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Ciciretti, M. A., and L. Ratclif. "USE OF NIV IN THE DRAINING THERAPY: CLINICAL CASE." Journal of Cystic Fibrosis 7 (July 2008): S9. http://dx.doi.org/10.1016/s1569-1993(08)60501-9.
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Wood, C., L. Morris, K. Raths, K. Waters, and K. Gray. "P165 Use of Initiation checklist to improve compliance with BPAP & CPAP." SLEEP Advances 2, Supplement_1 (October 1, 2021): A75. http://dx.doi.org/10.1093/sleepadvances/zpab014.204.
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Abstract Introduction Studies have shown that processes used during initiation of non-invasive respiratory (NIV) therapies (including CPAP and BPAP) for children, can influence subsequent compliance with therapy. Methods We implemented a structured checklist as a way of standardising a number of the steps during initiation of NIV in our paediatric sleep medicine service. This study retrospectively reviewed the medical records of children initiated on NIV between Nov 2018 and Dec 2020. We hypothesised that our use of a structured approach to the initiation process, with electronic documentation, would indicate areas in the initiation process that are associated with improved compliance with the therapy, in the long term. Results Initial results revealed that 220 children were commenced on therapy during the 2-year study period (51 BPAP & 169 CPAP). Total numbers with forms present 136 (62%) and complete forms 56 (41%). Forty-six (90%) children commenced on BPAP had forms present and 34 (74%) were completed. Ninety (53%) children commenced on CPAP had forms present and 22 (25%) were completed. Further analyses will evaluate whether sections of the initiation process and checklist (day (of week) of discharge, in-patient vs HITH, attendance at 1st follow-up appointment, financial assistance, severity of disease, eligibility for government-funded equipment) influence compliance when monitored by download at the first, subsequent sleep study. Discussion Use of standardised processes during initiation of NIV therapies can aid in evaluation of the factors that positively influence subsequent compliance with therapy.
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Al-Mukhaini, Khaloud S., and Najwa M. Al-Rahbi. "Noninvasive Ventilation and High-Flow Nasal Cannulae Therapy for Children with Acute Respiratory Failure: An overview." Sultan Qaboos University Medical Journal [SQUMJ] 18, no. 3 (December 19, 2018): 278. http://dx.doi.org/10.18295/squmj.2018.18.03.003.
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Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration to the lungs without the need for endotracheal intubation. As NIV has proven beneficial in comparison to invasive mechanical ventilation, it has become the optimal modality for initial respiratory support among children in respiratory distress. High-flow nasal cannulae (HFNC) therapy is a relatively new NIV modality and is used for similar indications. This review discusses the usefulness and applications of conventional NIV in comparison to HFNC.Keywords: Noninvasive Ventilation; Nasal Cannulae; Endotracheal Intubation; Mechanical Ventilation; Children.
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Bai, Linfu, Fei Ding, Weiming Xiong, Weiwei Shu, Lei Jiang, Yuliang Liu, and Jun Duan. "Early assessment of the efficacy of noninvasive ventilation tested by HACOR score to avoid delayed intubation in patients with moderate to severe ARDS." Therapeutic Advances in Respiratory Disease 16 (January 2022): 175346662210810. http://dx.doi.org/10.1177/17534666221081042.
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Background: Use of noninvasive ventilation (NIV) in patients with moderate to severe ARDS is controversial. We aimed to use HACOR (combination of heart rate, acidosis, consciousness, oxygenation and respiratory rate) score to comprehensively assess the efficacy of NIV in ARDS patients with PaO2/FiO2 ⩽ 150 mmHg. Methods: Secondary analysis was performed using the data collected from two databases. We screened the ARDS patients who used NIV as a first-line therapy. Patients with PaO2/FiO2 ⩽ 150 mmHg were enrolled. NIV failure was defined as requirement of intubation. Results: A total of 224 moderate to severe ARDS patients who used NIV as a first-line therapy were enrolled. Of them, 125 patients (56%) experienced NIV failure and received intubation. Among the intubated patients, the survivor had shorter time from initiation of NIV to intubation than nonsurvivors (median 10 vs 22 h, p < 0.01). The median differences of HACOR score before and 1–2 h of NIV were 1 point (interquartile range: 0–3). We defined the patients with △HACOR >1 as responders (n = 102) and the rest to non-responders (n = 122). Compared to non-responders, the responders had higher HACOR score before NIV. However, the HACOR score was lower in the responders than non-responders after 1–2 h, 12 h, and 24 h of NIV. The responders also had lower NIV failure rate (36% vs 72%, p < 0.01) and lower 28-day mortality (32% vs 47%, p = 0.04) than non-responders. Conclusions: NIV failure was high among patients with moderate to severe ARDS. Delayed intubation is associated with increased mortality. The reduction of HACOR score after 1–2 h of NIV can identify the patients who respond well to NIV.
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Cuerpo, Sandra, Maria Palomo, Fernanda Hernández-González, Joel Francesqui, Nuria Albacar, Carmen Hernández, Isabel Blanco, Cristina Embid, and Jacobo Sellares. "Improving home oxygen therapy in patients with interstitial lung diseases: application of a noninvasive ventilation device." Therapeutic Advances in Respiratory Disease 14 (January 2020): 175346662096302. http://dx.doi.org/10.1177/1753466620963027.
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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.
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Bedi, Prabhjot, Guillermo Hasbun, and Maria Castro-Codesal. "570 Comparing NIV Adherence in Early versus Advanced Stage Sleep Disordered Breathing for Children with Neuromuscular Disease." Sleep 44, Supplement_2 (May 1, 2021): A225. http://dx.doi.org/10.1093/sleep/zsab072.568.
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Abstract Introduction Children with neuromuscular disease (NMD) typically develop progressive sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), nocturnal hypoxemia and/or hypoventilation, due to loss of upper airway muscle tone and weakness of respiratory muscles. Commonly, the SDB initially presents during rapid eye movement (REM) sleep, as this stage is associated with physiological muscle atonia, but then progresses to non-REM (NREM) sleep and ultimately daytime respiratory insufficiency. Non-invasive ventilation (NIV) is currently the treatment of choice for children with NMD and SDB. However, the use of NIV in REM-related SDB is less demonstrated and adequate therapy adherence is unclear. The aim of this study is to determine differences in NIV adherence in children with early (REM) versus advanced (non-REM) SDB. Methods Children (0–18 years) diagnosed with NMD and using NIV for the past 10 years were included. Demographic, clinical, technology-related, and sleep study data were collected from medical charts and polysomnography reports. Adherence data (mean hours of NIV use and % days NIV was used >4hrs) were collected from NIV machine downloads. Children were categorized into two groups based on based on their apnea-hypopnea index (AHI) ratio between REM and NREM sleep. Children with REM-SDB were defined as a REM/NREM AHI ratio of ≥ 2. Children with NREM-SDB were defined as a REM/NREM AHI ratio < 2. Results A total of 14 children (9 REM-SDB and 5 NREM-SDB) were included in the analysis. Both groups were comparable with respect to demographic, clinical, and technology-related characteristics. A total of 24 adherence reports were available for the cohort (16 REM-SDB and 8 NREM-SDB). The mean hours of NIV use per night was comparable between the REM-SDB and NREM-SDB groups (9.2±1.3hrs vs. 9.0±0.4hrs respectively), but the percent days NIV was used >4hrs was higher in the NREM-SDB group (68.7±9.6 vs. 93.0±2.7, p=0.03). Conclusion NIV adherence was high for children with both REM-SDB and NREM-SDB. While hours of NIV use were comparable between both groups, suggesting good NIV tolerance through the night, children with REM-SDB had a lower percentage of days with NIV use >4hr, suggesting less willingness to use the therapy. Support (if any):
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De Jong, Audrey, Helena Huguet, Nicolas Molinari, and Samir Jaber. "Non-invasive ventilation versus oxygen therapy after extubation in patients with obesity in intensive care units: the multicentre randomised EXTUB-OBESE study protocol." BMJ Open 12, no. 1 (January 2022): e052712. http://dx.doi.org/10.1136/bmjopen-2021-052712.
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IntroductionPatients with obesity are considered to be at high risk of acute respiratory failure (ARF) after extubation in intensive care unit (ICU). Compared with oxygen therapy, non-invasive ventilation (NIV) may prevent ARF in high-risk patients. However, these strategies have never been compared following extubation of critically ill patients with obesity. Our hypothesis is that NIV is associated with less treatment failure compared with oxygen therapy in patients with obesity after extubation in ICU.Methods and analysisThe NIV versus oxygen therapy after extubation in patients with obesity in ICUs protocol (EXTUB-obese) trial is an investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients with obesity defined as a body mass index ≥30 kg/m² will be randomly assigned in the ‘NIV-group’ to receive prophylactic NIV applied immediately after extubation combined with high-flow nasal oxygen (HFNO) or standard oxygen between NIV sessions versus in the ‘oxygen therapy group’ to receive oxygen therapy alone (HFNO or standard oxygen,). The primary outcome is treatment failure within the 72 hours, defined as reintubation for mechanical ventilation, switch to the other study treatment, or premature study-treatment discontinuation (at the request of the patient or for medical reasons such as gastric distention). The single, prespecified, secondary outcome is the incidence of ARF until day 7. Other outcomes analysed will include tracheal intubation rate at day 7 and day 28, length of ICU and hospital stay, ICU mortality, day 28 and day 90 mortality.Ethics and disseminationThe study project has been approved by the appropriate ethics committee ‘Comité-de-Protection-des-Personnes Ile de FranceV-19.04.05.70025 Cat2 2019-A00956-51’. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If use of NIV shows positive effects, teams (medical and surgical) will use NIV following extubation of critically ill patients with obesity.Trial registration numberNCT04014920.
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Daines, Benjamin, Nitish Mittal, Amr Ismail, and Gilbert Berdine. "Survival following initiation of non-invasive ventilation during hospitalization for chronic hypercapnic respiratory failure." Southwest Respiratory and Critical Care Chronicles 9, no. 37 (January 28, 2021): 40–44. http://dx.doi.org/10.12746/swrccc.v9i37.793.
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Patients hospitalized with chronic hypercapnic respiratory failure often have comorbidities and are at increased risk for mortality after discharge. Non-invasive ventilation (NIV) has become a common therapy for these patients to improve gas exchange both while hospitalized and after discharge. To understand the survival of hypercapnic respiratory failure patients started on home NIV therapy, a prospective study was conducted analyzing rate of survival and predictors of mortality. Patients had a significant one-year mortality rate of 16.7% ± 0.71%. Analysis of demographic and physiologic data revealed that the only significant predictor of mortality was hours of NIV use per day, with greater use associated with increased mortality. Although initial results indicate that NIV can be an effective long term therapy for chronic hypercapnic respiratory failure, these patients remain at high risk of mortality and require regular monitoring. Continued study will increase this cohort and follow it for longer periods of time to better understand the predictors of mortality in patients hospitalized with chronic hypercapnic respiratory failure.
Key words: Obesity hypoventilation syndrome, noninvasive ventilation, hypercapnic respiratory failure
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Lockstone, Jane, Ianthe Boden, Iain K. Robertson, David Story, Linda Denehy, and Selina M. Parry. "Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): protocol for a single-centre, pilot, randomised controlled trial." BMJ Open 9, no. 1 (January 2019): e023139. http://dx.doi.org/10.1136/bmjopen-2018-023139.
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IntroductionPostoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this study is to detect whether there is a possible signal towards PPC reduction with the use of additional intermittent non-invasive ventilation (NIV) compared with continuous high-flow nasal oxygen therapy alone following high-risk elective upper abdominal surgery. Secondary objectives are to measure feasibility of: (1) trial conduct and design and (2) physiotherapy-led NIV and a high-flow nasal oxygen therapy protocol, safety of NIV and to provide preliminary costs of care information of NIV and high-flow nasal oxygen therapy.Methods and analysisThis is a single-centre, parallel group, assessor blinded, pilot, randomised trial, with 130 high-risk upper abdominal surgery patients randomly assigned via concealed allocation to either (1) usual care of continuous high-flow nasal oxygen therapy for 48 hours following extubation or (2) usual care plus five additional 30 min physiotherapy-led NIV sessions within the first two postoperative days. Both groups receive standardised preoperative physiotherapy and postoperative early ambulation. No additional respiratory physiotherapy is provided to either group. Outcome measures will assess incidence of PPC within the first 14 postoperative days, recruitment ability, physiotherapy-led NIV and high-flow nasal oxygen therapy protocol adherence, adverse events relating to NIV delivery and costs of providing a physiotherapy-led NIV and a high-flow nasal oxygen therapy service following upper abdominal surgery.Ethics and disseminationEthics approval has been obtained from the relevant institution and results will be published to inform future multicentre trials.Trial registration numberACTRN12617000269336; Pre-results.
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Patel, Shahid M., Girija P. Nair, Balaji G. Tuppekar, and Abhay G. Uppe. "Effectiveness of non-invasive ventilation in patients with type 2 respiratory failure." International Journal of Research in Medical Sciences 9, no. 3 (February 25, 2021): 794. http://dx.doi.org/10.18203/2320-6012.ijrms20210880.
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Background: Assess the use of non-invasive ventilation as an alternative way for ventilation in acute respiratory failure, determine factors that can predict the successful use of NIV, evaluate factors hindering success of NIV.Methods: Thirty hospitalised patients fulfilling inclusion criteria, diagnosed with Type II Respiratory Failure on ABG were recruited after obtaining an informed written consent. Complete history and detailed physical examination were followed by routine investigations.Results: Comparison of the pH on admission with the pH after 1st hour of NIV, the latter showed statistically significant improvement. Drop in PaCo2 and rise in PaO2 on ABG from admission and after stopping NIV was statistically significant. Patients with lower MMRC grade and severe cough showed significant improvement in pH, however patient with higher emergency visits and past hospitalisation showed less improvement in pH, after 1 hour of NIV therapy. A total 4 patients were intubated, with mean pH of 7.22, 3 out of them had higher emergency visits, 2 out of them had ICU admission.Conclusions: NIV treatment for COPD with type II respiratory failure avoids intubation, reduces complications and should be considered as first line therapy instead of ET intubation. Lower mMRC grade, lesser hospitalizations, lesser emergency visits, higher BMI, symptoms like cough, can have a positive predictive value for the outcome of NIV.
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Narita, Yukiya, Hirokazu Shoji, Sadayuki Kawai, Takuro Mizukami, Michio Nakamura, Toshikazu Moriwaki, Takeharu Yamanaka, et al. "REVIVE study: Prospective observational study of efficacy and safety in chemotherapy (CTx) after progressive disease of nivolumab (NIV) therapy for metastatic gastric cancer (mGC)." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): TPS178. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.tps178.
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TPS178 Background: Immune checkpoint inhibitors are drugs that block specific proteins produced by the immune system cells, such as T-cells; these proteins prevent T-cells from killing cancer cells. NIV is a standard care for pretreated mGC patients (pts), with increasing clinical use in Japan. Data from retrospective studies on various tumors have shown that after exposure to immune checkpoint inhibitors, the objective response rate to CTx potentially improves; however, enough data have not been accumulated. Although there are no recommended CTx regimen following NIV therapy, in a clinical setting, an irinotecan or oxaliplatin combination regimen (limited to cisplatin-refractory or cisplatin-intolerant pts) is frequently used as post-NIV CTx. This multicenter observational study aims to evaluate the efficacy and safety of CTx in NIV-refractory or NIV-intolerant mGC pts. Methods: We prospectively collect clinical and imaging data from NIV-pretreated mGC pts; these pts will be treated with cytotoxic agents. Pts who meet inclusion criteria A (histologically proven mGC pretreated with NIV, prior administration of a combination therapy of fluoropyrimidine plus platinum and taxanes, and written informed consent) at primary registration are registered. After primary registration, pts who meet inclusion criteria B [Eastern Cooperative Oncology Group Performance Status (ECOG PS 0-2), refractory or intolerant to NIV; prior administration of irinotecan monotherapy or oxaliplatin combination regimens and prior use of cisplatin; evaluable lesions according to RECIST ver. 1.1] at formal registration are registered. The primary endpoint is overall survival of NIV-pretreated mGC pts after CTx. For this study, we require 146 pts, with bilateral alpha = 0.05 and beta = 0.10, with a median threshold survival of 4.0 months and an expected median survival of 6.0 months. Therefore, we plan to enroll 200 pts, considering exclusions from the analysis; since May 2018, we have enrolled 27 pts. Clinical trial information: UMIN000032182.
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Nugroho, Nur Prasetyo, Rerdin Julario, and Septika Purnastuti Hapsari. "BENEFITS OF HIGH-FLOW NASAL OXYGEN THERAPY IN ACUTE HEART FAILURE." Pakistan Heart Journal 55, no. 1 (March 25, 2022): 4–9. http://dx.doi.org/10.47144/phj.v55i1.2113.
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Acute heart failure (AHF) is a life-threatening condition. The majority of patients come to the emergency room (ER) with pulmonary congestion and respiratory failure. Therefore, oxygen therapy is an essential modality in AHF apart from diuretics and improving hemodynamic. Non-invasive ventilation (NIV) is often required to reduce hypercapnia, acidosis, and respiratory rate in AHF. However, it is more invasive than conventional oxygen therapy. NIV is also less comfortable for patients and has limited use in the ER. The high-flow nasal oxygen (HFNO) is increasing in popularity during the COVID-19 pandemic. HFNO can deliver high flow oxygen with a constant fraction in patients with respiratory failure. Studies have reported the benefits of HFNO in acute heart failure. Therefore, HFNO may benefit and may be used as an alternative to acute heart failure patients who cannot tolerate NIV.
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Velasco-Álvarez, Diurbis, Javier Pozas Pérez, and Salvador Díaz-Lobato. "Satisfactory use of high flow nasal cannula in a patient with acute pulmonary embolism." Journal of Lung, Pulmonary & Respiratory Research 5, no. 6 (December 28, 2018): 212–13. http://dx.doi.org/10.15406/jlprr.2018.05.00193.
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High Flow Nasal Cannula (HFNC) oxygen therapy is a recent technique that delivers a high flow of heated and humidified gas to the patient.1 Compared to noninvasive ventilation (NIV), HFNC has been proved to be an effective alternative treatment for acute respiratory failure. HFNC also has a significant number of physiological advantages compared with other commonly used oxygen-based therapies, including PEEP, reduced anatomical dead space, constant FiO2 and it is better tolerated than NIV.2 After a thorough bibliographical research, only one article was found assessing the benefits of using HFNC in patients with acute pulmonary embolism.3 We present the case of an 86-year-old patient with acute pulmonary embolism and desaturation refractory to noninvasive ventilation that was successfully treated with high flow therapy.
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Das, Akshaya Kumar, Arushi Gupta, and Niti Dalal. "Effectiveness and safety of non invasive pressure ventilation in severe COVID-19 disease: A retrospective analysis." Panacea Journal of Medical Sciences 11, no. 2 (August 15, 2021): 209–15. http://dx.doi.org/10.18231/j.pjms.2021.045.
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Noninvasive ventilation (NIV) has a controversial role in treating acute hypoxemic respiratory failure in Severe COVID-19 disease. Noninvasive ventilation has been known to avoid intubation and prevent complications associated with mechanical ventilation, but the risk of aerosolization and consequent contraction of disease deterred clinicians from using it.: The medical records of 18 patients having severe COVID -19 disease with Acute respiratory distress syndrome (ARDS), who received NIV therapy in a tertiary care hospital were scrutinized from a period of 15 June 2020 to 28 June 2020. The parameters like respiratory rate (RR)and PaO2/FiO2(PF ratio) and SOFA score were collected from the day of admission to 5th day of ICU stay. Other parameters like outcomes of NIV therapy, complications and time taken from weaning from NIV were recorded. Forty-five health care workers, involved in the treatment were educated about use of PPE and NIV and were tested for COVID -19 by RT-PCR post-ICU rotation.: The statistical analysis was done by statistical package for social science version(SPSS) 22.0. The parameters were compared by using repeated measure analysis of variance.The mean age group of the patient in the study was 47.44 years. The respiratory rate and PaO2/FIO2 at the time of ICU admission were 29.28±3.74 per minute and 121.06±29.05 respectively. There was significant improvement in PF ratio throughout the observation (p=0.021) and the respiratory rate decreased after NIV therapy from the day of admission to the subsequent days (p=0.001). The major proportion (i.e. 88.8%) of patients with ARDS but SOFA score <5, had a favorable outcome with NIV therapy. 45 HCWs tested negative for SARS-CoV-2. Non-invasive ventilation can be safely used as an effective therapy for moderate to severe ARDS due to COVID-19 disease.
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Mehta, Akshay. "Synopsis on Non-invasive Ventilation in Neonatology." International Journal of Clinical Case Reports and Reviews 7, no. 04 (July 17, 2021): 01–06. http://dx.doi.org/10.31579/2690-4861/128.
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Non-invasive ventilation (NIV) is a mode of respiratory support commonly used on the neonatal unit. Since the advent of NIV, it has evolved from being used as a mode of respiratory support to wean infants from mechanical ventilation (MV) to a primary mode of respiratory support. NIV improve the functional residual capacity in the newborn (at term or preterm) avoiding invasive actions such as tracheal intubation. Newer methods of NIV support such as nasal bilevel positive airway pressure (BiPAP) and humidified high flow nasal cannula oxygen therapy (HHFNC) have emerged in attempts to reduce intubation rates and subsequent MV in preterm infants. With this synopsis, we aim to discuss various available NIV modes of ventilation in Neonatology, including indications, physiological principle, practical aspects and effects on important short and long-term morbidities associated with the use of NIV.
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Mire, Chad E., Yee-Peng Chan, Viktoriya Borisevich, Robert W. Cross, Lianying Yan, Krystle N. Agans, Ha V. Dang, et al. "A Cross-Reactive Humanized Monoclonal Antibody Targeting Fusion Glycoprotein Function Protects Ferrets Against Lethal Nipah Virus and Hendra Virus Infection." Journal of Infectious Diseases 221, Supplement_4 (November 4, 2019): S471—S479. http://dx.doi.org/10.1093/infdis/jiz515.
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Abstract Background Nipah virus (NiV) and Hendra virus (HeV) are zoonotic paramyxoviruses that cause severe disease in both animals and humans. There are no approved vaccines or treatments for use in humans; however, therapeutic treatment of both NiV and HeV infection in ferrets and non-human primates with a cross-reactive, neutralizing human monoclonal antibody (mAb), m102.4, targeting the G glycoprotein has been demonstrated. In a previous study, we isolated, characterized, and humanized a cross-reactive, neutralizing anti-F mAb (h5B3.1). The mAb h5B3.1 blocks the required F conformational change needed to facilitate membrane fusion and virus infection, and the epitope recognized by h5B3.1 has been structurally defined; however, the efficacy of h5B3.1 in vivo is unknown. Methods The post-infection antiviral activity of h5B3.1 was evaluated in vivo by administration in ferrets after NiV and HeV virus challenge. Results All subjects that received h5B3.1 from 1 to several days after infection with a high-dose, oral-nasal virus challenge were protected from disease, whereas all controls died. Conclusions This is the first successful post-exposure antibody therapy for NiV and HeV using a humanized cross-reactive mAb targeting the F glycoprotein, and the findings suggest that a combination therapy targeting both F and G should be evaluated as a therapy for NiV/HeV infection.
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Oczkowski, Simon, Begüm Ergan, Lieuwe Bos, Michelle Chatwin, Miguel Ferrer, Cesare Gregoretti, Leo Heunks, et al. "ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure." European Respiratory Journal 59, no. 4 (October 14, 2021): 2101574. http://dx.doi.org/10.1183/13993003.01574-2021.
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BackgroundHigh-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).Materials and methodologyThe European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF.ResultsThe task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF.ConclusionsHFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
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Oczkowski, Simon, Begüm Ergan, Lieuwe Bos, Michelle Chatwin, Miguel Ferrer, Cesare Gregoretti, Leo Heunks, et al. "ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure." European Respiratory Journal 59, no. 4 (October 14, 2021): 2101574. http://dx.doi.org/10.1183/13993003.01574-2021.
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BackgroundHigh-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).Materials and methodologyThe European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF.ResultsThe task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF.ConclusionsHFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
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Hukins, Craig, Michelle Murphy, and Timothy Edwards. "Dose–response characteristics of noninvasive ventilation in acute respiratory failure." ERJ Open Research 6, no. 1 (January 2020): 00041–2019. http://dx.doi.org/10.1183/23120541.00041-2019.
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Acute noninvasive ventilation (NIV) is a well-established therapy for acute respiratory failure but the dose–response characteristics of this therapy have not been defined. The aim of this study was to define this dose–response relationship.This study was a retrospective review of patients receiving NIV for acute respiratory failure in a tertiary hospital respiratory high-dependency unit between July 2012 and June 2017. Mask-on time (rather than the period that NIV was in use) as the “dose” was compared with hospital survival as the “response”.654 patients were included, 594 (91%) with hypercapnic respiratory failure (HCRF). NIV was used for a median (interquartile range (IQR)) duration of 2.74 (1.51–4.73) days and median (IQR) mask-on time was 34 (18–60) h (56.1% (41.2–69.5%) of treatment time). There was evidence of a dose–response relationship in the HCRF group up to a ceiling of 24 h mask-on time, but not in the hypoxaemic respiratory failure (HRF) group. There was a difference in survival with as little as 2 h mask-on time (92% compared with 73%; p<0.001). Patients requiring NIV for 80–100% of therapy time had lower survival.We conclude that there is evidence of a dose–response relationship between cumulative NIV usage (mask-on time) and survival from as little as 2 h to a ceiling of ∼24 h in HCRF, but not in HRF.
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Zouwayhed, Mazen, Saria Gouher, Balu Bhaskar, Moeena Zain, Samer Burghleh, Rania Khani, Razan Yousef, Abdul Rahman Khan, and Naim Aoun. "The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID-19 Pneumonia." New Emirates Medical Journal 3, no. 1 (April 2022): 54–58. http://dx.doi.org/10.2174/03666211227175233.
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Background: The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID 19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID 19 related respiratory failures being treated with NIV. Objective: The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID 19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID 19 pandemic. Methods: We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients. Results: Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients Conclusion: Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID 19 pneumonia.
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Geyze, Anton V., Iuliia V. Koroleva, Georgy P. Plotnikov, Natalya B. Kovalerova, and Andrey A. Manevskiy. "High-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantages." Medical Journal of the Russian Federation 28, no. 1 (July 26, 2022): 37–45. http://dx.doi.org/10.17816/medjrf108901.
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BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.
AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.
MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patients tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.
RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.
CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patients condition and ventilation requirement.
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Coudroy, Rémi, Jean-Pierre Frat, Stephan Ehrmann, Frédéric Pène, Nicolas Terzi, Maxens Decavèle, Gwenaël Prat, et al. "High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol." BMJ Open 9, no. 8 (August 2019): e029798. http://dx.doi.org/10.1136/bmjopen-2019-029798.
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IntroductionNon-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT02978300
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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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Treanor, D., M. Howard, A. Griffiths, and Z. Davidson. "P125 The effect of glucocorticoids on rate of lung function decline in Duchenne Muscular Dystrophy patients receiving Non-Invasive Ventilation." SLEEP Advances 3, Supplement_1 (October 1, 2022): A70. http://dx.doi.org/10.1093/sleepadvances/zpac029.193.
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Abstract Background Duchenne Muscular Dystrophy (DMD) causes progressive muscle weakness as a result of a mutation in the X-linked gene dystrophin. Recently glucocorticoid treatment has delayed deterioration in muscle strength prolonging survival. When respiratory failure develops, Non-invasive ventilation (NIV) is used to improve symptoms and prolong life. Recent research suggests the use of glucocorticoids with concomitant NIV may be associated with accelerated lung function decline. Methods To evaluate this we conducted a retrospective analysis of serial lung function data in patients with DMD across two healthcare campuses in Melbourne, Australia. A database of all patients with a coded diagnosis of DMD was collated from 1980-2010. Patient records were examined to collect data on age, lung function (FEV1/FVC/FER), glucocorticoid use (y/n), daily glucocorticoid dose, date of NIV initiation, FVC at NIV commencement, date of death (where applicable) and concomitant diagnosis of scoliosis or cardiomyopathy. This data was analysed to see if a trend for accelerated lung function decline with the use of NIV was observed. Progress to date A total of 356 patients were identified of which 36 had transitioned to the Austin Hospital adult Ventilation Service with available serial lung function data. There was no statistical difference in mean rate of decline in lung function post NIV initation (n=26, p=0.527) with glucocorticoid treatment. Intended outcome and impact Our inital results are in line with the previously observed rates of decline in lung function from other studies and do not indicate a negative synergistic effect on NIV with glucorticoid therapy.
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Almukhaini, Khaloud S., and Najwa M. Al-Rahbi. "Use of Noninvasive Ventilation and High-Flow Nasal Cannulae Therapy for Infants and Children with Acute Respiratory Distress Outside of Paediatric Intensive Care: A review article." Sultan Qaboos University Medical Journal [SQUMJ] 20, no. 3 (October 5, 2020): 245. http://dx.doi.org/10.18295/squmj.2020.20.03.002.
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Noninvasive ventilation (NIV) and high-flow nasal cannulae therapy (HFNCT) are first-line methods of treatment for children presenting with acute respiratory distress, with paediatric intensive care units (PICUs) providing an ideal environment for subsequent treatment monitoring. However, the availability of step-down units, where NIV and HFNCT can be safely utilised, has reduced the need for such patients to be admitted to PICUs, thereby leading to the better overall utilisation of critical care resources. In addition, NIV and HFNCT can also be used during transport instead of invasive ventilation, thus avoiding the complications associated with the latter approach. This review article examines the safety and applicability of these respiratory support approaches outside of paediatric intensive care as well as various factors associated with treatment success or failure.Keywords: Critical Care; Children; Pediatric Intensive Care Units; Noninvasive Ventilation; Nasal Cannulae; Transportation of Patients.
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Russo, Alessandro, Erica Binetti, Cristian Borrazzo, Elio Gentilini Cacciola, Luigi Battistini, Giancarlo Ceccarelli, Claudio Maria Mastroianni, and Gabriella d’Ettorre. "Efficacy of Remdesivir-Containing Therapy in Hospitalized COVID-19 Patients: A Prospective Clinical Experience." Journal of Clinical Medicine 10, no. 17 (August 24, 2021): 3784. http://dx.doi.org/10.3390/jcm10173784.
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Objectives: Remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in patients with COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: This was a prospective observational study conducted on a population of patients hospitalized for COVID-19. The primary endpoint of this study was the impact of remdesivir-containing therapy on 30-day mortality; the secondary endpoint was the impact of remdesivir-containing therapy on the need for high-flow oxygen therapy (HFNC), non-invasive ventilation (NIV), or mechanical ventilation. The data were analyzed after propensity score matching. Results: A total of 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) were treated with remdesivir and 113 (27.8%) were not. Overall, 61 patients (14.9%) were treated during hospitalization with HFNC, NIV, or mechanical ventilation, while 30-day mortality was observed in 21 patients (5.2%). Univariate analysis of patients treated with remdesivir or not showed no differences in 30-day mortality (4% vs. 6%, p = 0.411) in the two study groups. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality. The Kaplan–Meier curves of 30-day survival in patients treated with remdesivir or not before (p = 0.24) and after (p = 0.88) propensity score matching showed no differences between the two study groups. Finally, patients treated with remdesivir or not showed the same need for HFNC/NIV or mechanical ventilation. Conclusions: This real-life experience of remdesivir use in hospitalized patients with COVID-19 was not associated with significant increases in rates of survival or reduced use of HFNC/NIV or mechanical ventilation compared with patients treated with other therapies not including remdesivir.
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Veenstra, Pieter, Nic J. G. M. Veeger, Ralph J. H. Koppers, Marieke L. Duiverman, and Wouter H. van Geffen. "High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study." PLOS ONE 17, no. 10 (October 5, 2022): e0272372. http://dx.doi.org/10.1371/journal.pone.0272372.
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Background The use of High-flow nasal cannula (HFNC) is increasing in admitted COPD-patients and could provide a step in between non-invasive ventilation (NIV) and standard oxygen supply. Recent studies demonstrated that HFNC is capable of facilitating secretion removal and reduce the work of breathing. Therefore, it might be of advantage in the treatment of acute exacerbations of COPD (AECOPD). No randomized trials have assessed this for admitted COPD-patients on a regular ward and only limited data from non-randomized studies is available. Objectives The aim of our study was to identify the reasons to initiate treatment with HFNC in a group of COPD-patients during an exacerbation, further identify those most likely to benefit from HFNC treatment and to find factors associated with treatment success on the pulmonary ward. Material and methods This retrospective study included COPD-patients admitted to the pulmonary ward and treated with HFNC from April 2016 until April 2019. Only patients admitted with severe acute exacerbations were included. Patients who had an indication for NIV-treatment where treated with NIV and were included only if they subsequently needed HFNC, e.g. when they did not tolerate NIV. Known asthma patients were excluded. Results A total of 173 patients were included. Stasis of sputum was the indication most reported to initiate HFNC-treatment. Treatment was well tolerated in 83% of the patients. Cardiac and vascular co-morbidities were significantly associated with a smaller chance of successful treatment (Respectively OR = 0.435; p = 0.013 and OR = 0.493;p = 0.035). Clinical assessment judged HFNC-treatment to be successful in 61% of the patients. Furthermore, in-hospital treatment with NIV was associated with a higher chance of HFNC failure afterwards (OR = 0.439; p = 0.045). Conclusion This large retrospective study showed that HFNC-treatment in patients with an AECOPD was initiated most often for sputum stasis as primary reason. Factors associated with improved outcomes of HFNC-treatment was the absence of vascular and/or cardiac co-morbidities and no need for in-hospital NIV-treatment.
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McCreesh, Samuel. "Non-invasive ventilation as a prehospital intervention for acute COPD exacerbation." Journal of Paramedic Practice 11, no. 9 (September 2, 2019): 376–80. http://dx.doi.org/10.12968/jpar.2019.11.9.376.
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Chronic obstructive pulmonary disease (COPD) is the second most common respiratory illness in the UK, affecting over 1 million people. Acute exacerbations of COPD are a common presentation to the ambulance service and account for thousands of hospital admissions annually. Acute respiratory failure accompanies approximately 20% of exacerbations. Current prehospital treatment focuses on oxygen and pharmacological therapy to treat the underlying causes. Non-invasive ventilation (NIV) is a method of ventilatory support that does not require endotracheal intubation, avoiding significant risks associated with intubation and sedation. While some UK ambulance services have introduced NIV, UK guidelines primarily focus on hospital use. International trials have shown prehospital NIV to be more effective than standard treatment in terms of reducing the need for intubation and invasive ventilation in hospital. However, further research is necessary before NIV is introduced widely in UK prehospital paramedic practice.
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Liu, Jiajia, Conor Bell, Vagia Campbell, Julian DeBacker, Erik Tamberg, Christie Lee, and Sangeeta Mehta. "Noninvasive Ventilation in Patients With Hematologic Malignancy: A Retrospective Study." Journal of Intensive Care Medicine 34, no. 3 (January 31, 2017): 197–203. http://dx.doi.org/10.1177/0885066617690725.
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Introduction: Noninvasive ventilation (NIV) is commonly used as first-line therapy for immunocompromised patients with acute respiratory failure. However, it may not be appropriate for all patients, as failure of NIV and delayed endotracheal intubation (ETI) may increase mortality. We report our center’s experience and outcomes for patients with active hematologic malignancy (HM) treated with NIV. Methods: We conducted a retrospective study of consecutive patients with HM who were admitted to the intensive care unit (ICU) of Mount Sinai Hospital for acute respiratory failure between January 1, 2010, and May 31, 2015, and were initially treated with NIV. We compared the characteristics of patients who were successfully treated with NIV and avoided intubation and those who failed NIV. Results: Seventy-nine patients (mean age 56 ± 14 years, mean Acute Physiology and Chronic Health Evaluation II score 27 ± 5) with HM were treated with NIV for acute respiratory failure. The etiology of respiratory failure was multifactorial in 31 (39%) patients, with features of pneumonia in 61 (77%) patients, severe sepsis or septic shock in 33 (42%) patients, and pulmonary edema in 24 (30%) patients. The majority of patients were admitted with acute leukemia (n = 60, 76%), 8 (10%) with lymphoma, and 11 (14%) with chronic leukemia, multiple myeloma, or myelodysplastic syndrome. Of the 79 patients treated with NIV, 44 (56%) failed NIV and required ETI, 7 (9%) had a do-not-intubate (DNI) order and died, and 28 (35%) avoided ETI. Compared with patients who avoided ETI, those who failed NIV or had a DNI order and died were more likely to have acute leukemia (84% vs 61%; P = .02) and at baseline had higher Paco2 (39 vs 30; P = .038), higher fraction of inspired oxygen (Fio2) requirements (0.6 vs 0.4; P = .002), and more vasopressor use (31% vs 11%; P = .059). The ICU mortality was 42%; 3-month mortality was 57% overall and was significantly lower in the NIV success patients compared with the NIV failure group (21% vs 74%; P < .001). Conclusion: Two-thirds of patients with HM and respiratory failure failed NIV and required ETI, and had high subsequent mortality. Patients who failed NIV had higher Paco2, higher Fio2, and a trend toward more vasopressor use.
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Dmitrović, Radmila, Biljana Lazović, and Isidora Simonović. "High flow nasal oxygen therapy (HFNO) in opposition to non-invasive mechanical ventilation (NIV): Advantages, disadvantages and their use in COVID-19 infection: Brief review." Sanamed 16, no. 3 (2021): 227–30. http://dx.doi.org/10.24125/sanamed.v16i3.526.
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In the last few decades, different devices for oxygen application have become available, such as low flow systems, high flow systems (HFNO), and non-invasive ventilation (NIV). They are widely applicable and have many advantages as well as disadvantages. HFNO modalities decrease dead space, improve alveolar ventilation, and apply oxygen up to 60 l/min, delivering it humidified and heated opposite NIV, which increases anatomical dead space, maintains adequate minute ventilation, and is used in more conditions than HFNO, etc. In our research, we included 12 articles. The study was conducted using literature published up from 2013 to July 2020. In our research we used following keywords: 'non-invasive ventilation', 'high-flow nasal oxygen', 'advantages', 'disadvantages', 'COVID-19'. The HFNO system appears to be more successful than standard oxygen treatment and non-inferior to NIV. It is simple, easy to apply but still insufficiently researched. More research is needed in the future on the benefits and disadvantages of the HFNO system.
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Spicuzza, Lucia, and Matteo Schisano. "High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future." Therapeutic Advances in Chronic Disease 11 (January 2020): 204062232092010. http://dx.doi.org/10.1177/2040622320920106.
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Conventional oxygen therapy (COT) and noninvasive ventilation (NIV) have been considered for decades as frontline treatment for acute or chronic respiratory failure. However, COT can be insufficient in severe hypoxaemia whereas NIV, although highly effective, is poorly tolerated by patients and its use requires a specific expertise. High-flow nasal cannula (HFNC) is an emerging technique, designed to provide oxygen at high flows with an optimal degree of heat and humidification, which is well tolerated and easy to use in all clinical settings. Physiologically, HFNC reduces the anatomical dead space and improves carbon dioxide wash-out, reduces the work of breathing, and generates a positive end-expiratory pressure and a constant fraction of inspired oxygen. Clinically, HFNC effectively reduces dyspnoea and improves oxygenation in respiratory failure from a variety of aetiologies, thus avoiding escalation to more invasive supports. In recent years it has been adopted to treat de novo hypoxaemic respiratory failure, exacerbation of chronic obstructive pulmonary disease (COPD), postintubation hypoxaemia and used for palliative respiratory care. While the use of HFNC in acute respiratory failure is now routine as an alternative to COT and sometimes NIV, new potential applications in patients with chronic respiratory diseases (e.g. domiciliary treatment of patients with stable COPD), are currently under evaluation and will become a topic of great interest in the coming years.
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Ferrer, Miquel, and Antoni Torres. "Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations." Seminars in Respiratory and Critical Care Medicine 41, no. 06 (July 28, 2020): 786–97. http://dx.doi.org/10.1055/s-0040-1712101.
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AbstractNoninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory efficiency and reducing the work of breathing in patients with severe chronic obstructive pulmonary disease. Early studies indicate that some patients with acute hypercapnic respiratory failure can be managed with high-flow nasal therapy, but more information is needed before specific recommendations for this therapy can be made. Therefore, high-flow nasal therapy use should be individualized in each particular situation and institution, taking into account resources, and local and personal experience with all respiratory support therapies.
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Borodulina, E. A., G. Yu Chernogayeva, E. P. Gladunova, B. E. Borodulin, E. S. Vdoushkina, L. V. Povalyayeva, V. N. Tingayeva, and L. F. Abubakirova. "Noninvasive ventilation and inhalational nebulized therapy in the intensive care of acute exacerbation of chronic obstructive pulmonary disease." Russian Pulmonology 28, no. 3 (July 30, 2018): 313–17. http://dx.doi.org/10.18093/0869-0189-2018-28-3-296-306.
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The aim of the study was to increase the efficacy of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) using concomitant noninvasive ventilation (NIV) and inhalational nebulized therapy (INT). Methods. Patients with COPD were treated with concomitant NIV and INT (n = 50) or with NIV followed by INT after weaning the patients from ventilator (n = 49). Duration of the patient’s stay in the intensive care unit (ICU) was used to assess the efficacy of the treatment. The two therapeutic approaches were compared using blood gas analysis (partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the arterial blood and pulse oximetry. The target blood gas value indicating the efficacy of the therapy was pO2 > 60 mm Hg. Results. In 1 hour of the treatment, this outcome measure was achieved in 86% (n = 43) and in 59% (n = 29) of patients in the groups of concomitant vs consequent NIV + INT treatment, respectively (χ2 = 8.98; p = 0.0027). PO2 differed insignificantly in both groups and was < 45 mm Hg in 31 (62%) and 36 (73%) of patients, respectively (χ2 = 1.49 p = 0.22225), after 1 hour if the treatment. Pulse oximetry did not change in patients with the increase in PO2; this could be due to a low informative value of SaO2 during the intensive care of AECOPD. Conclusion. The concomitant use of NIV + INT in patients with AECOPD allowed 1.5-fold improvement in blood gas parameters during the first hour of the treatment. This could improve the treatment efficacy, avoid the need in invasive ventilation, and shorten the patient’s stay in ICU. Therefore, the blood gas parameters are more preferable for the choice of the type of respiratory support compared to the pulse oximetry in patients with AECOPD.
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Flores-González, Jose C., Juan Mayordomo-Colunga, Iolanda Jordan, Alicia Miras-Veiga, Cristina Montero-Valladares, Marta Olmedilla-Jodar, Andrés J. Alcaraz-Romero, et al. "Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/2565397.
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Objective. To determine the epidemiology and therapeutic management of patients with severe acute bronchiolitis (AB) admitted to paediatric intensive care units (PICUs) in Spain.Design. Descriptive, prospective, multicentre study.Setting. Sixteen Spanish PICUs.Patients. Patients with severe AB who required admission to any of the participating PICUs over 1 year.Interventions. Both epidemiological variables and medical treatment received were recorded.Results. A total of 262 patients were recruited; 143 were male (54.6%), with median age of 1 month (0–23). Median stay in the PICU was 7 days (1–46). Sixty patients (23%) received no nebuliser treatment, while the rest received a combination of inhalation therapies. One-quarter of patients (24.8%) received corticosteroids and 56.5% antibiotic therapy. High-flow oxygen therapy was used in 14.3% and noninvasive ventilation (NIV) was used in 75.6%. Endotracheal intubation was required in 24.4% of patients. Younger age, antibiotic therapy, and invasive mechanical ventilation (IMV) were risk factors that significantly increased the stay in the PICU.Conclusions. Spanish PICUs continue to routinely use nebulised bronchodilator treatment and corticosteroid therapy. Despite NIV being widely used in this condition, intubation was required in one-quarter of cases. Younger age, antibiotic therapy, and IMV were associated with a longer stay in the PICU.
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Huang, Cheng-Chieh, Hao-Min Lan, Chao-Jui Li, Tsung-Han Lee, Wen-Liang Chen, Wei-Yuan Lei, Pei-You Hsieh, et al. "Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study." Emergency Medicine International 2019 (October 13, 2019): 1–10. http://dx.doi.org/10.1155/2019/2130935.
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Objective. To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs). Method. We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database inception to 12 July 2019. This study included only randomized controlled trials (RCTs) that were conducted in EDs and compared HFNC therapy with COT or NIV. The primary outcome was the intubation rate. The secondary outcomes were the mortality rate, intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and patient dyspnea and comfort scores. Result. Five RCTs (n = 775) were included. There was a decreasing trend regarding the application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI, 0.26–1.09; p=0.08; I2 = 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22–0.78; p=0.006; I2 = 0%), reduced dyspnea scores (MD −0.82, 95% CI −1.45 to −0.18), and improved comfort (SMD −0.76 SD, 95% CI −1.01 to −0.51). Compared with the COT group, the HFNC therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79–1.99; p=0.34; I2 = 0%), ICU admission rate (RR, 1.11; 95% CI, 0.58–2.12; p=0.76; I2 = 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63–1.72; p=0.87; I2 = 0%), length of ED stay (MD 1.66, 95% CI −0.95 to 4.27), and hospital stay (MD 0.9, 95% CI −2.06 to 3.87). Conclusion. Administering HFNC therapy in ARF patients in EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient’s dyspnea level, and increase the patient’s comfort level compared with COT.
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Agarwal, Rajat, Rishi Kumar Saini, Aseem Rajpal, Rajesh Agrawal, and Amit Kumar. "Evaluation of non-invasive ventilation compliance in obstructive sleep apnea syndrome or obesity hypoventilation syndrome patients: an observational study." International Journal of Research in Medical Sciences 8, no. 12 (November 27, 2020): 4292. http://dx.doi.org/10.18203/2320-6012.ijrms20205025.
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Background: Recent times have seen the rise in obstructive sleep apnea syndrome/obesity hypoventilation syndrome (OSAS/OHS) patients across the globe. Availability of sleep study centers, questionnaires, and more awareness have made the diagnosis of OSAS/OHS early. But still, the majority of patients suffer from morbidity associated with OSAS/OHS despite the better diagnosis, the most common cause being non-adherence to (CPAP). This needs to be addressed more vigilantly and with utmost importance for successful management of OSAS/OHS.Methods: This is an observational study, we selected patients by reviewing sleep study records at a tertiary care center (Rohilkhand medical college and hospital) in Bareilly, India. All diagnosed patients with OSAS/OHS (i.e. AHI >5) were telephoned and enquired about symptoms and non-invasive ventilation (NIV) use. They were evaluated using a self-designed questionnaire.Results: In our study, we had total of 49 OSAS/OHS patients with mean age of 50.6 years and mean BMI of 35.63. Male patients were 37 (75.5%) and at the time of diagnosis AHI (mean) was 60.67 events/hour. In NIV users there were 24 patients (48.97%), 22 patients (91.7%) feel they have been benefitted from CPAP and 2 patients (8.3%) do not feel benefit from CPAP (NIV) use. Among NIV users there was significant drop of AHI (mean) to 8.07. Among NIV users there was a reduction in symptoms like excessive day time sleepiness in 18 patients (81.81%), witnessed apnea in 15 patients (88.23%), snoring in 21 patients (91.30%), blood pressure in 3 patients (21.42%), blood sugar levels in 2 patients (20%), morning headache in 5 patients (83.30%), depressive mood in 2 patients (40%), perceived memory loss in 3 patients (33.3%), sense of choking in 17 patients (94.4%) and weight loss in 19 patients (76%).Conclusions: CPAP significantly improves symptoms and provides objective as well as subjective benefit to OSAS/OHS patients but still significant proportion of patients hesitate to initiate the therapy. Poor education/awareness regarding OSAS/OHS and non-availability of affordable CPAP remains the leading cause of non-compliance. There is a need for early education, reinforcement and affordable CPAP therapy.
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Bertaina, Maurizio, Ivan J. Nuñez-Gil, Luca Franchin, Inmaculada Fernández Rozas, Ramón Arroyo-Espliguero, María C. Viana-Llamas, Rodolfo Romero, et al. "Non-invasive ventilation for SARS-CoV-2 acute respiratory failure: a subanalysis from the HOPE COVID-19 registry." Emergency Medicine Journal 38, no. 5 (March 16, 2021): 359–65. http://dx.doi.org/10.1136/emermed-2020-210411.
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BackgroundThe COVID-19 pandemic has seriously challenged worldwide healthcare systems and limited intensive care facilities, leading to physicians considering the use of non-invasive ventilation (NIV) for managing SARS-CoV-2-related acute respiratory failure (ARF).MethodsWe conducted an interim analysis of the international, multicentre HOPE COVID-19 registry including patients admitted for a confirmed or highly suspected SARS-CoV-2 infection until 18 April 2020. Those treated with NIV were considered. The primary endpoint was a composite of death or need for intubation. The components of the composite endpoint were the secondary outcomes. Unadjusted and adjusted predictors of the primary endpoint within those initially treated with NIV were investigated.Results1933 patients who were included in the registry during the study period had data on oxygen support type. Among them, 390 patients (20%) were treated with NIV. Compared with those receiving other non-invasive oxygen strategy, patients receiving NIV showed significantly worse clinical and laboratory signs of ARF at presentation. Of the 390 patients treated with NIV, 173 patients (44.4%) met the composite endpoint. In-hospital death was the main determinant (147, 37.7%), while 62 patients (15.9%) needed invasive ventilation. Those requiring invasive ventilation had the lowest survival rate (41.9%). After adjustment, age (adjusted OR (adj(OR)) for 5-year increase: 1.37, 95% CI 1.15 to 1.63, p<0.001), hypertension (adj(OR) 2.95, 95% CI 1.14 to 7.61, p=0.03), room air O2 saturation <92% at presentation (adj(OR) 3.05, 95% CI 1.28 to 7.28, p=0.01), lymphocytopenia (adj(OR) 3.55, 95% CI 1.16 to 10.85, p=0.03) and in-hospital use of antibiotic therapy (adj(OR) 4.91, 95% CI 1.69 to 14.26, p=0.003) were independently associated with the composite endpoint.ConclusionNIV was used in a significant proportion of patients within our cohort, and more than half of these patients survived without the need for intubation. NIV may represent a viable strategy particularly in case of overcrowded and limited intensive care resources, but prompt identification of failure is mandatory to avoid harm. Further studies are required to better clarify our hypothesis.Trial registration numbersNCT04334291/EUPAS34399.
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Yuval, Cavari, Shlomo Tal Levy, Neeman Eitan, Taragin Ben, Leder Michal, Yarza Shaked, and Lazar Isaac. "Intrapulmonary percussive ventilation for children with bronchiolitis on non-Invasive Ventilation support." Open Journal of Pediatrics and Child Health 7, no. 1 (November 1, 2022): 025–30. http://dx.doi.org/10.17352/ojpch.000042.
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Objective: Pediatric Intensive Care (PICU) admission of children with bronchiolitis as well as the use of Non-Invasive Ventilation (NIV) are increasing. The current treatment for bronchiolitis is supportive, and there are no specific studies addressing this group of severe bronchiolitis patients supported with NIV. Intrapulmonary Percussive Ventilation (IPV) is a lung recruitment physical therapy technique used in our PICU to augment lung aeration and improve gas exchange. We hypothesized that IPV treatment can be used to improve the clinical course of infants on NIV support suffering from bronchiolitis. Design: A prospective, open, randomized study. Setting: Single-center Pediatric ICU Patients: Children less than 2 years old admitted to our PICU between November 2016 and April 2018 with a diagnosis of bronchiolitis who were prescribed noninvasive positive pressure ventilation as their sole respiratory treatment modality Interventions: Patients were randomly assigned to two intervention groups: IPV vs. control (standard treatment). Measurements and main results: Thirty-eight infants with bronchiolitis treated with NIV support were randomized into two groups. The probability of a superior outcome (less chance of invasive mechanical ventilation and fewer PICU days) was 62.7% (95% CI, 45%-77%, p = 0.18) in the IPV group compared to the control group. Among the IPV group, there were no failures that required intubation in comparison to three intubations (13.6%) among the control group (p = 0.24). For the IPV group, the PICU length of stay (LOS) was 4.13 ± 2.45 days, compared to 6.18 ± 4.72 for the inhalation group. This difference was not statistically significant. Conclusions: In this single-center study, the use of IPV had no adverse reactions. The study failed to show a statistically significant effect of IPV treatment on the course of hospitalization of patients with bronchiolitis on NIV support in the PICU. Trial registration: Clinical Trials.gov NCT03037801.
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Schmitt, Felix C. F., Daniel Gruneberg, Niko R. E. Schneider, Jan-Ole Fögeling, Moritz Leucht, Felix Herth, Michael R. Preusch, et al. "Non-Invasive Ventilation as a Therapy Option for Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Acute Cardiopulmonary Oedema in Emergency Medical Services." Journal of Clinical Medicine 11, no. 9 (April 29, 2022): 2504. http://dx.doi.org/10.3390/jcm11092504.
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In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course.
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Ciobanu, Laura. "Is there enough room for non-invasive ventilation in pulmonary rehabilitation?" Biotechnology and Bioprocessing 1, no. 2 (December 10, 2020): 01–06. http://dx.doi.org/10.31579/2766-2314/007.
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Pulmonary rehabilitation (PR) is a non-pharmacological intervention addressed to chronic obstructive pulmonary disease (COPD) and non-COPD chronic respiratory patients, a key management strategy scientifically demonstrated to improve exercise capacity, dyspnoea, health status and psychological wellbeing. The main body of literature comes from COPD patients, as they provide the core evidence for PR programmes. PR is recommended even to severe patients having chronic respiratory failure; their significant psychological impairment and potential for greater instability during the PR programme will be carefully considered by the multidisciplinary team. Optimizing medical management (e g, inhaled bronchodilators, oxygen therapy, non- invasive ventilation) may enhance the results of exercise training. Patients who already receive long-term domiciliary non- invasive ventilation (NIV) for chronic respiratory failure might exercise with NIV during exercise training if acceptable and tolerable to the patient. It is not advisable to offer long-term domiciliary NIV with the only aim to improve outcomes during PR course. There are different attempts to use both negative and positive NIV in limited clinical studies. Long-term adherence to exercise is an important goal of PR programmes and teams, targeting to translate all-domain gains of PR into increased physical activity and participation to real life. Being a reliable alternative for the future, studies should focus on pressure regimens, type of devices, acceptability and portability for everyday activities.
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Diaz-Abad, Montserrat, Amal Isaiah, Valerie E. Rogers, Kevin D. Pereira, and Anayansi Lasso-Pirot. "Use of Noninvasive Ventilation with Volume-Assured Pressure Support to Avoid Tracheostomy in Severe Obstructive Sleep Apnea." Case Reports in Pediatrics 2018 (October 9, 2018): 1–4. http://dx.doi.org/10.1155/2018/4701736.
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Obstructive sleep apnea (OSA) is a common disorder in children but can occasionally present with life-threatening hypoxemia. Obesity is a significant risk factor for poor outcomes of OSA treatment. Continuous positive airway pressure (CPAP) is indicated in children who are not candidates for or have an unsatisfactory response to adenotonsillectomy. Children acutely at risk for significant morbidity with other therapies are candidates for a tracheostomy. An eight-year-old patient with morbid obesity and severe OSA refractory to CPAP therapy was treated successfully with a novel noninvasive ventilation (NIV) mode with volume-assured pressure support (VAPS) and avoided tracheostomy.
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Cheng, Chang, Wang, Hsiao, Lai, and Chao. "The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis." Medicina 55, no. 10 (October 16, 2019): 693. http://dx.doi.org/10.3390/medicina55100693.
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Background and objectives: High-flow nasal cannula (HFNC) can be used as a respiratory support strategy for patients with acute respiratory failure (ARF). However, no clear evidence exists to support or oppose HFNC use in immunocompromised patients. Thus, this meta-analysis aims to assess the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on the outcomes in immunocompromised patients with ARF. The Pubmed, Embase and Cochrane databases were searched up to November 2018. Materials and Methods: Only clinical studies comparing the effect of HFNC with COT or NIV for immunocompromised patients with ARF were included. The outcome included the rate of intubation, mortality and length of stay (LOS). Results: A total of eight studies involving 1433 immunocompromised patients with ARF were enrolled. The pooled analysis showed that HFNC was significantly associated with a reduced intubation rate (risk ratio (RR), 0.83; 95% confidence interval (CI), 0.74–0.94, I2 = 0%). Among subgroup analysis, HFNC was associated with a lower intubation rate than COT (RR, 0.86; 95% CI, 0.75–0.95, I2 = 0%) and NIV (RR, 0.59; 95% CI, 0.40–0.86, I2 = 0%), respectively. However, there was no significant difference between HFNC and control groups in terms of 28-day mortality (RR, 0.78; 95% CI, 0.58–1.04, I2 = 48%), and intensive care unit (ICU) mortality (RR, 0.87; 95% CI, 0.73–1.05, I2 = 57%). The ICU and hospital LOS were similar between HFNC and control groups (ICU LOS: mean difference, 0.49 days; 95% CI, −0.25–1.23, I2 = 69%; hospital LOS: mean difference, −0.12 days; 95% CI, −1.86–1.61, I2 = 64%). Conclusions: Use of HFNC may decrease the intubation rate in immunocompromised patients with ARF compared with the control group, including COT and NIV. However, HFNC could not provide additional survival benefit or shorten the LOS. Further large, randomized controlled trials are needed to confirm these findings.
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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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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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Bruni, Andrea, Eugenio Garofalo, Gianmaria Cammarota, Paolo Murabito, Marinella Astuto, Paolo Navalesi, Francesco Luzza, Ludovico Abenavoli, and Federico Longhini. "High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients." Reviews on Recent Clinical Trials 14, no. 4 (November 7, 2019): 247–60. http://dx.doi.org/10.2174/1574887114666190710180540.
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Background: High-Flow through Nasal Cannula (HFNC) is a system delivering heated humidified air-oxygen mixture at a flow up to 60 L/min. Despite increasing evidence in hypoxemic acute respiratory failure, a few is currently known in chronic obstructive pulmonary disease (COPD) patients. Objective: To describe the rationale and physiologic advantages of HFNC in COPD patients, and to systematically review the literature on the use of HFNC in stable and exacerbated COPD patients, separately. Methods: A search strategy was launched on MEDLINE. Two authors separately screened all potential references. All (randomized, non-randomized and quasi-randomized) trials dealing with the use of HFNC in both stable and exacerbated COPD patients in MEDLINE have been included in the review. Results: Twenty-six studies have been included. HFNC: 1) provides heated and humidified airoxygen admixture; 2) washes out the anatomical dead space of the upper airway; 3) generates a small positive end-expiratory pressure; 4) guarantees a more stable inspired oxygen fraction, as compared to conventional oxygen therapy (COT); and 5) is more comfortable as compared to both COT and non-invasive ventilation (NIV). : In stable COPD patients, HFNC improves gas exchange, the quality of life and dyspnea with a reduced cost of muscle energy expenditure, compared to COT. In exacerbated COPD patients, HFNC may be an alternative to NIV (in case of intolerance) and to COT at extubation or NIV withdrawal. Conclusion: Though evidence of superiority still lacks and further studies are necessary, HFNC might play a role in the treatment of both stable and exacerbated COPD patients.
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Ndreu, Arben, Dhimitër Kraja, Silva Bino, Artan Simaku, Iris Hatibi, Najada Çomo, Arjan Harxhi, et al. "Clinical Findings in Albanian Patients with 2009 Influenza AH1N1 Admitted at the Intensive Care Unit." ISRN Emergency Medicine 2013 (May 8, 2013): 1–6. http://dx.doi.org/10.1155/2013/914840.
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Due to the ease of cross-continent spread of infectious diseases, the 2009 influenza AH1N1 (H1N1) affected many countries. This observational prospective study looked at Albanian patients admitted with 2009 H1N1 at the ICU of the Department of Infectious Diseases at the University Hospital Center of Tirana, from November 2009 to March 2010. Demographic data, symptoms, comorbidities, and clinical outcomes were collected from each patient. The number of days spent in the ICU was recorded for each patient along with their radiological and laboratory findings, and outcome at discharge. Critical illness occurred in 31 patients admitted with confirmed 2009 H1N1. The median age of patients was 35 years. Five (16.1%) patients required endotracheal intubation; noninvasive oxygen therapy (NIV) was used in 15 (48.4%) patients via nasal tube; and continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) oxygen masks were used in 11 (35.5%) patients. All patients were treated with oseltamivir. Four patients admitted and treated did not survive. Critical illness in the setting of 2009 H1N1 admitted in the ICU predominantly affected young adults. NIV could play a role in treating 2009 influenza H1N1 infection-related hypoxemic respiratory failure that was associated with severe hypoxemia, pneumonia, requirement for prolonged mechanical ventilation, and the frequent use of antiviral therapy.
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He, Yuewen, Na Liu, Xuhui Zhuang, Xia Wang, and Wuhua Ma. "High-flow nasal cannula versus noninvasive ventilation in patients with COVID-19: a systematic review and meta-analysis." Therapeutic Advances in Respiratory Disease 16 (January 2022): 175346662210878. http://dx.doi.org/10.1177/17534666221087847.
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Background: During the novel coronavirus disease 2019 (COVID-19) pandemic raging around the world, the effectiveness of respiratory support treatment has dominated people’s field of vision. This study aimed to compare the effectiveness and value of high-flow nasal cannula (HFNC) with noninvasive ventilation (NIV) for COVID-19 patients. Methods: A comprehensive systematic review via PubMed, Web of Science, Cochrane, Scopus, WHO database, China Biology Medicine Disc (SINOMED), and China National Knowledge Infrastructure (CNKI) databases was conducted, followed by meta-analysis. RevMan 5.4 was used to analyze the results and risk of bias. The primary outcome is the number of deaths at day 28. The secondary outcomes are the occurrence of invasive mechanical ventilation (IMV), the number of deaths (no time-limited), length of intensive care unit (ICU) and hospital stay, ventilator-free days, and oxygenation index [partial pressure of arterial oxygen (PaO2)/fraction of inhaled oxygen (FiO2)] at 24 h. Results: In total, nine studies [one randomized controlled trial (RCT), seven retrospective studies, and one prospective study] totaling 1582 patients were enrolled in the meta-analysis. The results showed that the incidence of IMV, number of deaths (no time-limited), and length of ICU stay were not statistically significant in the HFNC group compared with the NIV group ( ps = 0.71, 0.31, and 0.33, respectively). Whereas the HFNC group performed significant advantages in terms of the number of deaths at day 28, length of hospital stay and oxygenation index ( p < 0.05). Only in the ventilator-free days did NIV show advantages over the HFNC group ( p < 0.0001). Conclusion: For COVID-19 patients, the use of HFNC therapy is associated with the reduction of the number of deaths at day 28 and length of hospital stay, and can significantly improve oxygenation index (PaO2/FiO2) at 24 h. However, there was no favorable between the HFNC and NIV groups in the occurrence of IMV. NIV group was superior only in terms of ventilator-free days.
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Baldomero, Arianne K., Anne Melzer, Nancy Greer, Brittany N. Majeski, Roderick Macdonald, and Timothy J. Wilt. "Effectiveness and harms of high-flow nasal oxygen (HFNO) for acute respiratory failure: a systematic review protocol." BMJ Open 10, no. 2 (February 2020): e034956. http://dx.doi.org/10.1136/bmjopen-2019-034956.
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IntroductionHigh-flow nasal oxygen (HFNO) use in adults hospitalised with acute respiratory failure (ARF) is increasing. However, evidence to support widespread use of HFNO compared with non-invasive ventilation (NIV) and conventional oxygen therapy (COT) is unclear. This protocol describes the methods for a systematic evidence review regarding the comparative effectiveness and harms of HFNO compared with NIV or COT for the management of ARF in hospitalised adult patients.Methods and analysisWe will search MEDLINE, Embase, CINAHL and Cochrane Library for randomised-controlled trials (RCTs) of adult patients hospitalised with ARF or who developed ARF while hospitalised. ARF will be defined as SpO2<90%, PaO2:FiO2ratio ≤300, PaO2≤60 mm Hg, or PaCO2≥45 mm Hg. The intervention is HFNO (humidified oxygen, flow rate ≥20 L/min) compared separately to NIV or COT. The critical outcomes are: all-cause mortality, hospital-acquired pneumonia, intubation/reintubation (days of intubation), intensive care unit admission/transfers, patient comfort and hospital length of stay. The important outcomes are: delirium, 30-day hospital readmissions, barotrauma, compromised nutrition (enteral or parenteral nutrition), gastric dysfunction, functional independence at discharge and skin breakdown or pressure ulcers. We will calculate risk ratios and Peto ORs (for rare events) and corresponding 95% CIs for categorical outcomes. Mean and standardised mean difference will be calculated for continuous outcomes. Where possible and appropriate, meta-analysis will be performed for each outcome.ConclusionThis systematic review will provide a comprehensive evaluation of the evidence regarding the comparative effectiveness and harms of HFNO compared with NIV or COT for the management of ARF in hospitalised adult patients to inform clinical practice and to identify research gaps in the management of ARF in hospitalised adults. The results will inform the work of the American College of Physicians-Clinical Guidelines Committee in their development of a clinical guideline related to use of HFNO in adult patients with ARF.Ethics and disseminationNo ethical approval will be needed because we will be using data from previously published studies in which informed consent was obtained by the primary investigators. We will publish our results in a peer-reviewed journal.PROSPERO registration numberCRD42019146691
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Alnajada, Asem Abdulaziz, Bronagh Blackwood, Abdulmajeed Mobrad, Adeel Akhtar, Ivan Pavlov, and Murali Shyamsundar. "High flow nasal oxygen for acute type two respiratory failure: a systematic review." F1000Research 10 (June 16, 2021): 482. http://dx.doi.org/10.12688/f1000research.52885.1.
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Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 – 7.7 vs NIV median 7.6, IQR 6.3 – 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.
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Alnajada, Asem Abdulaziz, Bronagh Blackwood, Abdulmajeed Mobrad, Adeel Akhtar, Ivan Pavlov, and Murali Shyamsundar. "High flow nasal oxygen for acute type two respiratory failure: a systematic review." F1000Research 10 (September 20, 2021): 482. http://dx.doi.org/10.12688/f1000research.52885.2.
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Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 – 7.7 vs NIV median 7.6, IQR 6.3 – 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.