive ventilation in ARDS. COVID-19 ignited other debates on emerging concepts such as ARDS phenotypes and patient self-inflicted lung injury from vigorous spontaneous breathing. Over a year later, these early perplexities have receded into the background without having been reviewed or resolved. With a full year of evidence having been published, this narrative review systematically analyzes whether COVID-19-associated respiratory failure is essentially ARDS, with perhaps a somewhat different course of presentation. This includes a review of the severity of hypoxemia and derangements in pulmonary mechanics, PEEP requirements, recruitment potential, ability to achieve lung-protective ventilation goals, duration of mechanical ventilation, associated mortality, and response to noninvasive ventilation. This paper also reviews the concepts of ARDS phenotypes and patient self-inflicted lung injury as these are crucial to understanding the contentious debate over the nature and management of COVID-19.

Living the Present with an Enemy from the Past: The Role of Noninvasive Ventilation in a Poliomyelitis Survivor

Living the Present with an Enemy from the Past: The Role of Noninvasive Ventilation in a Poliomyelitis Survivor

Role of Non Invasive Ventilation in Neurology Clinical Practice

Role of Non Invasive Ventilation in Neurology Clinical Practice

Treatment approach to apnestic breathing in Arnold Chiari malformation: any role of non-invasive ventilation?

Treatment approach to apnestic breathing in Arnold Chiari malformation: any role of non-invasive ventilation?

Non-invasive Ventilation in Children With Neuromuscular Disease.

The respiratory muscles are rarely spared in children with neuromuscular diseases (NMD) which puts them at risk of alveolar hypoventilation. The role of non-invasive ventilation (NIV) is then to assist or “replace” the weakened respiratory muscles in order to correct alveolar hypoventilation by maintaining a sufficient tidal volume and minute ventilation. As breathing is physiologically less efficient during sleep, NIV will be initially used at night but, with the progression of respiratory muscle weakness, NIV can be extended during daytime, preferentially by means of a mouthpiece in order to allow speech and eating. Although children with NMD represent the largest group of children requiring long term NIV, there is a lack of validated criteria to start NIV. There is an agreement to start long term NIV in case of isolated nocturnal hypoventilation, before the appearance of daytime hypercapnia, and/or in case of acute respiratory failure requiring any type of ventilatory support. NIV is associated with a correction in night- and daytime gas exchange, an increase in sleep efficiency and an increase in survival. NIV and/or intermittent positive pressure breathing (IPPB) have been shown to prevent thoracic deformities and consequent thoracic and lung hypoplasia in young children with NMD. NIV should be performed with a life support ventilator appropriate for the child's weight, with adequate alarms, and an integrated (±additional) battery. Humidification is recommended to improve respiratory comfort and prevent drying of bronchial secretions. A nasal interface (or nasal canula) is the preferred interface, a nasobuccal interface can be used with caution in case of mouth breathing. The efficacy of NIV should be assessed on the correction of alveolar ventilation. Patient ventilator synchrony and the absence of leaks can be assessed on a sleep study with NIV or on the analysis of the ventilator's in-built software. The ventilator settings and the interface should be adapted to the child's growth and progression of respiratory muscle weakness. NIV should be associated with an efficient clearance of bronchial secretions by a specific program on the ventilator, IPPB, or mechanical insufflation-exsufflation. Finally, these children should be managed by an expert pediatric multi-disciplinary team.

The Role of Non-Invasive Ventilation (NIV) in the Era of COVID-19 Pandemic

The Role of Non-Invasive Ventilation (NIV) in the Era of COVID-19 Pandemic

Sleep, Obstructive Sleep Apnea, and Chronic Alveolar Hypoventilation in Cystic Fibrosis: Role of Noninvasive Ventilation During Sleep

We describe sleep disturbances in patients with cystic fibrosis emphasizing treatment of abnormal breathing during sleep with noninvasive ventilation. Advances in treatment have transformed cystic fibrosis from a pediatric disorder to an adult condition. The increase in cystic fibrosis life expectancy renders these patients at high risk for nocturnal and diurnal respiratory failure. Hypoventilation during sleep precedes diurnal hypoventilation in cystic fibrosis. In advanced cases, noninvasive ventilation improves awake ABGs, respiratory muscle strength, dyspnea, subjective sleep quality, and level of daily activities and attenuates sleep hypoventilation. Noninvasive ventilation can ameliorate symptoms and improve gas exchange, particularly in cystic fibrosis with advanced lung dysfunction. There is insufficient literature describing the effect of noninvasive ventilation on survival in cystic fibrosis.

The Role of Noninvasive Ventilation in Cystic Fibrosis: A Cochrane Review Summary With Commentary

One of the primary indications for noninvasive ventilation (NIV) is for the treatment of acute respiratory failure. NIV is often used in attempts to avoid tracheal intubation, and it is also commonly utilized for managing chronic respiratory failure in neuromuscular disease as well as other

The role of noninvasive ventilation in avoiding reintubation of weaned patients from mechanical ventilation guided by expiratory and inspiratory muscle strength assessment

Introduction Prolonged unnecessary mechanical ventilation (MV) has a multitude of complications. The main goal after placing a critically ill patient on MV is to define the best time to begin the weaning process. The peak expiratory flow (PEF) and maximum inspiratory pressure (MIP) are measures of inspiratory and expiratory muscle efficiency and can be used as weaning predictors. Noninvasive ventilation (NIV) can be used as a tool to prevent reintubation after weaning of MV.Objective The aim of this study was to determine whether prophylactic NIV would benefit patients with various cough strengths and various level of MIP to decrease the incidence of reintubation.Patients and methods In this prospective observational study, 80 mechanically ventilated patients were enrolled. At the time of their first spontaneous breathing trial, PEF and MIP were measured. Then, patients were randomly assigned to facemask and NIV groups.Results A total of 36 (90%) patients in NIV group were successfully weaned from MV, whereas four (10%) patients failed to be weaned. On the contrary, 29 (72.5%) patients in face mask group were successfully weaned from MV, whereas 11 (27.5%) patients failed to be weaned.Conclusion NIV has an important role to prevent reintubation after weaning of MV. Moreover, MIP and PEF have an excellent accuracy in prediction of NIV success after extubation.

Bilevel Positive Airway Pressure ventilation efficiently improves respiratory distress in initial hours treating children with severe asthma exacerbation

Treatment of severe asthma exacerbation could be challenging, especially in the initial hours of acute attack when systemic corticosteroid is yet to take effect. In spite of using inhaled agents, the role of non-invasive ventilation (NIV), including Bilevel Positive Airway Pressure (BiPAP), had been addressed recently. We reviewed 5-year experience in our hospital for records of patients who were admitted to pediatric intensive care unit because of severe asthma attack. The included admission records from 2012 to 2017 were grouped according to BiPAP use (Yes/No). Clinical parameters (heart rate (HR), respiratory rate (RR), SpO2 and serum pCO2) at selected time intervals of treatment were collected for both groups and analyzed. We included data of 46 admissions from 33 different patients (24 with BiPAP and 21 without BiPAP.) The BiPAP group had significantly higher initial RR as well as higher severity scores compared with the other group (p < 0.001). The RR improved significantly in the following time intervals in BiPAP group. There was no significant difference in HR between groups in any of the time intervals. The serum pCO2 levels decreased significantly after initiation of ventilation support in the BiPAP group, and SpO2 levels improved significantly for both groups. BiPAP seemed efficient in improving respiratory rate and oxygenation in our study. It does not seem to cause additional irritation regarding that HR was not increased in BiPAP group compared with non-BiPAP group. Overall, BiPAP ventilation is safe and efficient in treating children with severe asthma attack.

Role of Noninvasive Ventilation in the Management of Obese Patients

National Health and Nutrition Examination Survey data reports that in USA, the prevalence of obesity was 39.8% in adults and 18.5% in youth in 2015–2016. It was also observed that prevalence of obesity was high in middle-aged adults (42.8%) than in younger adults (35.7%).

Outcomes of paediatric critical care asthma patients.

The aim of this study was to characterise patients with asthma admitted to an Australian paediatric intensive care unit (PICU). This was a retrospective review of patients with asthma admitted to a university-affiliated, 23-bed, tertiary PICU between January 2000 and December 2011, with a subset of pharmacotherapy and biochemical data from patients admitted between July 2007 and December 2011. A total of 589 admissions (501 patients) with asthma over 12 years constituted 4.4% of all PICU admissions. Three patients died (0.6%). Non-invasive ventilation (NIV) was used in 104 (17.7%) admissions, and 41 (7%) were invasively ventilated. On 12 (2%) occasions, patients received both NIV and invasive ventilation. Over 12 years, there was a significant trend to increased use of NIV, 11-39% (P < 0.0001), and invasive ventilation, 6-14% (P < 0.001). All received steroids and nebulised β2-agonists. A total of 92% received intravenous (IV) β2-agonists, 65% of these for less than 12 h. PICU and hospital stay were proportional to the duration of IV β2-agonist infusion (P < 0.0001). A total of 47.1% received IV magnesium sulphate, increasing from 19 to 75% (P < 0.001). The majority (48%) were transferred directly to PICU from other hospitals. Median PICU stay was 1.04 days (0.72-1.63); hospital stay was 3.16 days (2.29-4.71), and both were unchanged. Intensive care length of stay (LOS) was unchanged over 12 years. Both invasive and NIV and IV magnesium sulphate use increased. LOS was directly related to the duration of IV β2-agonist. Asthma patients admitted to PICU typically have a brief stay and have a fairly predictable course. Prospective studies could explore the contribution of IV agents and the role of NIV.

The role of non-invasive ventilation used immediately after planned extubation for adults with chronic respiratory disorders.

Objectives:To estimate the benefits of non-invasive ventilation (NIV) used immediately after planned postextubation in patients with chronic respiratory disorders.Methods:Cochrane Library, PubMed, the Chinese BioMedical Literature Database of clinical trials (CBD) and Embase were searched for pertinent studies by 2 trained investigators. Pooled odds ratios and 95% confidence intervals (CIs) were calculated by employing both fixed-effects and random-effects models.Results:Eight studies enrolling 736 patients were included in the meta-analysis. Compared with general oxygen therapy, NIV used immediately after planned extubation in patients with chronic respiratory disease reduced the reintubation rate (p=0.02), ventilator-associated pneumonia (VAP) incidence rate (p=0.000), and ICU mortality (p=0.002) and increased the level of PO2 (p=0.03).Conclusion:Non-invasive ventilation used immediately after planned extubation seems to be advantageous for decreasing the reintubation rate, VAP incidence, and ICU death rate in patients with chronic respiratory disease.

Trends and Outcomes of Noninvasive and Invasive Ventilation in Acute Respiratory Failure Due to Pneumonia

SESSION TITLE: Airway/Mechanical Ventilation SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 08:45 AM - 10:00 AM PURPOSE: Non-invasive ventilation (NIV) started gaining popularity in early 2000s and since then NIV use in acute respiratory failure (ARF) has been increasing through out the world. Currently, NIV is first choice to treat ARF due to COPD, CHF and also to prevent post extubation failure in COPD patients. Role of NIV in PNA is not well defined. On the other hand, invasive mechanical ventilation (IMV) has been the cornerstone of ARF due to PNA. The purpose of this study is to compare over all and annual trends and outcomes associated with NIV use in PNA and its impact on IMV, length of stay (LOS), cost and mortality in USA METHODS: We used the Nationwide Inpatient Sample (NIS) for years 2002-2012. The Clinical Classifications Software (CCS) for ICD-9-CM was used to extract data for pneumonia as the primary diagnosis on discharge. ICD-9 code 93.90 was used for NIV and 96.70, 96.71 and 96.72 were used for IMV. Pearson and spearman correlation coefficients were calculated for annual trends in in-hospital mortality, length of stay (LOS), and total charges for pneumonia patients, along with trends in the use of NIV and IMV. Mortality, LOS, and total charges were also compared between patients with NIV only, with NIV and IMV and IMV only, along with demographics. RESULTS: We extracted 4,162,668 cases of PNA from 2002 to 2012. NIV was used in 102,338(2.4%) and IMV in 232,087 (5.5%) cases. Mean age of the population who had NIV and IMV was (mean/SEM) {66.53(0.06) vs 61.99(0.04), P<0.001} respectively. Further analysis revealed that the use of NIV was lowest in population 80 years or older. There were no gender or racial differences noted. LOS was higher in IMV as compared to NIV (mean/SEM) {15.5(0.03) vs 10.1(0.03), P<0.001}, mortality was higher {0.29(0.0) vs 0.17(0.0) P<0.001} and cost was also higher in IMV group {124141.5(311.71)vs 69967(293.14), P<0.001}. Because of the confounding factor that patients who fail NIV would be intubated and hence resulted in higher mortality and LOS for IMV, we looked for differences in LOS and mortality and cost for PNA with IMV alone and NIV + IMV. LOS and cost was higher in NIV + IMV group (mean/SEM) {17.5(0.12) vs 15.4 (0.04) P<0.001} & {142444.8(1114.3) vs 123575.67(324.1) P<0.001) respectively. Mortality is slightly lower in the NIV+IMV as compared to IMV alone {0.27(0) vs 0.29(0)}. Annual incidence of PNA has been increasing in the hospitalized patients since 2002 to 2012 but it is not significant when adjusted for rate of growth in population. The use of NIV has increased significantly from 2002 (0.97%) to 2012 (4.37%). The trend for IMV in pneumonia is unchanged (5.6%) and there is significant improvement in mortality from 6.5% in 2002 to 4.3% in 2012 CONCLUSIONS: Our study shows the increasing trend of using NIV for PNA in USA. This trend highlights that there is an observable clinical benefit of NIV in PNA. There is 12% mortality benefit with NIV as compared to IMV but it doesn’t decrease intubation rates, this is similar to prior studies CLINICAL IMPLICATIONS: Our study will encourage physicians to consider earlier institution of NIV in PNA. it will promote further research to better define patients who would benefit from NIV DISCLOSURE: The following authors have nothing to disclose: Faraz Siddiqui, Saqib Abbassi, A H Siddiqui, Nauree Narula, Amina Saqib, Michel Chalhoub No Product/Research Disclosure Information