Academic literature on the topic 'NIV therapy referral'
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Journal articles on the topic "NIV therapy referral"
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Wood, C., S. Aristobil-Adele, J. Wittwer, K. Gray, and K. Waters. "P140 Non-invasive Ventilation prior to Adenotonsillectomy." SLEEP Advances 3, Supplement_1 (October 1, 2022): A74—A75. http://dx.doi.org/10.1093/sleepadvances/zpac029.208.
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Abstract Introduction Prolonged wait times to ENT surgery, combined with the risk for post-operative respiratory events in children with severe OSA led to a clinical pathway of implementing CPAP therapy in children with severe OSA whilst on waiting lists for adenotonsillectomy. This study evaluated the impact of this pathway on the clinical care of these patients. Methods A retrospective review of medical records of patients under 18yrs of age diagnosed with OSA and initiated on CPAP whilst awaiting review by ENT / Adenotonsillectomy, between January 2019 and December 2020. Results 36 patients were identified, age 4.3 ± 3.2 years, 86% male, and 80.6% had comorbidities. 16 (44.4%) were overweight or obese, and for 8 (22.2%) obesity was the primary comorbidity. Mean delays: Sleep study to Referral = 4.5 ± 10.5 weeks, Referral to NIV initiation 5.6 ± 8.7 weeks, and NIV to ENT surgery 13.6 ± 13.6 weeks. Total delay from referral to the surgery was 19.6 ± 19.4 weeks. 31 (86%) children were initiated on therapy in hospital, and five (13.9%) patients were non-compliant with the therapy. Discussion Current delays to ENT surgery for children identified with OSA on sleep study average 5 months. Where OSA is sufficient to recommend ENT surgery, the majority (80%) of children tolerated CPAP therapy while they await surgery. We suggest that the benefits obtained are that therapy can be instituted more rapidly than surgery, and where children are able to use CPAP therapy it reduced the requirement for high-dependency or intensive care admission post-operatively.
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Rajagopalan, P. "P093 Chronic Obstructive Pulmonary Disease – Obstructive Sleep Apnoea Overlap Syndrome – Prevalence in a Home ventilation service." SLEEP Advances 3, Supplement_1 (October 1, 2022): A60. http://dx.doi.org/10.1093/sleepadvances/zpac029.163.
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Abstract Introduction Chronic Obstructive Pulmonary Disease - Obstructive Sleep Apnoea Overlap Syndrome (COPD-OSA) prevalence is 1–4% in general population but higher in those with severe airways obstruction. With higher rate of hospitalisation, exacerbation frequency and mortality than in either condition alone, yet there are no randomised control trials (RCT) to guide management. Our aim was to assess the prevalence of obesity and OSA within a COPD home ventilation cohort as we hypothesise that COPD-OSA is under recognised. Methods A retrospective analysis of active patients in a UK NHS hospital Home Ventilation Service. 113 patients were initiated on non-invasive ventilation (NIV) between 2014–2021 and whose documented cause of respiratory failure was COPD. Using electronic healthcare records the body mass index (BMI), diagnosis of OSA, PaCO2 at time of referral and route of referral collected. Results 108 patients had BMI recorded; in 48% it was ≥30 and 26% ≥40. 28% had diagnosed OSA but in those with a BMI of ≥30, 49% had OSA. 54% of those with OSA had a previous trial of continuous positive airway pressure (CPAP). 57% of referrals were as outpatients. None had a documented formal diagnosis of ‘COPD-OSA Overlap Syndrome’. Conclusion 50% of COPD patients requiring home ventilation were obese and 28% had diagnosed OSA. Although this study was a retrospective electronic record review, it suggests COPD-OSA Overlap Syndrome is common and underrecognized. Given the high prevalence it needs greater recognition as a discrete disease entity and urgent RCTs to establish optimum therapy, CPAP or NIV.
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Matabuena-Gómez-Limón, M. R., and F. Leiva-Cepas. "Use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments: a systematized review." ACTUALIDAD MEDICA 106, no. 106(813) (2021): 188–97. http://dx.doi.org/10.15568/am.2021.813.rev02.
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The aim of this study si to revise the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments. A systematized database review will be carried out by the search of articles attending the presented subject following a unique approach; restricting the results to findings in the last five years either in Spanish or English. A research performed in paediatric population concluded that the early management of acute respiratory failure and the use of high flow nasal cannulae reduced the hospitalization period and the referral to specialized hospitals, and gave more independence to regional hospitals in its management; reducing, therefore, the number of patients needing the implementation of invasive procedures. With respect to patients with exacerbations of the chronic obstructive pulmonary disease (COPD) and its early management in the prehospital care, an increase in the mortality in those patients who were exposed to high flow compared to the conventional oxygen therapy was observed. Following the results of a meta-analysis, no benefits were found in the use of high flow nasal cannulae opposed to the conventional therapy or NIV in the emergency departments, in terms of need for intubations, failures in the treatment, hospitalization and mortality.The data are inconclusive in all the studies analyzed and there is no agreement between the different authors. There is a scarce piece of bibliography regarding the use of NIV in the emergency departments due to the fact that the majority of the research are focused on the use of this techniques in intensive care units. In conclussion, there is a diversity in the results of the revised articles according to the use of NIV in the emergency departments.
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Kundavaram, Abhilash Paul Prabhakar, Saravanan Selvan, Vivek Raja, Ponnivalavan Mathiyalagan, Rohini Kanagarajan, Narmadha P. Reddy, Natarajan Rajendiran, et al. "Retrospective study of comparison of clinical severity and outcome of hospitalised COVID-19 patients during the first and second waves of the pandemic in India." BMJ Open 12, no. 11 (November 2022): e062724. http://dx.doi.org/10.1136/bmjopen-2022-062724.
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ObjectivesTo compare the clinical severity and outcome of hospitalised patients during the two waves of the COVID-19 pandemic in India.SettingA tertiary care referral hospital in South India.ParticipantsSymptomatic SARS CoV-2 reverse transcriptase PCR positive patients presenting to the emergency department during the two waves were recruited. The first wave spanned between April and December 2020 and the second wave between April and May 2021.Primary and secondary outcome measuresThe primary outcome of interest was mortality. Secondary outcomes included illness severity at presentation, need for oxygen therapy, non-invasive ventilation (NIV) and hospital or intensive care unit admission.ResultsThe mean (SD) age of the 4971 hospitalised patients in the first wave was similar to the 2293 patients in the second wave (52.5±15.4 vs 52.1±15.1 years, p=0.37). When compared with the first wave, during the second wave, a higher proportion of patients presented with critical illness (11% vs 1.1%, p<0.001) and needed supplemental oxygen therapy (n=2092: 42.1% vs n=1459: 63.6%; p<0.001), NIV (n=643; 12.9% vs n=709; 30.9%; p<0.001) or inotropes/vasoactive drugs (n=108; 2.2% vs n=77: 3.4%; p=0.004). Mortality was higher during the second wave (19.2% vs 9.3%; p<0.001). On multivariable regression analysis, age >60 years (risk ratio, RR 2.80; 95% CI 2.12 to 3.70), D-dimer >1000 ng/mL (RR 1.34; 95% CI 1.15 to 1.55), treatment with supplemental oxygen (RR 14.6; 95% CI 8.98 to 23.6) and presentation during the second wave (RR 1.40; 95% CI 1.21 to 1.62) were independently associated with mortality.ConclusionThe second wave of the COVID-19 pandemic in India appeared to be associated with more severe presentation and higher mortality when compared with the first wave. Increasing age, elevated D-dimer levels and treatment with supplemental oxygen were independent predictors of mortality.
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Brown, Karen A., Gianluca Bertolizio, Marisa Leone, Steven L. Dain, and David S. Warner. "Home Noninvasive Ventilation." Anesthesiology 117, no. 3 (September 1, 2012): 657–68. http://dx.doi.org/10.1097/aln.0b013e318263bccc.
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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.
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Paone, Gregorino, Vittoria Conti, Giuseppe Biondi-Zoccai, Elena De Falco, Isotta Chimenti, Mariangela Peruzzi, Corrado Mollica, et al. "Long-Term Home Noninvasive Mechanical Ventilation Increases Systemic Inflammatory Response in Chronic Obstructive Pulmonary Disease: A Prospective Observational Study." Mediators of Inflammation 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/503145.
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Background. Long-term home noninvasive mechanical ventilation (NIV) is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD.Methods. Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha). Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed.Results. Ninety-three patients were included (48 NIV, 45 oxygen), with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (P>0.5). Conversely, NIV group exhibited higher HNP and IL-6 systemic levels (P<0.001) and lower IL-10 concentrations (P<0.001). Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (P=0.005). These findings were confirmed after propensity matching and pH stratification.Conclusions. These findings challenge prior paradigms based on the assumption that pulmonary inflammation isper sedetrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state.
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McDowell, Grace, Maksymilian Sumowski, Hannah Toellner, Sophia Karok, Ciara O'Dwyer, James Hornsby, David J. Lowe, and Christopher M. Carlin. "Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode." BMJ Open Respiratory Research 8, no. 1 (November 2021): e000828. http://dx.doi.org/10.1136/bmjresp-2020-000828.
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BackgroundOutcomes for patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to evaluate outcomes of home-NIV in hypercapnic patients with COPD who had been set-up at our centre using remote-monitoring and iVAPS-autoEPAP NIV mode (Lumis device, ResMed).MethodsRetrospective analysis of a data set of 46 patients with COPD who commenced remote-monitored home-NIV (AirView, ResMed) between February 2017 and January 2018. Events including time to readmission or death at 12 months were compared with a retrospectively identified cohort of 27 patients with hypercapnic COPD who had not been referred for consideration of home-NIV.ResultsThe median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38 to 250.63) versus the comparison cohort (66 days, 95% CI 21.9 to 110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77 to 394.23) and 70 days (95% CI, 55.31 to 84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9 mmol/L (p<0.0151) and daytime partial pressure of carbon dioxide 2.2 kPa (p<0.032) in home-NIV patients with no required increase in nurse home visits is compatible with effectiveness of this service model. Median reduction of 14 occupied bed days per annum was observed per patient who continued home-NIV throughout the study period (N=32).ConclusionThese findings demonstrate the feasibility and provide initial utility data for a technology-assisted service model for the provision of home-NIV therapy for patients with COPD.
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Hannan, Liam M., Linda Rautela, David J. Berlowitz, Christine F. McDonald, Jennifer M. Cori, Nicole Sheers, Caroline Chao, Fergal J. O'Donoghue, and Mark E. Howard. "Randomised controlled trial of polysomnographic titration of noninvasive ventilation." European Respiratory Journal 53, no. 5 (March 17, 2019): 1802118. http://dx.doi.org/10.1183/13993003.02118-2018.
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Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1versuscontrol 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1versuscontrol 14.6 (11–19) arousals·h−1; p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day−1versuscontrol −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.
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Cocanougher, Benjamin T., Lauren Flynn, Pomi Yun, Minal Jain, Melissa Waite, Ruhi Vasavada, Jason D. Wittenbach, et al. "Adult MTM1-related myopathy carriers." Neurology 93, no. 16 (September 20, 2019): e1535-e1542. http://dx.doi.org/10.1212/wnl.0000000000008316.
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ObjectiveTo better characterize adult myotubularin 1 (MTM1)–related myopathy carriers and recommend a phenotypic classification.MethodsThis cohort study was performed at the NIH Clinical Center. Participants were required to carry a confirmed MTM1 mutation and were recruited via the Congenital Muscle Disease International Registry (n = 8), a traveling local clinic of the Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH and Cure CMD (n = 1), and direct physician referral (n = 1). Neuromuscular examinations, muscle MRI, dynamic breathing MRI, cardiac MRI, pulmonary function tests (PFTs), physical therapy assessments including the Motor Function Measure 32 (MFM-32) scale, and X chromosome inactivation (XCI) studies were performed.ResultsPhenotypic categories were proposed based on ambulatory status and muscle weakness. Carriers were categorized as severe (nonambulatory; n = 1), moderate (minimal independent ambulation/assisted ambulation; n = 3), mild (independent ambulation but with evidence of muscle weakness; n = 4), and nonmanifesting (no evidence of muscle weakness; n = 2). Carriers with more severe muscle weakness exhibited greater degrees of respiratory insufficiency and abnormal signal on muscle imaging. Skeletal asymmetries were evident in both manifesting and nonmanifesting carriers. Skewed XCI did not explain phenotypic severity.ConclusionThis work illustrates the phenotypic range of MTM1-related myopathy carriers in adulthood and recommends a phenotypic classification. This classification, defined by ambulatory status and muscle weakness, is supported by muscle MRI, PFT, and MFM-32 scale composite score findings, which may serve as markers of disease progression and outcome measures in future gene therapy or other clinical trials.
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Sheth, Sunil A., Nerses Sanossian, Qing Hao, Sidney Starkman, Latisha K. Ali, Doojin Kim, Nestor R. Gonzalez, et al. "Collateral flow as causative of good outcomes in endovascular stroke therapy." Journal of NeuroInterventional Surgery 8, no. 1 (November 6, 2014): 2–7. http://dx.doi.org/10.1136/neurintsurg-2014-011438.
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BackgroundEndovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome.MethodsDemographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.ResultsHigher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival.ConclusionsImproved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome.