Дисертації: "De novo acute respiratory failure"

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Berrube, Élise. "Patient self-inflicted lung injury et ventilator induced lung injury : De l'insuffisance respiratoire aiguë de novo à l'exacerbation aiguë de pneumopathie intersititielle diffuse." Electronic Thesis or Diss., Normandie, 2024. http://www.theses.fr/2024NORMR030.

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Introduction Au cours de l’insuffisance respiratoire aiguë (IRA) de novo ou du syndrome de détresse respiratoire aiguë (SDRA), la ventilation invasive (VI) appliquée au patient pour pallier aux altérations sévères de l’hématose, de même que les efforts respiratoires spontanés, peuvent paradoxalement aggraver les lésions alvéolaires initiales et provoquer alors des lésions dénommées ventilator induced lung injury (VILI) ou patient self-inflicted lung injury (P-SILI).L’exacerbation aiguë de pneumopathie interstitielle diffuse (EAPID), bien que proche sémiologiquement, histologiquement et radiologiquement du SDRA et ayant bénéficié de l’amélioration des connaissances du VILI et du P-SILI, reste grevée d’une mortalité bien plus élevée. MéthodeNous nous sommes donc intéressés aux conséquences de la ventilation et des efforts respiratoires spontanés au cours des EAPID.RésultatsNous avons tout d’abord étudié les conséquences des stratégies d’oxygénation non invasives au cours de l’IRA de novo et montré que la ventilation non invasive (VNI) augmentait le volume courant par rapport à l’oxygénothérapie à haut débit (OHD) sans augmentation du recrutement alvéolaire, donc exposant le poumon à un risque de surdistention. Nous avons ensuite mis au point un modèle de poumon artificiel mécanique reproduisant la ventilation spontanée au cours de l’IRA de novo et les mécanismes physiopathologiques impliqués dans le P-SILI.Nous avons ensuite utilisé ces connaissances acquises au cours de l’IRA de novo pour modéliser la ventilation spontanée des patients atteints de PID au repos, au cours d’un exercice maximal et d’une EAPID. Nous avons mis en évidence que l’hétérogénéité de l’atteinte pulmonaire, et donc de la compliance dans les PID, était associée tant à l’effort qu’au cours de l’EAPID à la présence de mécanismes impliqués dans le P-SILI : recrutement/dérecrutement alvéolaires, surdistension, concentration du stress pulmonaire, et phénomène de Pendelluft.Nous avons ensuite soumis ce modèle d’EAPID aux contraintes de la VI. Nous avons ainsi pu montrer que celle-ci, appliquée avec des volumes courants supérieurs à 5 ml/kg de poids prédit sur la taille, des niveaux de pressions expiratoire positive supérieure à 4 cmH2O et une fréquence respiratoire supérieure à 25/min, était potentiellement délétère selon notre modèle. Nous avons parallèlement évalué, au cours d’une étude clinique rétrospective, les conséquences de la stratégie d’oxygénation non invasive appliquée au cours de l’EAPID. A contrario de ce que nous avions pu montrer dans l’IRA de novo, nous n’avons pas retrouvé de différence entre la VNI et l’OHD en termes de mortalité ou de recours à la VI. Grace à notre modèle expérimental d’EAPID, nous devrions pouvoir comprendre les mécanismes physiopathologiques expliquant ce résultat et envisager une stratégie d’oxygénation optimisée et personnalisée pour la prise en charge de l’EAPID. ConclusionNotre travail de recherche, à la fois expérimental et clinique, a donc permis de mettre en évidence la possibilité de P-SILI et de VILI au cours des EAPID, de montrer que le risque de surdistension est majeur dans cette pathologie au cours de la VI. La stratégie d’oxygénation non invasive optimale reste encore à déterminer
IntroductionIn the course of de novo acute respiratory failure (ARF) or acute respiratory distress syndrome (ARDS), invasive mechanical ventilation (IMV) and spontaneous respiratory efforts, may paradoxically worsen initial alveolar lesions and cause ventilator induced lung injury (VILI) or patient self-inflicted lung injury (P-SILI). Acute exacerbation of diffuse interstitial lung disease (AE-ILD) presents similar characteristics to ARDS in semiology, histology and radiology. However, the risk of mortality remains higher in AE-ILD despite improved knowledge of VILI and P-SILI. MethodsWe were interested in the effects of ventilation and spontaneous respiratory effort during AE-ILD.ResultsWe first studied the effects of non-invasive oxygenation strategies during de novo ARF, and showed that non-invasive ventilation (NIV) increased tidal volume compared to high flow nasal canulae oxygen therapy (HFNC) without increasing alveolar recruitment, thus exposing the lung to the risk of overdistention. We then developed a mechanical artificial lung model reproducing spontaneous ventilation during de novo ARF and studied the pathophysiological mechanisms involved in P-SILI.We then used this knowledge learned from de novo ARF to model spontaneous ventilation in patients with ILD at rest, during maximal exercise and AE-ILD. We demonstrated that the inhomogeneity of lung injury and of compliance in ILD was associated during exercise and AE-ILD, with the presence of mechanisms involved in P-SILI: recruitment/derecruitment, overdistension, stress concentration and Pendelluft phenomenon.We then exposed this AE-ILD model to the challenges of IMV. We showed that IMV applied with tidal volumes of more than 5 ml/kg PBW, positive expiratory pressure levels of more than 4 cmH2O and respiratory rates of more than 25 cpm were deleterious in our model. At the same time, we evaluated the effects of non-invasive oxygenation strategies during AE-ILD in a retrospective clinical study. We found no difference between NIV and HFNC in mortality or use of invasive ventilation. ConclusionOur research has highlighted the occurence of P-SILI and VILI during AE-ILD and has shown a major risk of overdistension in AE-ILD during IMV. Our model of AE-ILD could help us to develop optimized and personalized oxygenation strategies for AE-ILD patients

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Gaspari, Romolo Joseph. "Pathophysiology of Respiratory Failure Following Acute Organophosphate Poisoning : A Dissertation." eScholarship@UMMS, 2009. https://escholarship.umassmed.edu/gsbs_diss/445.

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Organophosphate (OP) poisoning is a health issue worldwide with over 200,000 deaths per year. Although not a problem in most developed countries, in some third world countries, one third of a hospital’s population could be patients with OP exposure. Even with the most aggressive therapy, 10-40% of patients admitted to an intensive care unit will die. Research into the best practice for treating OP poisoning is lacking, due somewhat to a lack of detailed understanding of the physiology of OP poisoning. Our research uses animal models of acute OP poisoning to explore the mechanism of OP-induced respiratory failure. Our research shows that animals poisoned with dichlorvos demonstrated a uniformly fatal central apnea that, if prevented, was followed immediately by a variable pulmonary dysfunction. Potential mechanisms for dichlorvos-induced central apnea can be divided into direct effects on the central respiratory oscillator (CRO) and feedback inhibition of the CRO. Two afferent pathways that can induce apnea include vagal feedback pathways and feed-forward pathways from the cerebral hemispheres. In our studies we found that vagal feedback and feed forward inhibition from the cerebral hemispheres were not required for OP-induced central apnea. The pre-Botzinger complex in the brainstem is thought to be the kernel of the CRO, but exposure of the pre-Botzinger complex to dichlorvos was not sufficient for apnea. Although OP induced central apnea was uniformly fatal, partial recovery of the CRO occurred post apnea with mechanical ventilation. Central apnea was ubiquitous in our rat poisoning model, but pulmonary dysfunction was extremely variable, with a range of pulmonary effects from fulminate pulmonary failure with prominent pulmonary secretions to no pulmonary dysfunction at all. Vagal efferent activity is involved in neural control of pulmonary tissue but the vagus was not involved in OP-induced pulmonary dysfunction. Anti-muscarinic medications are the mainstay of clinical therapy and are commonly dosed by their effects on pulmonary secretions. Our studies found that atropine (the most common therapeutic agent for OP poisoning) resulted in a ventilation-perfusion mismatch secondary to effects on the pulmonary vasculature.

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Tomii, Keisuke. "Noninvasive ventilation for various types of life-threatening acute respiratory failure." Kyoto University, 2011. http://hdl.handle.net/2433/135384.

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4

Hammond, Brandon. "Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/603630.

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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Objectives: To examine current oxygenation index (OI) data and outcomes using EMR data to identify a specific OI values associated with outcome. Methods: Retrospective review of electronic medical record (EMR) data for patients age 1 month ‐ 20 years mechanically ventilated for >24 hours in the PICU. Serial, average and maximum OI values were calculated. Length of mechanical ventilation, hospital stay and outcome were assessed. Results: OI was calculated on 65 patients from EMR data, of which 6 died (9.2%). The median maximum OI was 10 for all patients, 17 for non‐survivors (NS), and 8 for survivors (S), (p=0.14 via Wilcoxon rank‐sum test). Odds ratios (OR) indicated 2.1 times increase odds of death (p=.08), 95% confidence interval (0.89–5.03) for each one‐percent increase in maximum OI. Average OI OR also revealed 2.1 times increase in odds of death (p=.14), 95% confidence interval (0.77–5.48). ROC analysis indicated a higher discriminate ability for max OI (AUC = 0.68) than average OI (AUC = .58). OI cut points for mortality were established. Mortality was unchanged until max OI >17, for which mortality nearly tripled at a value of 18% versus 6‐7% for range 0‐17. Conclusions: Serial assessment of OI values may allow creation of alert values for increased mortality risk and aid in development of clinical decision rules. Consideration for escalation of therapies for respiratory failure such as high frequency ventilation or ECMO at lower levels of OI than historically reported may be warranted. This study also helps to validate prior reports that OI is useful as a severity score for clinical research and outcome prediction.

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Nelson, Diane L. "Pulmonary Drug Delivery via Reverse Perfluorocarbon Emulsions: A Novel Method for Bacterial Respiratory Infections and Acute Respiratory Failure." Research Showcase @ CMU, 2018. http://repository.cmu.edu/dissertations/1147.

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Inhaled drug delivery is currently the gold standard for treating many respiratory diseases. However, improved treatments are needed for lung diseases like Cystic Fibrosis (CF) and Acute Respiratory Distress Syndrome (ARDS), where mucus or fluid build-up in the lung limits ventilation and, thus, delivery of inhaled drugs. Delivery is most needed in the diseased or damaged regions of the lung, but if an area is not ventilated, inhaled drug will simply not reach it. To overcome this, this research proposes delivering drugs to the lungs within a perfluorocarbon (PFC) liquid. The lungs will be filled with a reverse emulsion containing a disperse phase of aqueous drugs within the bulk PFC and then ventilated. The PFC functions as both a respiratory medium, providing gas exchange, and as a delivery vehicle, providing a more uniform deposition of drugs. After treatment, the highly volatile PFCs are exhaled, returning the patient to normal respiration. This technique improves upon current therapies as follows. First, drugs are delivered directly to where they are needed, yielding higher concentrations in the lung and lower systemic concentrations. Second, PFCs are ideal for washing out lung exudate and mucus. The low surface tension and high density of PFC allows it to easily penetrate plugged or collapsed alveoli, detach infected mucus from the airway walls, and force these fluids to the top of the lungs where they can then be removed via suction. Mucus and exudate removal should allow drugs to penetrate previously plugged airways during emulsion delivery and subsequent treatment with inhaled therapies. Thus, drug delivery via emulsion would be used as a pre-treatment to enhance inhaled or systemic drug therapy. Third, PFC’s anti-inflammatory properties help return to normal lung function. This research examines two applications of this technology: delivery of antibiotics to combat respiratory infections (antibacterial perfluorocarbon ventilation, APV) or delivery of growth factors to enhance alveolar repair (perfluorocarbon emulsions for alveolar repair, PEAR). This work represents an in-depth analysis of the emulsions used during APV and PEAR. Initial efforts evaluated emulsion efficacy under in vitro setting that better simulated lung in vivo antibiotic delivery. The subsequent studies utilized an in vivo rat model of bacterial respiratory infection to validate the effects of emulsion on pharmacokinetics and to assess APVs potential treatment benefits. Lastly, in vitro methods of cellular response assessed the utility of delivering growth factors in PEAR. Significant advancements were made in optimizing the emulsion as a viable means of pulmonary drug delivery. Final efforts resulted in a promising emulsion formulation that overcame the quick transport of tobramycin away from the lung and successfully reduced pulmonary bacterial load in vivo. In vitro applications of PEAR showed the emulsions posed a significant barrier to the availability and, thus, the biological effect of lysophosphatidic acid growth factors. Further in vivo work is required to improve APV’s efficacy over conventional treatments and to determine PEAR’s feasibility and efficacy in promoting lung repair.

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Boyarskiy, O. O., O. O. Tikhonova, G. O. Solomennyk, and O. I. Mohylenets. "Features of acute respiratory viral infections in patients with congenital syndrome of immune-endocrine failure." Thesis, Sumy State University, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47814.

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Congenital syndrome of immune-endocrine insufficiency (CSIEI) is the type of constitution that is morphologically characterized by primary hyperplasia of the thymus, generalized hyperplasia of lymphoid tissue, adrenal hypoplasia in combination with various anomalies of cardiovascular, and less frequently of urogenital systems. Features of CSIEI in a functional sense are the failure of infectious and immune violations of adaptation under stress. Endocrine failure, which occurs in patients with CSIEI, usually go unnoticed in the outpatient setting and in the ICU appears addisonian crisis with hypovolemia and shock, which are resistant to treatment. Objective: to develop criteria for lifetime diagnosis and prevention CSIEI.

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ZAMBELLI, VANESSA. "Pet imaging for evaluation of inflammatory response in a murine model of acute respiratory failure." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2013. http://hdl.handle.net/10281/43295.

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Background: Acute Respiratory Distress Syndrome (ARDS) is a life-threatening form of acute respiratory failure, with a still high mortality. Aspiration pneumonitis is a clinical disorder that, entailing a direct lung injury, is associated to ARDS. It is characterized by an acute inflammatory response with neutrophilic recruitment into the lung and a late fibrotic evolution of injury. This study investigates whether the use of PET could allow to monitor this inflammatory response and its correlation with the later fibroproliferative phase in an experimental model of acute respiratory failure. Since to date no specific therapeutic strategies are available for ARDS patients, we tested the effects of exogenous surfactant treatment on lung injury evolution, by monitoring it with CT-PET imaging. Methods: Hydrochloric acid (0,1M) was instilled (1,5 ml/kg) into the right bronchus of mice. The study was divided into three parts. Time-course experiment: four groups of mice underwent micro-CT and micro-PET scans and sacrificed at different time point (6hrs, 24 hrs, 48 hrs and 7 days after surgery) to assess arterial blood gases, histology and bronchoalveolar lavage (BAL). Long-term experiment: one group of mice underwent a micro-CT scan 1 hour after lung injury and a series of [18F]FDG-PET at the same time points. 21 days after respiratory static compliance was measured and lung tissue was collected in order to measure the OH-proline content. Treatment experiment: two groups of mice were treated with exogenous surfactant (Curosurf ®) or vehicle (sterile saline 0.9 %) three hours after HCl instillation. Animals underwent micro-CT and a series of micro-PET scans. 21 days after they were sacrificed to measure lung mechanics and collagen deposition. Results: Histological analysis showed a rapid recruitment of neutrophils into the damaged lung 6 hours after injury, with a peak after 24 hours. Macrophages, as expected, reached the peak after 48 hours. [18F]FDG signal, as inflammation marker, showed similar time course to that of recruited inflammatory cells (sum of two cell types). Mice that were sacrificed 21 days after the surgery were characterized by a correlation between a reduced respiratory static compliance and a high PET signal 7 days after lung injury. PET signal correlated also with collagen content. This correlation was confirmed in treatment experiment, in which we found that exogenous surfactant administration improved lung fibrotic evolution, by reducing collagen deposition. Conclusions: This study demonstrated the possibility to use PET imaging to follow the inflammatory response also in longitudinal studies. Moreover a correlation between a persistence of inflammatory process and fibrotic evolution was showed. We speculate that it is possible that acute treatments of the inflammation capable of reducing the fibroproliferative process, could be monitored using the FDG-PET method.

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Van, der Schyff Nasief. "Risk factors for prolonged ventilation in patients with chronic obstructive pulmonary disease presenting with acute respiratory failure." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/12112.

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Includes abstract.
Includes bibliographical references (leaves 35-37).
Patients with COPD presenting to the Emergency Unit with acute hypercapnic respiratory failure often require invasive mechanical ventilation and subsequent admission to the intensive care unit (ICU). These patients are at an increased risk of prolonged and complicated ventilation and often experience weaning difficulties. In addition, the impact of a previous episode of pulmonary tuberculosis that might have resulted in structural lung disease on the duration of mechanical ventilation in such patients has not previously been evaluated. Methods: All patients with COPD admitted to the Respiratory ICU at Tygerberg academic hospital from the 01st January 2004 until 31st December 2007 requiring intubation and invasive mechanical ventilation for acute hypercapnic respiratory failure were included in the study.

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Balfour, Liezl. "Development of a clinical pathway for non-invasive ventilation in a private hospital in Gauteng." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/30377.

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Despite the advantages of using NIV, healthcare professionals are not in agreement about precisely when to commence NIV (Elliott, Confalonieri& Nava 2002:1159; Lightowler, Wedzicha, Elliott&Ram 2003: [4]; Garpestad &Hill 2006:147), which adds to the underutilisation of NIV. The aim of this study was to collaboratively develop a clinical pathway for NIV. Two main objectives were identified, namely (i) to identify the components of a clinical pathway for NIV, and (ii) to develop a clinical pathway for NIV that can be implemented in the CCU. The research design utilised for this study was qualitative, contextual, explorative and descriptive in nature. The study consisted of three phases, namely Phase 1: Components of the clinical pathway, Phase 2: Literature control, and Phase 3: Development of the clinical pathway. The objectives of the study were met, and a clinical pathway for NIV was developed.
Dissertation (MCur)--University of Pretoria, 2011.
Nursing Science
unrestricted

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Steinhorst, Renata Campos. "Influência dos procedimentos hemodialíticos na mecânica respiratória em pacientes com insuficiência renal, aguda ou crônica, sob ventilação mecânica invasiva." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5148/tde-04012007-170650/.

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Introdução: A insuficiência renal (IRen) aguda ou renal crônica podem levar a complicações respiratórias, que podem culminar com insuficiência respiratória aguda (IRpA), severa hipoxemia e alterações de mecânica respiratória (MR). O tratamento hemodialítico, pode desencadear um processo inflamatório pulmonar entretanto, a correção da hipervolemia que proporciona, pode melhorar a IRpA. O objetivo deste estudo foi avaliar a influência da hemodiálise (HD) na MR de pacientes com IRen sob ventilação mecânica invasiva (VMI). Materiais e Métodos: Pacientes com IRen, idade 18 a 75 anos, em VMI e em HD. Parâmetros analisados: clínicos gerais, laboratoriais (hemograma, gasometria arterial, função renal), características da HD e MR (complacência estática e dinâmica, e resistência do sistema respiratório). Os parâmetros foram analisados antes do início da HD e 4 horas após seu início. Resultados: (média ± DP) Foram analisados 37 pacientes, idade 51 ± 17 anos. Houve perda de peso, e melhora dos parâmetros laboratoriais (p < 0,05) exceto a PaO2 e a saturação de O2. A HD não alterou a pressão arterial e nem a MR, porém o delta da complacência dinâmica apresentou correlação com o delta de creatinina (p = 0,02). Conclusão: A HD por 4 horas não altera a MR de pacientes sob VMI.
Introduction: Renal failure (RF), acute or chronic, can induce respiratory complications that can evolve to acute respiratory failure (ARpF), hypoxemia and severe changes in respiratory mechanics (RM). Hemodialysis (HD) can produce pulmonary inflammation and worse the ARpF. On other hand, HD corrects hypervolemia and thus can improve the ARpF. The objective of this study was evaluating the HD role in RM of RF patients in use of invasive mechanical ventilation (IMV). Materials and Methods: Patients with RF, age 18 to 75 years, in use of IMV and HD. Analyzed parameters: age, gender, HD characteristics, respiratory and renal laboratory tests, and RM evaluation (static and dinamic compliance and resistence). Parameters were evaluate before HD and 4 hours after it started. Results (mean ± SD): We studied 37 patients, age 51 ± 17 years. During HD the patients lost body weight and presented an improvement in pulmonary and renal parameters (p < 0.05) except for PaO2 and arterial O2 saturation (p > 0.05). HD did not induce hemodynamic instability. There was correlation (p = 0.02) between the changes in plasma creatinine and the changes in dynamic compliance. Conclusion: HD for 4 hours did not modify respiratory mechanics in patients in use of IMV.

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Deshpande, Gaurang. "Testing metabolic and pharmacological agents for recovery following de novo acute heart failure in an isolated rat heart model." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/18610.

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Acute heart failure is a potentially lethal clinical emergency without any effective therapy. Using an isolated rat heart model, we established and validated a model of de novo acute heart failure to study novel putative cardio protective therapies against acute heart failure, including glucose, insulin and the molecular agent sphingosine-1-phosphate(component of high density lipoprotein) for recovery. In isolated rat hearts, the protocol consisted of three phases: stabilization at normotensive perfusion pressure, hypotensive acute heart failure and recovery by restoring normotension. Low glucose (2.5mM) and high albumin-bound free fatty acids (1.3mM) (±adrenaline 10-M) were added in theperfusate. Molecular and metabolic agents were administered either alone or in combination in the acute heart failure or recovery phases. Effects of glucose, insulin and sphingosine-1-phosphatewere observed on heart function, cell death and mitochondrial respiration. In the absence of adrenaline, combination of glucose andsphingosine-1-phosphateduring acute heart failure improved functional recovery by increasing the heart rate. In the presence of adrenaline, glucose and sphingosine-1-phosphate administered separately were cardioprotective in the recovery phase by improving heart rate. The combination of glucose+insulin and glucose+sphingosine-1-phosphate in the recovery phase also increased heart rate. Glucos9+sphingosine-1-phosphate+insulin increased heart rate and left ventricular developed pressure.Sphingosine-1-phosphate reduced expression of cytochrome C, but metabolic agents had no effect.AG490 (inhibitor of signal transducer and activator of transcription 3) attenuated the cardio protective effect of sphingosine-1-phosphatewithincreased expression of the phosphorylated inactive form of this transcription factor protein. Conclusion: We have established and validated an ex-vivo model of de novoacute heart failure. The combination of metabolic and molecular treatments improved heart function by increasingsinus node activity_ Sphingosine-1-phosphate not only improved heart rate, but also reduced cell death, an effect mediated via activation of signal transducer and activator of transcription 3. Our data provide novel principles and approaches for the treatment of acute heart failure.

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Wigger, Olivier. "Usefulness of a clinical diagnosis of critical illness polyneuro-myopathy in patients with SIRS and acute respiratory failure to predict outcome /." Bern : [s.n.], 2008. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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Dial, M. S. (Mary Sandra). "The effectiveness of mask continuous positive pressure in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease /." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33746.

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Context. Exacerbations of chronic obstructive lung disease (COPD) that result in acute respiratory failure are a significant health care problem with high morbidity and mortality. Recent reports have shown that preventing intubation with the use of non-invasive positive pressure ventilation significantly decreases the morbidity and mortality associated with respiratory failure in this population.
Objective. To evaluate whether patients with COPD and acute respiratory failure treated with non-invasive continuous positive airway pressure (CPAP) have improved clinical outcomes after adjusting for potentially confounding covariates when compared to similar patients who were intubated or treated with medical therapy.
Design and setting. Comparison of three retrospective cohorts, one in which CPAP was routinely available and two in which CPAP were not available for the management of this type of patient. Data were collected on all patients admitted to two ICU's in tertiary care teaching hospitals during the time periods defined by the cohorts.
Population. Two hundred and thirty-eight patients with chronic obstructive lung disease and acute respiratory failure admitted to two intensive care units between January 15th 1985 to December 31st 1995. (Abstract shortened by UMI.)

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Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

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Fisher, Kimberly A. "Impact of COPD on the Mortality and Treatment of Patients Hospitalized with Acute Decompensated Heart Failure (The Worcester Heart Failure Study): A Masters Thesis." eScholarship@UMMS, 2007. http://escholarship.umassmed.edu/gsbs_diss/717.

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Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

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Muguruma, Kohei. "The epidemiology and volume-outcome relationship of extracorporeal membrane oxygenation for respiratory failure in Japan: A retrospective observational study using a national administrative database." Kyoto University, 2020. http://hdl.handle.net/2433/253494.

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Mildner, Reinout Joannes. "The resolution of acute lung inflammation in infants with severe respiratory failure treated with extra-corporeal membrane oxygenation, studied by non-bronchoscopic bronchoalveolar lavage." Thesis, University of Leicester, 2003. http://hdl.handle.net/2381/29434.

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Mortamet, Guillaume. "Evaluation du travail respiratoire dans l'insuffisance respiratoire aigue de l'enfant." Thesis, Paris Est, 2018. http://www.theses.fr/2018PESC0010/document.

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Chez l’enfant, l’insuffisance respiratoire aiguë est responsable de la majeure partie des admissions en soins intensifs. La population pédiatrique étant marquée par une grande hétérogénéité en termes d’âge, de pathologie respiratoire et de maturation pulmonaire, une individualisation de la prise en charge thérapeutique est indispensable. Dans ce contexte, différents outils sont disponibles pour évaluer de manière plus objective le travail respiratoire du patient en insuffisance respiratoire aiguë. Objectifs - Le principal objectif de la thèse est d’évaluer l’intérêt diagnostique et thérapeutique de la mesure du travail respiratoire dans l’insuffisance respiratoire aiguë hypercapnique de l’enfant.Méthodes - Trois principaux outils d’évaluation du travail respiratoire ont été utilisés dans nos travaux : la mesure des pressions œsogastriques, la mesure de l’activité électrique du diaphragme et la mesure de la consommation en oxygène par la calorimétrie.Résultats - Nous avons pu mettre en évidence les intérêts de ces outils de mesure aux différents stades d’évolution de la maladie : (i) à la phase initiale pour indiquer l’initiation d’une ventilation non invasive et pour optimiser ces réglages ; (ii) à la phase d’évolution de la maladie pour évaluer l’interaction patient-ventilateur ; (iii) à la phase de sevrage ventilatoire pour détecter précocement une augmentation du travail respiratoire.Conclusion - Tout au long du processus évolutif de la maladie, la surveillance objective du travail respiratoire peut aider à comprendre les mécanismes de la maladie pulmonaire, optimiser les réglages de l’assistance respiratoire, et adapter les interventions thérapeutiques
Acute respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit and is associated with significant morbidity and mortality. Since the pediatric population is characterized by a great heterogeneity in terms of age and respiratory pathology, individualization of therapeutic management is essential. Different minimally invasive methods have been described to assess the patient's work of breathing in acute respiratory failure.Objectives - The main objective of the project was to assess the diagnostic and therapeutic contribution of the measurement of the work of breathing in children with acute hypercapnic respiratory failure.Methods - We used in the present work three tools to assess the work of breathing: oesogastric pressures, electrical activity of the diaphragm monitoring and oxygen consumption measurements.Results - We highlighted how these different methods are valuable during the ICU stay: (i) in the early phase of the disease to initiate or withdraw noninvasive ventilation and to optimize its settings; (ii) in the recovery phase to evaluate the patient-ventilator interaction; (iii) during the weaning process to early detect an increase in work of breathing.Conclusion - Throughout the disease process, the work of breathing assessment can be useful to enhance our understanding of the pathophysiology of lung disease, to optimize mechanical ventilation settings and adapt therapeutic interventions

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Boissier, Florence. "Dysfonction vasculaire pulmonaire et ventriculaire droite au cours du SDRA : approche échocardiographique." Thesis, Paris Est, 2014. http://www.theses.fr/2014PEST0057.

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Contexte: Le syndrome de détresse respiratoire aigüe (SDRA) est associé à une dysfonction vasculaire pulmonaire. Objectifs: Préciser le retentissement cardiaque de cette dysfonction vasculaire pulmonaire en recherchant la fréquence et le pronostic du foramen ovale perméable, du passage transpulmonaire de bulles en échographie de contraste, du cœur pulmonaire aigu (CPA), de la dysfonction systolique ventriculaire droite ainsi que de la déformation ventriculaire gauche au cours du SDRA. Nous avons aussi évalué la tolérance hémodynamique de la ventilation en Pression Expiratoire Positive (PEP) élevée. Méthodes: Les explorations étaient menées par échographie trans-œsophagienne (ETO) traditionnelle et en signature acoustique. Résultats: La faisabilité de l'ETO en décubitus ventral est bonne. Le foramen ovale perméable, détecté chez 19% des patients, est associé à une moins bonne réponse à l'augmentation de la PEP et à un recours aux thérapeutiques de sauvetage plus fréquent. Le passage de bulles transpulmonaire ne rend pas compte du seul shunt intra-pulmonaire anatomique, et dépend plus des conditions hémodynamiques (augmentation du débit cardiaque associée au sepsis) que de la ventilation. Le CPA, retrouvé chez 22% des patients, est associé à une pression motrice plus élevée, et au sepsis ; il est fréquemment associé à une insuffisance circulatoire, avec une mortalité plus élevée à J28. La quantification de la déformation ventriculaire gauche systolique par l'index d'excentricité est un bon marqueur de CPA, mais pas la dysfonction contractile ventriculaire droite évaluée en signature acoustique. Enfin, nous n'avons pas retrouvé de lien robuste entre la tolérance hémodynamique et l'efficacité respiratoire (recrutement alvéolaire) des niveaux de PEP élevés, sous réserve d'un nombre limité de patients. Conclusion: Les conséquences cardiaques de la dysfonction vasculaire pulmonaire restent fréquentes et associées à un pronostic péjoratif, avec des implications respiratoires et circulatoires
Context: Acute respiratory distress syndrome (ARDS) leads to pulmonary vascular dysfunction Aims: We assessed cardiac consequences of pulmonary vascular dysfunction by detecting patent foramen ovale and transpulmonary bubbles transit using contrast echocardiography, acute cor pulmonale, right ventricle systolic dysfunction and left ventricle deformation during ARDS. We also assessed hemodynamic tolerance of high positive end expiratory pressure (PEEP). Methods: Transesophageal echocardiography (TEE) was performed with standard measurements and speckle tracking. Results: TEE could be safely performed in prone position. Patent foramen ovale was detected in 19% of patients, and was associated with a poor oxygenation response to PEEP, and greater use of adjunctive interventions. Transpulmonary bubbles transit was not solely related to anatomical intrapulmonary shunt, but was merely influenced by hemodynamic status (increased cardiac output associated with sepsis). Acute cor pulmonale occurred in 22% of patients, and was associated with a higher driving pressure and with sepsis; it was often associated with circulatory failure, with higher day-28 mortality. Left ventricle systolic deformation (evaluated by eccentricity index) but not right ventricle contractile impairment (evaluated with speckle tracking) was associated with acute cor pulmonale. Finally, we did not find a robust relation between hemodynamic tolerance and alveolar recruitment with higher PEEP levels, but the limited number of patients restricted the power of the analysis. Conclusion: Cardiac consequences of pulmonary vascular dysfunction remain frequent and associated with a poorer prognosis, with respiratory and circulatory implications

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Mazo, Torre Cristopher Alan. "Biomarcadores asociados a complicaciones del postoperatorio inmediato y tardío que condicionan el reingreso en la unidad de cuidados intensivos del paciente trasplantado de pulmón." Doctoral thesis, Universitat Autònoma de Barcelona, 2020. http://hdl.handle.net/10803/670656.

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Aquesta tesi inclou dos estudis que fan noves contribucions al coneixement sobre les causes, el pronòstic i el maneig de la insuficiència respiratòria aguda en el pacient amb trasplantament de pulmó. L’estudi 1 va ser el primer estudi prospectiu en mostrar una associació entre els nivells de procalcitonina (PCT) durant el període postoperatori (72h) i la funció de l’empelt a les 72h del trasplantament. Es va demostrar que un punt de tall de PCT<2 ng/ml dins de les primeres 24h té un alt valor per excloure la disfunció primària de l’empelt (DPE) grau 3 a les 72h i per predir la supervivència a la UCI. A més, tant la PCT com la IL-10 a les 48h es van associar amb una funció de l’empelt millor un any després de la cirurgia. L’estudi 2 ha estat l’estudi prospectiu multicèntric més gran fet fins ara, sobre trasplantats de pulmó que reingressen a la UCI més enllà del període postoperatori. La insuficiència respiratòria aguda va ser el principal condicionant de reingrés i es va associar amb una alta mortalitat. La pneumònia bacteriana es va identificar com la causa principal reingrés (i un factor de risc independent de mortalitat) a la UCI, essent P. aeruginosa el principal patogen, mentre l’aspergil·losi, P. jiroveci i els virus respiratoris (inclosa la grip) van ser causes poc prevalents. El rebuig de l’empelt va ser relativament infreqüent (només el 5% dels pacients van ingressar per rebuig agut de l’empelt), i la presència d’anticossos específics anti-HLA de el donant abans de l’admissió a la UCI no va influir en els resultats. En contrast, la DCE es va identificar com un predictor significatiu de mort; la supervivència es va correlacionar inversament amb la gravetat de l’obstrucció en el fenotip obstructiu, i el fenotip restrictiu s’ha de considerar com una indicació per a cures pal·liatives.
Esta tesis incluye dos estudios que hacen nuevas contribuciones al conocimiento sobre las causas, el pronóstico y el manejo de la insuficiencia respiratoria aguda en el paciente con trasplante de pulmón. El estudio 1 evalúa la asociación de los niveles plasmáticos de procalcitonina (PCT), IL-6-8-10 a las 24h, 48h y 72h en adultos después del trasplante, con la mortalidad en la UCI, la oxigenación, el diagnóstico y la gravedad de la disfunción primaria del injerto (DPI) y la función de injerto un año después del trasplante. Se incluyeron consecutivamente, 100 pacientes al ingresar en la UCI después del trasplante en el Hospital Universitario Vall d´Hebron y fueron seguidos por un año. Unos niveles más elevados PCT a las 24h se asoció con una relación PaO2/FIO2 más baja y la persistencia de DPI grado 3 a las 72h después del trasplante (p <0.05). La PCT a las 24h fue mayor en los 9 pacientes fallecidos (2,90 vs 1,47 ng/ml, p <0,05), con un AUC =0,74 para predecir la mortalidad en la UCI. Todos los pacientes con PCT <2 ng/ml a las 24h del trasplante, sobrevivieron en la UCI (p <0,05). La PCT y la IL-10 a las 48h se correlacionaron con el VEMS (rho = -0.35) y la CVF (rho = -0.29) al año del trasplante. (p <0,05). Este fue el primer estudio prospectivo en mostrar una asociación entre los niveles plasmáticos de PCT durante el período postoperatorio (72h) y la función del injerto a las 72h del trasplante. Se demostró que un punto de corte de PCT < 2 ng/ml dentro de las primeras 24h tiene un alto valor para excluir la DPI grado 3 a las 72h y para predecir la supervivencia en la UCI. Además, tanto la PCT como la IL-10 a las 48h se asociaron con una función del injerto significativamente mejor un año después de la cirugía. El estudio 2 pretende identificar las principales causas de reingreso y los predictores independientes de mortalidad en la UCI de adultos trasplantados de pulmón (objetivo principal). Se incluyeron prospectivamente a todos los adultos trasplantados que reingresaron en la UCI después del alta postoperatoria entre 2012 y 2016, en los 5 principales centros de trasplante de España. Los pacientes fueron seguidos hasta el alta hospitalaria o la muerte. Ciento cincuenta y tres trasplantados presentaron 174 reingresos en la UCI con una mediana de seis meses [RIQ 2-25] posterior al trasplante. Treinta y nueve (25.5%) receptores presentaron disfunción crónica del injerto (DCI), 13 de los cuales (todos fallecieron) tenían síndrome restrictivo del injerto (SRI). La insuficiencia respiratoria aguda (110, 71,9%) fue el principal condicionante de reingreso en UCI. El rechazo del injerto (seis, 5% agudo) causó solo 12 (11%) reingresos, mientras que la neumonía (56, 36,6%) fue la causa principal (50 ingresaron por insuficiencia respiratoria y 6 por shock), siendo P. aeruginosa (50% multirresistentes) el patógeno predominante. Cincuenta y cinco (35.9%) receptores murieron en la UCI y 69 (45.1%) en el hospital. En el análisis multivariante, el síndrome de bronquiolitis obliterante (BOS) estadio 2 (OR ajustado: 7.2 (1-65.7)), BOS estadio-3 (aOR: 13.7 (2.5-95.3)), SRI (aOR: > 50) y la neumonía al ingreso en la UCI (aOR : 2.5 (1-7.1)) se identificaron como predictores independientes de mortalidad en la UCI. Solo ocho (5%) pacientes tenían anticuerpos específicos anti-HLA del donante positivos, previo al reingreso en la UCI, y esta variable no afectó al modelo. Este ha sido el estudio de cohorte prospectivo multicéntrico más grande hecho hasta la fecha, sobre trasplantados de pulmón que reingresan en la UCI más allá del período postoperatorio. La insuficiencia respiratoria aguda
This thesis includes two studies that make new contributions to the knowledge on the causes, prognosis and management of acute respiratory failure in the patient with lung transplantation (LT). Study 1 was designed to evaluated the association of procalcitonin (PCT), IL-6-8-10 plasma levels at 24h, 48h and 72h in adults after LT with ICU-mortality, oxygenation, diagnosis and severity of primary graft dysfunction (PGD), and one-year graft function after LT. One hundred LT patients were enrolled consecutively at ICU admission following LT in Vall d’Hebron University Hospital and followed until one year after the transplant. Higher PCT levels at 24h were associated with lower PaO2 / FIO2 ratio and Grade 3 PGD over the first 72h after LT (p <0.05). PCT at 24h was higher in the 9 patients who died (2.90 vs 1.47 ng/mL, p <0.05), with AUC = 0.74 for predicting ICU-mortality. All patients with PCT < 2 ng/ml at 24h following LT, survived in the ICU (p <0.05). PCT and IL-10 at 48h were correlated with FEV1 (rho = -0.35) and FVC (rho = -0.29) one year after LT. (p <0.05). This was the first prospective study showing an association between the PCT plasma levels in the post-operative period (72h) and graft function at 72h after LT. Results showed that a breakpoint of PCT < 2 ng/mL within 24h has a high predictive value to exclude grade 3 PGD at 72h and for ICU-survival. Moreover, both PCT and IL-10 within 48 hours were associated with significantly better graft function one year after surgery. Study 2 aimed to assess the main causes of intensive care readmissions (ICUr) in LT adults and to identify independent predictors of ICU-mortality (primary end-point). This Spanish 5-centre prospective cohort study enrolled all LT adults with ICUr after post-LT ICU discharge, between 2012 and 2016. Patients were followed until hospital discharge or death. One hundred and fifty-three LT recipients presented 174 ICUr a median of six months [IQR 2-25] post-LT. Chronic lung allograft dysfunction (CLAD) was reported in 39 (25.5%) recipients, 13 of whom (all exitus) had restrictive allograft syndrome (RAS). Acute respiratory failure (ARF) (110, 71.9%) was the main condition requiring ICUr. Graft rejection (six, 5% acute) caused only 12 (11%) admissions whereas pneumonia (56, 36.6%) was the main cause (50 admitted for ARF and 6 for shock), with P. aeruginosa (50% multidrug-resistant) being the predominant pathogen. Fifty-five (35.9%) and 69 (45.1%) recipients died in the ICU and the hospital respectively. Bronchiolitis obliterans syndrome (BOS) stage-2 (adjusted-OR: 7.2 (1-65.7)), BOS stage-3 (aOR: 13.7 (2.5-95.3)), RAS (aOR: >50) and pneumonia at ICUr (aOR: 2.5 (1-7.1)) were identified in multivariate analyses as independent predictors of ICU mortality. Only eight (5%) patients had positive donor-specific antibodies (DSA) prior to ICUr, and this variable did not affect the model. This was the largest prospective, multi-centre cohort study to date on LT recipients in the ICU beyond the post-operative period. ARF was the main condition requiring ICUr in LT recipients, and was associated with high mortality. Importantly, bacterial pneumonia was identified as the main cause of ICUr (and an independent risk factor for ICU-mortality), with P. aeruginosa being the main pathogen. Aspergillosis, P. jiroveci and respiratory virus pulmonary infections (including influenza) were unlikely causes of severe ARF. Graft rejection was relatively infrequent (only 5% of patients were admitted for acute allograft rejection), and presence of DSA before ICU admission did not influence outcomes. In contrast, CLAD was identified as a significant predictor of death; survival was inversely correlated with severity of obstruction in the BOS phenotype, and the RAS phenotype should be considered as an indication

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Passarini, Juliana Nalin de Souza 1977. "Ventilação não invasiva (VNI) em emergência : preditores de sucesso ou insucesso em casos de insuficiência respiratória aguda decorrente oo edema agudo de pulmão (EAP) e exacerbação da doença pulmonar obstrutiva crônica (DPOC) = Noninvasive ventilation (NIV) in emergency : predictors of success or failure in cases of acute respiratory failure arising out of acute pulmonary edema (EAP) and exacerbation of chronic obstructive pulmonary disease (COPD)." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309758.

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Orientadores: Ivete Alonso Bredda Saad, Lair Zambon
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-21T00:25:19Z (GMT). No. of bitstreams: 1 Passarini_JulianaNalindeSouza_M.pdf: 2072157 bytes, checksum: 3d2a54d3e91c2db910e546c24bcdb356 (MD5) Previous issue date: 2012
Resumo: O objetivo deste estudo foi analisar os casos de insuficiência respiratória aguda (IRpA) decorrente do Edema Agudo de Pulmão (EAP) e agudização da Doença Pulmonar Obstrutiva Crônica (DPOC) submetidos a ventilação mecânica não invasiva (VNI) a fim de identificar fatores associados ao sucesso ou insucesso do método em um serviço de urgência e emergência. Trata-se de um estudo descritivo e analítico prospectivo. Estabeleceu-se uma pressão expiratória entre 5 e 8 cmH2O, e pressão inspiratória entre 10 e 12 cmH2O, com suplementação de oxigênio para manter a saturação periférica de oxigênio (SpO2) superior a 90%. A variável desfecho considerada foi a intubação endotraqueal (IE). Foram incluídos 152 pacientes, o tempo de VNI foi de 10 horas para os pacientes com DPOC (n=60) e de 7,5 para os pacientes com EAP (n=92). Foi observada diferença estatisticamente significante nos pacientes que evoluíram para IE quanto menor SpO2 e pior escore de APACHE II (p<0,001). O uso de BiPAP mostrou 2,3 vezes mais chance de ocorrência de IE em comparação com os pacientes que usaram CPAP (p=0,032). Entre os pacientes com diagnóstico de EAP a chance de evolução para IE foi 63% menor. Dos 152 casos, 75,7% evoluíram com sucesso. As variáveis associadas a IE foram taquipneia, SpO2 abaixo de 80%, pacientes que receberam BiPAP, com maior valor de APACHE II, menor valor de escala de coma de Glasgow (ECG) e aqueles com diagnóstico de DPOC
Abstract: The objective of this study was to analyze the cases of acute respiratory failure (ARF) due to acute pulmonary edema and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) undergoing noninvasive ventilation (NIV) to identify factors associated with success or failure of the method in an emergency department. This is a prospective descriptive and analytical study. It was established an expiratory pressure of 5 to 8 cmH2O, inspiratory pressure of 10 to 12 cmH2O and supplemental oxygen to maintain oxygen saturation (SpO2) above 90%. The outcome variable was considered endotracheal intubation (EI). The study included 152 patients NIV time was 10 hours for COPD patients (n = 60) and 7.5 hours to APE patients (n = 92). Statistically significant difference was observed in patients who developed EI for the lower SpO2 and worse APACHE II score (p <0.001). The use of BiPAP showed 2.3 times greater chance of occurrence of IE compared with patients who used CPAP (p = 0.032). Among patients diagnosed with EAP the chance of developing into IE was 63% lower. Of the 152 cases, 75.7% progressed successfully. Variables associated with IE were tachypnea, SpO2 below 80%, patients who received BiPAP, with the highest APACHE II, lower value of Glasgow coma scale (GCS) and those diagnosed with COPD
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências

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Darmon, Michaël. "Outils d'évaluation de la réponse rénale aux agressions chez le patient de réanimation." Thesis, Paris Est, 2010. http://www.theses.fr/2010PEST0038.

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Palanca, Arias Daniel. "Valor predictor del cociente saturación hemoglobina/fio2 en pacientes pediátricos con insuficiencia respiratoria aguda debida a neumonía tratados con ventilación no invasiva. Predictive value of the pulse oximetric saturation/fraction of inspired oxygen ratio in pediatric patients with acute respiratory failure due to pneumonia treated with non-invasive ventilation." Doctoral thesis, Universidad de Cantabria, 2014. http://hdl.handle.net/10803/276848.

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El uso de la ventilación no invasiva (VNI) en pacientes con fracaso respiratorio hipoxémico debido a neumonía es controvertido, alcanzando elevadas tasas de fracaso en el Síndrome de Distrés Respiratorio Agudo (SDRA). Recientemente, el cociente SpO2/FiO2 (SF) se ha equiparado al cociente paO2/FiO2 (PF) para la valoración del SDRA. Determinamos en una cohorte de pacientes, diagnosticados de neumonía y tratados con VNI, si el cociente SF es una variable con valor predictor de fracaso durante las primeras horas y clasificamos mediante dicho cociente el SDRA según la última definición de Berlín (leve, moderado, grave) para identificar aquellos pacientes de mayor riesgo. La tasa global de éxito de la VNI fue del 77%. Tanto el cociente SF como la FC a las 2h se identificaron como factores predictores independientes de fracaso. El diagnóstico de SDRA mediante el cociente SF, podría utilizarse para identificar a una población más susceptible de fracaso.
The use of non-invasive ventilation (NIV) in patients with hypoxemic acute respiratory failure (ARF) due to pneumonia is discussed. The most frequent cause of ARF was pneumonia and acute respiratory distress syndrome (ARDS) was the main cause of treatment failure. A good correlation between SF ratio (SpO2/FiO2) and PF ratio (paO2/FiO2) was recently confirmed. We aimed to evaluate if the SF ratio is a reliable predictive factor for NIV failure in pediatric patients with moderate hypoxemic ARF due to pneumonia and could classify ARDS according to the recent Berlin definition (mild, moderate and severe) to identify high-risk children. Our NIV success rate was 77%. SF ratio and heart rate at two hours were found to be independent predictors of NIV failure. The diagnosis of ARDS based on the SF ratio was not identified as an independent NIV outcome predictor. However, it may be useful in classifying high-risk children.

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Rozé, Hadrien. "Activité électrique diaphragmatique au cours du sevrage ventilatoire après insuffisance respiratoire aigue." Thesis, Bordeaux, 2014. http://www.theses.fr/2014BORD0293/document.

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Le contrôle de la ventilation procède d’une interaction complexe entre des efférences centrales à destination des groupes musculaires ventilatoires et des afférences ventilatoires provenant de mécano et de chémorécepteurs. Cette commande de la ventilation s’adapte en permanence aux besoins ventilatoires. L’activation électrique du diaphragme (EAdi) informe sur la commande ventilatoire, la charge des muscles respiratoires, la synchronie patient-ventilateur et l’efficacité de la ventilation des patients de réanimation. L’utilisation inadaptée d’un mode deventilation spontanée avec une sur ou sous-assistance peut entrainer des dysfonctions diaphragmatiques, des lésions alvéolaires et des asynchronies. La première étude a permis de cibler l’assistance du mode NAVA en fonction de l’EAdi enregistrée lors d’un échec de test de sevrage. Nous avons observé une augmentation quotidienne de cette EAdi au cours du sevrage jusqu’à l’extubation. La deuxième étude a montré que cette augmentation n’est pas associée à une modification de l’efficacité neuro-ventilatoire lors du test de sevrage, possiblement en rapport avec l’inhibition d’une sédation résiduelle. La troisième étude a montré l’importance de l’inhibition de cette sédation résiduelle par midazolam sur l’EAdi et le volume courant au début du sevrage ainsi que la corrélation qui existe entre les deux. Une dernière étude a montré l’absence d’augmentation du volume courant sous NAVA chez des patients transplantés pulmonaires aux poumons dénervés sans réflexe de Herring Breuer par rapport à un groupe contrôle. Par ailleurs le volume courant sous NAVA était corrélé à la capacité pulmonaire totale. Ces études ont montré l’intérêt du monitorage l’EAdi dans le sevrage
The control of breathing results from a complex interaction involving differentrespiratory centers, which feed signals to a central control mechanism that, in turn, provides outputto the effector muscles. Afferent inputs arising from chemo- and mechanoreceptors, related to thephysical status of the respiratory system and to the activation of the respiratory muscles, modulatepermanently the respiratory command to adapt ventilation to the needs. Diaphragm electricalactivation provides information about respiratory drive, respiratory muscle loading, patientventilatorsynchrony and efficiency of breathing in critically ill patients. The use of inappropriatelevel of assist during spontaneous breathing with over or under assist might be harmful withdiaphragmatic dysfunction, alveolar injury and asynchrony. The first study settled NAVA modeaccording to the EAdi recorded during a failed spontaneous breathing trial (SBT). An unexpecteddaily increase of EAdi has been found during SBT until extubation. The second study did not findany increase of the neuroventilatory efficiency during weaning, possibly because of residualsedation. A third study described the inhibition of residual sedation on EAdi and tidal volume at thebeginning of the weaning, and the correlation between them. The last study did not find anyincrease of tidal volume under NAVA after lung transplantation, with denervated lung withoutHerring Breuer reflex, compared to a control group. Moreover tidal volume under NAVA wascorrelated to total lung capacity. These studies highlight the interest of EAdi monitoring duringweaning

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Mas, Serra Arantxa. "Ventilación no invasiva en la atención prehospitalaria urgente de pacientes disneicos." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/321357.

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INTRODUCCIÓN: La disnea es un motivo frecuente de alerta de los servicios de emergencias prehospitalarios (SEP). En los pacientes con mayor gravedad puede ser necesaria la intubación y la ventilación mecánica invasiva, procedimientos con elevado número de complicaciones. La ventilación no invasiva (VMNI) ha demostrado su utilidad en reducir el número de intubaciones y la mortalidad de los pacientes con insuficiencia respiratoria aguda, especialmente aquellos con enfermedad pulmonar obstructiva crónica (EPOC) agudizada o con edema agudo de pulmón (EAP). El beneficio de esta técnica aplicada en el medio prehospitalario en los pacientes con disnea no ha sido estudiada. OBJETIVOS: El objetivo principal del estudio fue determinar si la aplicación de VMNI en el ámbito prehospitalario en pacientes con disnea mejoraba los signos clínicos y gasométricos de insuficiencia respiratoria a la llegada al hospital. Los secundarios fueron valorar las complicaciones asociadas a la técnica (en tolerancia, carga de trabajo de enfermería y tiempo de asistencia) y estudiar su impacto en el pronóstico de estos enfermos. MATERIAL Y MÉTODO: Estudio prospectivo randomizado. Se incluyeron pacientes adultos que activaban el SEP de Manresa en los años 2001 y 2002 por disnea de origen no traumático, con frecuencia respiratoria (FR) >28 respiraciones/minuto y/o saturación de oxigeno por pulsioximetría (SpO2 ) < 92% o SpO2<90% a cualquier FR. Todos los pacientes recibieron tratamiento médico estándar y se aleatorizaron a oxigenoterapia convencional (Grupo Control) o VMNI a parámetros fijos (PEEP 7 cm H2O, presión de soporte 12 cmH2O). Se compararon constantes vitales a la llegada al hospital y se realizó gasometría arterial antes de modificar las condiciones de soporte respiratorio del traslado. Se recogieron también datos diagnósticos y evolutivos de los pacientes. RESULTADOS: Se incluyeron 31 pacientes en el grupo control (GC) y 33 en el grupo VMNI, sin diferencias en las constantes, los índices de gravedad y en la sospecha diagnóstica inicial aunque al alta el GC tuvo más pacientes con diagnóstico EAP o EPOC que el grupo VMNI. La asistencia tendió a ser más prolongada en el grupo VMNI (mediana 36 minutos en el GC versus 41 en el grupo VMNI, p= 0,090) . Hubo que retirar la VMNI en dos casos por intolerancia. No se produjeron intubaciones durante la asistencia La aplicación de VMNI produjo una mejoría significativa fisiológica y gasométrica . El grupo VMNI llegó menos taquipneico (descenso medio de la FR 4,5 resp/min en el GC versus 11,9 resp/min el grupo VMNI, p= 0,000), con SpO2 más elevada (mediana 93% versus 95%, p= 0,001), menos acidosis ( pH medio 7,25 versus 7,33, p= 0,023) y menor PaCO2 (mediana 48 versus 40,6 mmHg, p= 0,028). Estas diferencias se mantuvieron cuando se analizaron únicamente los pacientes con EPOC y EAP. Hubo más pacientes fallecidos en el grupo VMNI que en el GC (21,2% versus 3,2%, χ2 p=0,054) y más pacientes con orden de limitación del esfuerzo terapéutico (0 casos versus 18,2% de casos, χ2 p=0,025), siendo la mortalidad entre grupos similar cuando se analizaron únicamente los pacientes con EAP y/o EPOC (mortalidad GC 3,2% vs 8,7% en el grupo VMNI, χ2 0,569). Hubo un aumento de la carga de trabajo atribuida a cuidados respiratorios, aunque no se evidenció una mayor necesidad de soporte psicológico con la VMNI. CONCLUSIONES: La aplicación de VMNI durante la asistencia prehospitalaria de pacientes con disnea mejora las condiciones clínicas y gasométricas de llegada de los pacientes, aunque en nuestro estudio ello no se traduce en un mejor pronóstico. Su uso aumenta la carga de trabajo del esquipo, a expensas de una mayor dedicación a los cuidados respiratorios, y puede retrasar la llegada de los pacientes al hospital.
INTRODUCTION: Dyspnoea is a frequent trigger for activation the pre-hospital emergency teams (PET). Patients with severe respiratory distress may require intubation and invasive mechanical ventilation. Both techniques may be harmful and can lead to large number of complications, especially in the pre-hospital setting. Non-invasive ventilation (NIV) has proved to be useful in decreasing intubations and mortality in patients with acute respiratory failure, in particular those with acute cardiogenic pulmonary edema (ACPE) or chronic obstructive pulmonary disease (COPD). However, the usefulness of NIV in the pre-hospital setting has not been studied. OBJECTIVES: The primary aim of the study was to determine whether the application of NIV in patients who complain of dyspnoea in the pre-hospital setting results in clinical and gasometrical improvement at hospital arrival. Secondary objectives were to assess the complications of the technique in terms of tolerance, team workload and the impact in the duration of transport. METHODS: We performed a prospective randomized controlled trial including adult patients attended by the PET in Manresa (Spain) during 2001 and 2002, who complained dyspnoea. Inclusion criteria were non-traumatic origin, respiratory rate (RR) > 28 breaths/minute and/or oxygen saturation by pulseoximetry (SpO2) < 92% or SpO2 <90% at any RR. Patients were randomized, in addition to standard medical treatment, to conventional oxygen therapy (Control Group) or NIV with fixed pre-set parameters (PEEP 7 cmH2O, pressure support 12 cmH2O). Vital signs and blood gas analyses were recorded upon hospital arrival, before introducing any therapeutical change. Diagnostic accuracy and outcomes were also analysed. RESULTS: 31 patients were assigned to control group (CG) and 33 to NIV. At inclusion vital signs, severity scores and presumptive diagnoses were similar between groups. However, after diagnostic reassessment at discharge, more patients with ACPE or COPD were allocated in the CG. The assistance time was similar between groups (median 36 minutes in the CG and 41 in the NIV group). Two patients did not tolerate NIV. No patient needed intubation during the pre-hospital assistance. NIV application was associated with greater physiological and gasometrical improvement. NIV group had significantly greater RR change (mean improvement or RR 4,5 b/min in the CG and 11,9 b/min in the NIV group, p= 0,000) higher SpO2 (median 93% vs. 95%, p= 0,001), higher pH (mean 7,25 vs. 7,33, p= 0,023) and lower PaCO2 (median 48 vs. 40,6 mmHg p= 0,028). These differences remained when the analysis was restricted to patients with final diagnosis COPD or ACPE. NIV group tended to have higher mortality (21,2% versus 3,2%, χ2 p=0,054). Nevertheless, more patients had do not resuscitate orders in this group (0 patients versus 18,2% , χ2 p=0,025) and the non-homogeneous distribution of patients with diagnostic of COPD and APE could determine these results. When the analysis was restricted to the patients with these diagnoses there were no differences in mortality (CG 3,2% vs. NIV 8,7%, χ2 p=0,569). The team workload was slightly greater in the NIV group, mainly due to respiratory care, as well as the transport time ( median 36 min in the CG versus 41 in NIV group, p= 0,090). CONCLUSIONS: The use of pre-hospital NIV in patients with dyspnoea improves clinical and gasometrical conditions at hospital arrival, but this improvement does not translate into a better prognosis of these patients. Prehospital NIV increases nursing workload and may extend the time of transport.

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Frat, Jean-Pierre. "Impact clinique des techniques non-invasives d'oxygénation au cours de l'insuffisance respiratoire aiguë." Thesis, Poitiers, 2019. http://www.theses.fr/2019POIT1402.

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L’oxygénothérapie conventionnelle, l’oxygénothérapie nasale à haut débit (OHD, et la ventilation non-invasive (VNI), sont les trois techniques d’oxygénation disponibles en réanimation dans la prise en charge des patients en insuffisance respiratoire aiguë hypoxémique. Cependant, la place de chacune n’est pas clairement déterminée pour éviter l’intubation, ainsi la morbidité et mortalité associées à la ventilation invasive, ou encore en cas d’échec pour sécuriser la procédure d’intubation. Objectifs : Conduire des études cliniques chez des patients avec une insuffisance respiratoire aiguë hypoxémique pour: 1- déterminer la stratégie d’oxygénation non-invasive la plus efficace sur l’intubation et la mortalité ; 2- déterminer les facteurs associés à l’échec de chacune des techniques d’oxygénation ; 3- déterminer la technique de pré-oxygénation la plus efficace pour diminuer le risque d’hypoxémie sévère lors de la procédure d’intubation trachéale en cas de recours à la ventilation invasive. Méthodes : 1- Une première étude pilote a évaluée la faisabilité de l’utilisation de l’OHD entre les séances de VNI, chez les patients en insuffisance respiratoire aigüe hypoxémique ; 2- Un grand essai clinique randomisé a comparé les trois stratégies d’oxygénation sur le pronostic dans la même population de patients; 3- Une analyse post-hoc a déterminé les facteurs associés à l’intubation et à la mortalité avec chacune des trois stratégies d’oxygénation; 4- Un nouvel essai clinique randomisé a comparé l’efficacité de la pré-oxygénation par VNI et OHD chez des patients nécessitant un intubation lors de la prise en charge d’une insuffisance respiratoire hypoxémique. Résultats : Chez les patients avec une insuffisance respiratoire aiguë hypoxémique : 1- l’OHD permettait une baisse significative de la fréquence respiratoire et l’amélioration de l’oxygénation comparée à l’oxygène standard, qui restait cependant inférieure à la VNI 2- l’OHD permettait une amélioration de la mortalité comparativement à toutes les autres techniques et une diminution du recours à l’intubation chez les patients les plus sévères; 3- des volumes courants excessifs 1 heure après la mise en route de la VNI était associés à une augmentation du risque, ce qui pourrait expliquer des effets délétères de la VNI; 4- La pré-oxygénation avant intubation par VNI diminuait le risque de survenue d’hypoxémie sévère comparativement à une pré-oxygénation par OHD. Conclusions : Les patients avec une insuffisance respiratoire aiguë hypoxémique semblent avoir un meilleur pronostic après un traitement de première ligne par OHD en termes de mortalité et d’intubation, comparativement à l’oxygénothérapie conventionnelle et à la VNI. Cependant, la VNI garde une place au cours de la pré-oxygénation avant ventilation invasive, pour sécuriser la procédure d’intubation et diminuer le risque d’épisodes d’hypoxémie sévère
Standard oxygen, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV), and are three strategies of oxygenation usually applied in the ICU for patients with acute hypoxemic respiratory failure. However, it is not well established which technique is better to avoid intubation and thus the related morbidity and mortality, but also which one can secure intubation procedure in case of failure. Objectives: To conduct clinical studies in patients with acute hypoxemic respiratory failure: 1- to compare oxygen strategies including standard oxygen, HFNO, or NIV (associated with HFNO) in terms of intubation and mortality rates; 2- to determine factors associated with oxygen strategies failure, i.e. intubation and mortality; 3- to determine which technique of pre-oxygenation best decreases the risk of severe hypoxemia during intubation procedure before invasive ventilation. Methods: 1- feasibility and efficiency of the association of NIV/HFNO (HFNO interspaced between NIV sessions) were validated in a first clinical study conducted in patients with acute hypoxemic respiratory failure; 2- Impact on prognosis of standard oxygen, HFNO, association of NIV/HFNO were compared in multicenter randomized controlled trial in the same population; 3- factors associated with intubation and mortality were determined in a post-hoc analysis; 4- efficiency of NIV and HFNO during pre-oxygenation were compared in a multicenter randomized controlled trial in patients requiring intubation during the management of acute hypoxemic respiratory failure. Results: In patients treated for acute hypoxemic respiratory failure, HFNO has shown 1- beneficial respiratory effects, with an increase in PaO2, decrease in respiratory rate, as compared to standard oxygen; 2- a better prognosis in terms of mortality and intubation as compared to standard oxygen and NIV; 3- factors associated with intubation and mortality after NIV treatment included high tidal volume generated by patients within the first hours of NIV initiation; 4- pre-oxygenation by NIV before intubation of patients with acute hypoxemic respiratory failure decreased the risk of severe hypoxemia during the intubation procedure as compared pre-oxygenation with HFNO. Conclusions: Patients with acute hypoxemic respiratory failure seem to benefit of a first line treatment with HFNO in terms of mortality and intubation as compared standard oxygen and NIV. However, NIV has a place in these patients during pre-oxygenation before intubation to secure intubation procedure by decreasing the risk of severe hypoxemia

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Coudroy, Rémi. "Stratégies d'oxygénation non invasives dans l'insuffisance respiratoire aiguë hypoxémique des patients immunodéprimés." Thesis, Poitiers, 2019. http://www.theses.fr/2019POIT1403.

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L’insuffisance respiratoire aiguë est la première cause d’admission en Réanimation des patients immunodéprimés. Malgré les progrès thérapeutiques, leur mortalité reste très élevée en cas de recours à la ventilation mécanique invasive. La ventilation non invasive (VNI) est recommandée comme traitement de première ligne en raison de la diminution de mortalité rapportée dans les études randomisées anciennes. Récemment, ces bénéfices ont été remis en cause par des essais de plus grande ampleur. Toutefois, il est possible que les réglages de la VNI n’aient pas été optimaux dans ces études, diminuant ainsi son efficacité. Par ailleurs, l’oxygénothérapie nasale à haut débit (OHD) est une technique d’oxygénation récente avec des résultats prometteurs dans de nombreuses situations cliniques. L’objectif final de ce projet était de conduire une étude prospective randomisée multicentrique comparant la VNI avec des réglages optimisés à l’OHD chez les patients immunodéprimés admis en Réanimation pour une insuffisance respiratoire aiguë. Nous avons tout d’abord validé l’hypothèse de recherche du projet, son objectif principal, les calculs d’effectif et le taux de recrutement au moyen d’une étude pilote rétrospective. Puis nous avons élaboré le protocole de VNI à partir d’une revue systématique de la littérature comparant l’efficacité des différents protocoles de VNI publiés. Ensuite, nous avons analysé les facteurs de risque d’échec de la VNI chez les patients hypoxémiques afin d’identifier les paramètres physiologiques respiratoires à surveiller chez les patients traités par VNI. En outre, nous avons identifié les mécanismes responsables des effets physiologiques de l’OHD au moyen d’une étude sur banc puis chez des volontaires sains. Enfin, nous avons sélectionné la méthode d’estimation de la fraction inspirée en dioxygène mesurée au masque la plus fiable en comparant les différentes méthodes existantes dans le but d’affiner les critères d’inclusion du projet. Ces cinq études préliminaires nous ont permis de conduire une étude prospective randomisée dans 30 centres en France et en Italie dans le but de comparer les effets de l’OHD seule délivrée à 60 L/min à son association à la VNI intensive (administrée au moins 12 heures par jour avec une pression expiratoire positive d’au moins 8 cmH2O et un volume courant expiré inférieur à 8 ml/kg de poids prédit) sur la mortalité à 28 jours chez 300 patients immunodéprimés admis en Réanimation pour une insuffisance respiratoire aiguë
Acute respiratory failure is the leading cause of intensive care unit admission in immunocompromised patients. Despite therapeutic progresses, their mortality rate remains intolerably high when invasive mechanical ventilation is needed. Noninvasive ventilation (NIV) is currently recommended as first-line treatment in this setting given the mortality reduction reported in old randomized trials. Recently, benefits of NIV have been challenged by large sample sized trials. However, NIV settings may have been suboptimal in these studies and consequently dampened its efficacy. Moreover, high-flow nasal cannula oxygen therapy (HFOT), a more recent oxygenation technique, was associated with promising results in various clinical settings. This project aims at conducting a randomized multicenter controlled trial comparing optimized NIV with HFOT in critically ill immunocompromised patients with acute respiratory failure. First, we validated the research hypothesis, the primary outcome, the sample size calculation and the recruitment rate of the project by means of a pilot retrospective study. Then, the NIV protocol was built based on a systematic review of literature comparing the efficacy of previously published NIV protocols. Afterwards, we identified factors independently associated with NIV failure in hypoxemic patients to identify respiratory parameters to monitor during NIV. Next, we determined mechanisms leading to physiological effects of HFOT in a bench study and a study on healthy volunteers. Last, we chose the most reliable method to estimate inspired oxygen fraction under oxygen mask in a study comparing the different existing methods in order to refine inclusion criteria of the project. All in all, these five above-mentioned preliminary studies enabled to conduct a prospective multicenter randomized trial in 30 centers in France and in Italy aiming at comparing effects of HFOT alone at 60 L/min to its association with optimized NIV (applied at least 12 hours a day with a positive end-expiratory pressure of at least 8 cmH2O and an expired tidal volume lower than 8 ml/kg of predicted body weight) on mortality at day 28 in 300 immunocompromised patients admitted to the ICU for acute respiratory failure

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Patout, Maxime. "Evaluation des techniques pour la prise en charge diagnostique et thérapeutique de l'insuffisance respiratoire chronique A Randomized controlled trial on the effect of needle gauge on the pain and anxiety experienced during radial arterial puncture Long term survival following initiation of home non-invasive ventilation : a European study Neural respiratory drive predicts long-term outcome following admission for exacerbation of COPD : a post hoc analysis Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation Polysomnography versus limited respiratory monitoring and nurse-led titration to optimise non-invasive ventilation set-up a pilot randomised clinical trial Chronic ventilator service Step-down from non-invasive ventilation to continuous positive airway pressure : a better phenotyping is required AVAPS-AE versus ST mode : a randomized controlled trial in patients with obesity hypoventilation syndrome Technological advances in home non-invasive ventilation monitoring : reliability of data and effect on patient outcomes Efficacy of a home discharge care bundle after acute exacerbation of COPD Prediction of severe acute exacerbation using changes in breathing pattern of COPD patients on home noninvasive ventilation Charasteristics and outcome of patients set up on high-flow oxygen therapy at home Trial of portable continuous positive airway pressure for the management of tracheobronchomalacia." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR115.

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L’insuffisance respiratoire chronique est un syndrome défini par une défaillance monoviscéralerespiratoire. Sa principale origine est aujourd’hui le syndrome obésité-hypoventilation qui concerne 4 à 5% des patients obèses. L’IRC est aussi le stade évolutif terminal de la bronchopneumopathie chronique obstructive qui touche 6 à 8% de la population adulte. L’incidence de ces pathologies et donc de l’insuffisance respiratoire est en augmentation constante. Dans cette thèse, nous avons évalué les nouvelles modalités diagnostiques et thérapeutiques qui pourraient améliorer la prise en charge des patients atteints d’insuffisance respiratoire chronique.Concernant la prise en charge diagnostique, nous avons montré que les données fournies par l’électromyographie de surface des muscles intercostaux, outil qui évalue le travail respiratoire, constituent un marqueur pronostique indépendant chez les patients atteints de bronchopneumopathie chronique obstructive. Nous avons également montré leur pertinence pour prédire l’efficacité clinique et l’observance à la ventilation non-invasive à domicile.Concernant la prise en charge thérapeutique, nous avons montré que l’utilisation d’un mode semi-automatisé de ventilation non-invasive a la même efficacité que celle de modes classiques en permettant une mise en place plus rapide du traitement. Nous avons également rapporté l’intérêt de l’oxygénothérapie à haut débit au domicile alors que ce traitement était utilisé jusque-là dans le seul cadre des soins intensifs. Enfin, nous avons rapporté les bénéfices de la pression positive continue au cours de l’effort chez les patients ayant une trachéobronchomalacie. Concernant le suivi des patients, nous avons montré que les données des logiciels de ventilation non invasive permettent de prédire la survenue d’une exacerbation sévère de BPCO mais que l’utilisation de la télémédecine chez les patients insuffisants respiratoires chroniques ne peut être encore pleinement intégrée dans la pratique clinique. Au cours de cette thèse, nous avons identifié de nouveaux outils physiologiques, de nouvelles modalités d’administration des traitements et de nouveaux outils de suivi à domicile, à même d’améliorer la prise en charge des patients insuffisants respiratoires chroniques
Single-organ respiratory failure defines chronic respiratory failure. Obesity hypoventilation syndrome is the main cause of chronic respiratory failure and occurs in 4 to 5% of obese patients. Chronic respiratory failure is also the end-stage evolution of chronic obstructive pulmonary disease that has a prevalence of 6 to 8% in the adult population. The incidence of these diseases increases so does the incidence of chronic respiratory failure. In this thesis, we will evaluate novel diagnostic and therapeutic modalities that could improve the care of patients with chronic respiratory failure. Regarding diagnostic modalities, we have seen that evaluating the work of breathing with surface parasternal electromyography was an independent prognostic marker in patients with chronic obstructive pulmonary disease. We have also seen that it was a relevant tool to predict the clinicalefficacy and compliance to home non-invasive ventilation. Regarding therapeutic modalities, we have shown that the use of a semi-automatic mode of non-invasive ventilation had the same efficacy of a standard mode with a shorter length of stay for its setup. We have shown the relevance and feasibility of the use of high-flow oxygen therapy in the home setting whilst it was only used in intensive care units. Finally, we have shown the benefits of continuous positive airway pressure during exertion in patients with tracheobronchomalacia. Regarding patients’ follow-up, we have shown that the use of data from built-in software could predict the onset of a severe exacerbation of chronic obstructive pulmonary disease. However, we also show that the implementation of tele-medicine in patients with chronic respiratory failure cannot be included in daily clinical practice yet. In this thesis, we have identified novel physiological tools, novel ways to administer treatments and novel follow-up tools that can improve the management of patients with chronic respiratory failure

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Marjanovic, Nicolas. "Approche globale du support ventilatoire en médecine d'urgence." Thesis, Poitiers, 2020. http://theses.univ-poitiers.fr/64158/2020-Marjanovic-Nicolas-These.

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L’insuffisance respiratoire aiguë est un motif fréquent de consultation dans un service d’urgences. Le traitement de première intention repose sur l’oxygénothérapie conventionnelle. En cas d’échec ou d’emblée en cas d’urgence vitale immédiate, le recours à un support ventilatoire devient nécessaire. Les supports ventilatoires englobent l’oxygénothérapie à haut-débit nasal humidifiée (OHD) et la ventilation mécanique qui peut être invasive ou non-invasive. Les données concernant l’intérêt du support ventilatoire en médecine d’urgence sont issues pour l’essentiel de travaux conduits en réanimation, et une approche globale de leur place en médecine d’urgence n’a jamais été réalisé.L’objectif de ce travail est de proposer une évaluation globale du support ventilatoire en médecine d’urgence, en analysant l’intérêt de l’OHD, d’introduction récente aux urgences, et la pratique aux urgences de la ventilation mécanique non-invasive et invasive.Nous avons dans un premier temps évalué les effets cliniques et gazométriques de l’OHD au cours de l’insuffisance respiratoire aiguë hypoxémique de novo, puis au cours de l’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP cardiogénique, aux travers de deux études prospectives. Puis, nous avons réalisé une compilation des données de l’ensemble des études prospectives réalisés aux urgences pour déterminé si la mise en place précoce de l’OHD au cours des détresses respiratoires aiguës sans cause spécifique était susceptible d’améliorer le devenir des patients. Nous avons constaté qu’une mise en place précoce de l’OHD, dès l’admission du patient aux urgences, était associée à une amélioration des paramètres cliniques et gazométriques en cas d’insuffisance respiratoire aiguë de novo comparativement à l’oxygénothérapie conventionnelle, et de manière similaire à la ventilation non-invasive en cas d’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP. En revanche, au cours des détresses respiratoires aiguës admises aux urgences, quelle qu’en soit la cause, l’OHD n’a pas été associé à une diminution au recours à la ventilation mécanique, ni à une diminution de la mortalité.Parallèlement, nous avons réalisé une évaluation des pratiques de la ventilation mécanique aux urgences, en analysant, indépendamment de l’indication de la ventilation mécanique, trois déterminants susceptibles d’influer le pronostic des patients. Nous avons dans un premier temps conduit un banc d’essai de l’ensemble des ventilateurs mécaniques de médecine d’urgence commercialisés en Europe et en Amérique du Nord pour évaluer leur performance et leur utilisabilité aux travers de deux études. Puis, nous avons réalisé une évaluation des pratiques de la ventilation mécanique, et mesuré l’association entre les paramètres réglés (notamment la ventilation à faible volume) et le pronostic du patient. Nous avons mis en évidence que les ventilateurs de médecine d’urgence récents ont une performance technique proche des ventilateurs de réanimation en raison des évolutions technologiques et de l’émergence des ventilateurs à turbine. L’augmentation de leurs performances et de leur complexité n’a pas été associée à une dégradation de leur utilisabilité. Enfin, dans les 6 services d’urgences participants, la majorité des patients ont bénéficié d’une ventilation mécanique à faible volume courant (entre 6 et 8 mL/kg de poids idéal théorique), répondant ainsi aux recommandations des sociétés savantes. En revanche, une ventilation à faible volume courant n’a pas été associée à une diminution de l’incidence du syndrome de détresse respiratoire aigu ou une diminution du taux de mortalité.Ces études permettent une évaluation globale du support ventilatoire aux urgences, intégrant la ventilation mécanique invasive et non-invasive, par son approche clinique et technologique, et un traitement émergent, l’OHD, par son impact clinique, gazométrique et pronostique aux urgences
Acute respiratory failure is a common complaint of patients visiting the Emergency Department and conventional oxygen therapy is its first-line treatment. Ventilatory support is required when nasal oxygen therapy is not enough or as a first-line treatment in the most severe cases. Ventilatory supports include high-flow and humidified nasal cannula oxygen (HNFO) and mechanical ventilation. Data assessing their values in Emergency Departments (EDs) mainly come from research conducted in Intensive Care Units. In addition, a comprehensive approach of their application and their results in Emergency Departments has never been conducted.The aim of this research is to provide a comprehensive assessment of ventilatory supports in EDs by assessing the place of HFNO, introducing recently in this setting, and the practice of noninvasive and invasive mechanical ventilation in EDs. We assessed first the clinical and biological impact of HFNO in patients admitting to an ED for de novo acute hypoxemic respiratory failure, then in patients admitting for acute hypercapnic respiratory failure secondary to acute heart failure, through two prospective studies. In addition, we provided a matching of data issued from all prospective trials conducted in the EDs. We aimed to determine if early application of HFNO in patients with acute respiratory failure improves outcome. We found HFNO applied early was associated with an improvement in clinical and biological patterns in patients admitted for de novo acute hypoxemic respiratory failure, and similarly in patients admitted for acute hypercapnic respiratory failure due to acute heart failure. However, HFNO was not associated with a reduction of mechanical ventilation requirements or in mortality. In addition, we assessed mechanical ventilation in the ED by analysing three determinants that may influence patient’s outcome. First, we conducted a large bench test assessing performance and usability of all emergency ventilators marketed in Europe or North America and assessing through two distinct studies. Then, we assessed the mechanical ventilation practice in six French EDs and measured the association between mechanical ventilation settings and patients’ outcome. Performance of recent emergency ventilator were closes to ICU ventilators due to high technological improvements in the last decades. These improvements were associated with an increase of their complexity without impairment of their usability. Finally, in six French EDs, most of the patients were treated with a low tidal volume (between 6 and 8 mL/kg of predicted body weight) as recommend by scientific societies. However, a low tidal volume strategy was not associated with a reduction in the acute respiratory distress incidence as well as in mortality. These studies provided a comprehensive assessment of the ventilator support in the ED, including invasive and noninvasive ventilation, through a clinical and technological approach, and an emerging treatment, HFNO, by its clinical, biological and prognostic impact

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FOSTER, DAVID ALAN. "ACUTE RESPIRATORY ILLNESS IN END-STAGE RENAL DISEASE PATIENTS." 1990. http://books.google.com/books?id=oFBYAAAAMAAJ.

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Pei-YiLo and 羅蓓怡. "High flow nasal cannula to treat the acute respiratory failure." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/262742.

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碩士
國立成功大學
公共衛生研究所碩士在職專班
107
Purpose: To evaluate the predictors of high flow nasal cannula (HFNC) failure in intensive care unit (ICU) patients with acute respiratory failure (ARF). Methods: The patients are collected from a medical center in Taiwan between June 13, 2017, and December 31, 2018. One hundred eighty-nine subjects were divided into a HFNC success group (48%) and a HFNC failure group (52%). The clinical characteristics and physiologic effects before HFNC used were retrospectively reviewed and compared between the groups. Results: The study outcome of hospital mortality, ICU length, and hospital length were significantly higher in the HFNC failure group than in the HFNC success group. The results of the multivariate analysis indicated that APACHE II and PaO2/FiO2 were significantly different between groups. The support vector machine (SVM) classifier model shows that APACHE II + PaO2/FiO2 gives the highest accuracy of 72.1% to predict HFNC failure. Conclusion: The baseline APACHE II and PaO2/FiO2 were independently associated with HFNC failure. Key words: High flow nasal cannula failure, SVM, predictors

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32

Hsang, Yang Li, and 楊麗香. "Clinical Efficacy of Manual Hyperinflation on Atelectasis in Patients With Acute Respiratory Failure." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/40096845718389526945.

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碩士
長庚大學
護理學研究所
97
Regarding in the intubated ICU patients receiving mechanical ventilation, successful sputum clearance and ventilation are an important task. The literature and the clinical experience all demonstrated the effect of MH on the patients receiving mechanical ventilation, it may improve sputum clearance and ventilation. However, there are few emperical studues to support its routine use in clinical practice. The purpose of this study was to examine the effectiveness of MH on sputum clearance and ventilation on Atelectasis in Patients With Acute Respiratory Failure. A controlled, randomized, single blind, experimental design was used. Each patient was assigned a random numder upon entering the research project, which allowed randomly allocation to two groups: experimental group and control group. The sample were collected in the ICU of a Medical Center in northern Taiwan. A total of 28 patients joined the study in two groups, i.e., experimental group and control group, 14 patients in each group. Case from the experimental group received ventilation support and additional manual hyperinflation while cases from the control group were only received ventilation support. Patients in experimental group received the manual hyperinflation at a peak airway pressure of 20 cm H2O once of 20 minutes in 3 times per day for two days. Outcome measurements were evaluated by noting changes in the patient,s score in dry/wet ratio of sputum, sputum viscosity, tidal volume, maximal respiratory pressure, PaO2/Fio2, upper chest X-ray film, dynamic lung compliance and the index of rapid shallow breathing. Dry/wet ratio of sputum, sputum viscosity, tidal volume, maximal respiratory pressure, dynamic lung compliance and the index of rapid shallow breathing were assessed every day. PaO2/ Fio2 and upper chest X-ray film were assessed once every three days. Upon giving the conclusions are as follows: 一、For the sputum clearance, patients from the experiment group were significant improvement than those from control group in terms of sputum viscosity(p=0.011);while patients from both group were no significant difference in dry/wet ratio of sputum. 二、For the ventilation, patients from the experimental group were significant improvement than those from control group in terms of the index of rapid shallow breathing on second day and third day(p=0.062,p=0.050); while patients from both groups were no significant difference in terms of tidal volume, maximal respiratory pressure, PaO2/Fio2,dynamic lung compliance and upper chest X-ray film. This study showed MH improved sputum clearance and ventilation in patients with acute respiratory failure.

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33

Alimagham, Farah Christina. "Assessment of a Microfluidic Intravenous Oxygen Generating Platform to Aid Acute Respiratory Failure." Master's thesis, 2015. http://hdl.handle.net/10362/50887.

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Acute respiratory failure is associated with a high mortality rate, despite the advances in conventional treatments. This work presents the development of a proof-of-concept device for assessing the viability of an oxygen-generating catheter, deployed intravenously, to temporarily sustain a patient who is suffering from acute respiratory failure. The assessment device mimics the interface between the catheter and bloodstream (deoxygenated water substitutes the blood), and consists of two parallel channels separated from each other by an oxygen-permeable membrane that simulates the catheter material. Several polydimethylsiloxane membranes with enhanced permeability were developed and tested on the device according to their permeation rates. The highest permeation rate achieved was 3.6×10-7 cm3/s (equivalent in-blood value) considering the device’s surface area and applied pressure. However, the extrapolation of this value to a catheter with increased surface area demonstrated a predicted oxygen permeation rate of 1.6×10-3 cm3/s. Although the oxygen permeation rates achieved here do not yet reach the minimum required rate to sustain a patient with only 30 % of their lungs functional (1.6 cm3/s O2), it may be enhanced further by improving certain parameters such as material permeability, surface area and applied pressure. The ability to administer oxygen or other gases directly into the bloodstream may portray a technique for short-term rescue of severely hypoxemic patients to increase whole body or at-risk organ oxygenation.

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34

Shen, Hui-I., and 沈慧怡. "The Performance of Non-invasive Positive Pressure Ventilation Applied in Acute Respiratory Failure after Extubation." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/75080834293084545136.

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碩士
中臺科技大學
健康產業管理研究所
99
Abstract Background: Patients of respiratory failure with endo trachea intubation emerged in an endless stream in the hospital. According to the literatures, re-intubation resulting from extubation failure would increase death risk, length of stay, medical expense, and nosocomial. Therefore, extubation success rate has become an important issue in quality of care. Objectives: This study aimed to identify the association between the successful-weaning of non-invasive positive pressure ventilation after extubation and related-quality indicators by analyzing the correlation of patient characteristics before extubation, weaning parameters and two different methods for respiratory care after extubation. The results would provide the direct that prompted quality of care and set up the standard process. Method: A retrospective study collected medical records data of patients who were respiratory failure after extubation in a regional teaching hospital in Taichung from January, 2009 to December, 2010. The study group was patients who used non-invasive positive pressure ventilation after extubation , those who used oxygen after extubation were defined in control group. 157 cases were qualified in this study finally. Statistical methods included descriptive statistics, Chi-square test, independent samples t-test, logistic regression, and multiple regression analysis. Results: Patients in study group were older, longer days of intubation and poor score of consciousness than the control group. There was no significant difference between two groups in the success of extubation, death, re-intubation, and pneumonia after controlling the patient characteristics and weaning parameters. However, the study group had longer length of stay in ICU after extubation and total length of stay after extubation than the control group. Conclusion: To reduce complications occurred in poor condition patient, those who are older, longer days of intubation and poor score of consciousness have more necessity to use the non-invasive positive pressure ventilation after extubation. Non-invasive positive pressure ventilation can be used for preventive purpose after extubation immediately. Keywords: respiratory failure, weaning index, non-invasive positive pressure ventilation, re-intubation

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35

Hung, Shih-Chiang, and 洪士強. "Effect of Deferring Admission to Intensive Care Unit for Acute Respiratory Failure Patients in Emergency Department." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/81376299609721693833.

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碩士
高雄醫學大學
公共衛生學研究所
99
Objective: Adverse outcomes related to delay intensive care unit admission for critical patients in emergency department have been recognized in previous studies. There is still no study using length of waiting time as a variable to study the associations of adverse outcomes. The study was to explore impact of the length of emergency department boarding time for critically ill patient. Design: This was a retrospective cohort study based on charts review. From Jul 2009 to Jun 2010, all non-traumatic adult patients (age >17 years old) intubated and requiring mechanical ventilation in emergency department were included in study. Demographics, triage results, length of stay in emergency department, intensive care unit and hospital, intensive care unit waiting time, components of Acute Physiology and Chronic Health Evaluation II scores, principal diagnostic categories leading to respiratory failure, 72 hours unplanned revisits, 14 days readmission, status of hospital discharge and days of ventilator using were collected. The results of surviving and no surviving were analyzed by using Chi-square, Fisher’s exact test, Student’s t test, and Wilcoxon’s rank sum test. Models of Cox’s regression and logistic regression were used for multivariate analysis. Setting: Emergency department and intensive care units. Patients: All non-traumatic adult patients in emergency department, intubated and requiring mechanical ventilation owing to acute respiratory failure, were enrolled in the study. Intervention: none Measurements and main results: The primary outcomes were 21-day intensive care unit mortality, in-hospital mortality, continuous ventilator utilization over 21 days, and prolonged hospital stays over 30 days. There were 1014 patients included into the study. Under Cox regression model, we found that the hazard effect of intensive care unit -waiting time on patient survival probability was changing hour by hour, and then quality reversed. Using a method like titration in chemistry, we located the time of quality-reversing beginning at hour 9 to 10 for 21-day intensive care unit mortality, and hour 11 to 12 for in-hospital mortality. The hazard ratio of intensive care unit-waiting hour was 1.146 (95% confidence interval, 1.066–1.232) for 21-day intensive care unit mortality in the first 9 hours, and 1.056 (95% confidence interval, 1.005–1.110) for in-hospital mortality in the first 11 hours. When intensive care unit -waiting time extended beyond the turning points, the hazardous effect was reversing. Additionally, compared with respiratory infection, the diagnostic categories of intracranium hemorrhage, sepsis, out hospital cardiac arrest , gastrointestinal bleeding, cardiovascular disease(not coronary artery disease) were associated with higher hospital mortality; diagnostic category of congestive was associated with better survival probability. For ventilator dependence over 21 days and prolonged hospital stay over 30 days, the adjusted odds ratios of entire waiting time in emergency department was 1.015 (95% confidence interval, 1.008–1.022) and 1.016 (95% confidence interval, 1.008–1.024) respectively. Conclusion: Critically ill patients requiring mechanical ventilation should be transferred to intensive care unit from emergency department as soon as possible, not over 9 hours. Survival benefit of intensive care unit admission faded progressively as time passed by and vanished after 10 hours boarding in emergency department, because most potential patients were expired during the waiting course. For critically ill patients, intensive care unit -waiting in emergency department has shadow-like adverse effects on extra use of healthcare resources, which were accessed via prolong length of ventilator dependence and hospital stay in the study. Delayed intensive care unit admission in emergency department is a vicious cycle, because of that we could not save the potential patients, the survivor crowd the healthcare capacity and result in more critical patients stasis in emergency department. This is a systemic healthcare problem that has threatened medical care quality and patient safety. Healthcare authority should identify and make more efforts to manage the problem.

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36

Carvalho, Maria da Graça Maciel. "Comparison Between High-Flow Nasal Cannula and Noninvasive Ventilation for Acute Hypoxemic Respiratory Failure: A Retrospective Study." Master's thesis, 2020. https://hdl.handle.net/10216/128916.

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OBJETIVO: Avaliar o impacto da cânula nasal de alto fluxo (CNAF) em doentes com insuficiência respiratória aguda hipoxémica (IRAH), em comparação com ventilação mecânica não invasiva (VNI). MÉTODOS: Conduzimos um estudo retrospetivo unicêntrico de doentes com IRAH admitidos na Unidade de Cuidados Intensivos (UCI) que realizaram CNAF ou VNI. Os outcomes primários incluem mortalidade na UCI e mortalidade aos 90 dias. A necessidade de ventilação mecânica invasiva (VMI) e o tempo de internamento na UCI foram definidos como outcomes secundários. RESULTADOS: Um total de 101 doentes foram incluídos no estudo (VNI 82; CNAF 19). A mortalidade na UCI (VNI 19.5% e CNAF 0%; p=0.037) e a necessidade de VMI (VNI 45.1% e CNAF 15.8%; p=0.018) foram significativamente menores no grupo da CNAF. Não foram observadas diferenças na mortalidade aos 90 dias ou no tempo de internamento na UCI. Na análise de subgrupo, a CNAF associou-se a menor risco de internamentos mais longos na UCI nos seguintes subgrupos: 100PURPOSE: To evaluate the impact of high-flow nasal cannula (HFNC) on patients with acute hypoxemic respiratory failure (AHRF) when compared to noninvasive mechanical ventilation (NIV). METHODS: We conducted a retrospective single-center study of patients with AHRF admitted in the Intensive Care Unit (ICU) who performed HFNC or NIV. The primary outcomes included mortality during ICU stay and 90-day mortality. The need for invasive mechanical ventilation (IMV) and ICU length of stay were defined as secondary outcomes. RESULTS: A total of 101 patients were included in the study (NIV 82; HFNC 19). Mortality during ICU stay (NIV 19.5% versus HFNC 0%; p=0.037) and need for IMV (NIV 45.1% versus HFNC 15.8%; p=0.018) were significantly lower in the HFNC group. No differences were observed in 90-day mortality or ICU length of stay. In the subgroup analysis, HFNC was associated with a decreased risk of longer ICU stay in the following subgroups: 100

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37

Carvalho, Maria da Graça Maciel. "Comparison Between High-Flow Nasal Cannula and Noninvasive Ventilation for Acute Hypoxemic Respiratory Failure: A Retrospective Study." Dissertação, 2020. https://hdl.handle.net/10216/128916.

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OBJETIVO: Avaliar o impacto da cânula nasal de alto fluxo (CNAF) em doentes com insuficiência respiratória aguda hipoxémica (IRAH), em comparação com ventilação mecânica não invasiva (VNI). MÉTODOS: Conduzimos um estudo retrospetivo unicêntrico de doentes com IRAH admitidos na Unidade de Cuidados Intensivos (UCI) que realizaram CNAF ou VNI. Os outcomes primários incluem mortalidade na UCI e mortalidade aos 90 dias. A necessidade de ventilação mecânica invasiva (VMI) e o tempo de internamento na UCI foram definidos como outcomes secundários. RESULTADOS: Um total de 101 doentes foram incluídos no estudo (VNI 82; CNAF 19). A mortalidade na UCI (VNI 19.5% e CNAF 0%; p=0.037) e a necessidade de VMI (VNI 45.1% e CNAF 15.8%; p=0.018) foram significativamente menores no grupo da CNAF. Não foram observadas diferenças na mortalidade aos 90 dias ou no tempo de internamento na UCI. Na análise de subgrupo, a CNAF associou-se a menor risco de internamentos mais longos na UCI nos seguintes subgrupos: 100PURPOSE: To evaluate the impact of high-flow nasal cannula (HFNC) on patients with acute hypoxemic respiratory failure (AHRF) when compared to noninvasive mechanical ventilation (NIV). METHODS: We conducted a retrospective single-center study of patients with AHRF admitted in the Intensive Care Unit (ICU) who performed HFNC or NIV. The primary outcomes included mortality during ICU stay and 90-day mortality. The need for invasive mechanical ventilation (IMV) and ICU length of stay were defined as secondary outcomes. RESULTS: A total of 101 patients were included in the study (NIV 82; HFNC 19). Mortality during ICU stay (NIV 19.5% versus HFNC 0%; p=0.037) and need for IMV (NIV 45.1% versus HFNC 15.8%; p=0.018) were significantly lower in the HFNC group. No differences were observed in 90-day mortality or ICU length of stay. In the subgroup analysis, HFNC was associated with a decreased risk of longer ICU stay in the following subgroups: 100

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38

Liu, Sin-Yin, and 劉思吟. "Airway microbiome dynamic in chronic obstructive pulmonary disease patients with acute exacerbation and respiratory failure- A longitudinal study." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/36293914599942083277.

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碩士
國立中興大學
生命科學系所
103
Objectives: This study aimed to examine the pulmonary complex bacterial diversity dynamics in patients with chronic obstructive pulmonary disease (COPD) acute exacerbation and to explore the relationships between complex bacterial diversity dynamics and clinical outcomes in patients with COPD acute exacerbation. Materials & Methods: The serial endotracheal aspirates (EA) were collected via endotracheal tubes or tracheostomy to minimize upper airway contamination. We also collected anthropometric and demographic data, results of chest X-ray and pulmonary function tests, and COPD-associated clinical findings of the enrolled subjects. Using culture-independent molecular methods, including DNA extraction, PCR-16SrDNA, and new-generation sequence, the pulmonary complex bacterial diversity dynamics were analyzed. The relationships between complex bacterial diversity dynamics and clinical outcomes were also examined. Results: A total of 9 COPD patients with acute exacerbation-related respiratory failure were enrolled. Increased pulmonary complex bacterial diversity of serial EA samples, as determined by Simpson scores and Shannon scores, was found in 6subjects with weaning success. Decreased pulmonary complex bacterial diversity was found in 3 subjects with weaning failure. Conclusion: The dynamics of pulmonary complex bacterial diversity might predict the weaning outcomes in COPD patients with acute exacerbation-related respiratory failure.

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39

Chen, Chun Wei, and 陳俊偉. "The Factors Associated with Prognosis and Medical Consumptions of Patients with Acute Respiratory Failure in Intensive Care Units." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/98970242238965522563.

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碩士
長庚大學
商管專業學院碩士學位學程在職專班醫務管理組
102
The percentage of ventilator-dependent patients out of total national health insurance population is less than 0.01%. However, the percentage of medical expenses due to ventilator-dependent patients is around 4.3%~5.1% of the national health insurance budget. Previous studies have issued the appropriateness of the utilizations among long-term mechanical ventilators (LMV), particularly focused on the predictors of the patient’s prognoses. The study aims to explore the predictors for patient’s prognosis and medical consumptions. The results are anticipated to be applicable to future health care management. The study is a retrospective clinical data collection and analyses. Study subjects were respiratory failure patients in ICUs of a regional hospital in northern Taiwan. During a two-year study period, the study has collected 657 patients for the analyses. The variables include basic demographic variables, disease characteristics, and biophysiological indicators. Both univariate (t test, and ANOVA) and multiple variable (logistic regression model, and general linear model) statistics were used to construct the predictive models for patient’s prognosis and medical consumptions. The findings have demonstrated that patient’s age, general comorbidities, major complications &; comorbidities, and disease severity (APACH II) are predictors to chance of weaning and death. The factors associated with length of LMV and medical expenses are type of ventilators, with comorbidity as neurologic diseases, APACHE II score, and patient's serum albumin level. The results give clues for future designs of medical decision and patient’s classification systems among LMV patients.

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40

Han, Chia-Li, and 韓嘉麗. "The correlations betwccn bioconductivity from laogong (P8) to yoygquan (K1) and severity indices in patients with acute respiratory failure." Thesis, 1996. http://ndltd.ncl.edu.tw/handle/70636388008512148797.

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41

CHIU, CHU-YA, and 邱琡雅. "The Use of Ventilator Parameters to Predict the Successful Weaning of Non-invasive Positive Pressure Ventilator in Patients with Acute Respiratory Failure." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/7b8x4m.

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碩士
長榮大學
醫務管理學系碩士班
107
Background Noninvasive positive pressure ventilation has been widely used for the care of patients with acute respiratory failure in intensive care units as an alternative to endotracheal intubation. However, past studies that examined the predictors of successful use of this treatment had mostly used laboratory test results as predictors. Few studies have investigated whether some important ventilator parameters, such as respiratory rate, tidal volume, rapid shallow breathing index, lung compliance, and airway resistance, predict successful use of noninvasive positive pressure ventilation. This study will be one of the first in Taiwan to explore the predictors of successful use of noninvasive positive pressure ventilation within seventy-two hours after its use. Method 148 patients with acute respiratory failure treated in a regional hospital in southern Taiwan were included in this retrospective analysis. We collected data on the respiratory rate, tidal volume, rapid shallow breathing index, lung compliance, airway resistance, fraction of inspired oxygen (FiO2), and the Glasgow coma scale(GCS) at 0, 2, 4, 6, 12, 24, 48 hours after the start of noninvasive positive pressure ventilation. For each of the seven time-dependent covariates, we defined five time-varying covariates. Cox’s proportional hazards models were used for analysis. Result 75 patients (50.67%) successfully weaned from noninvasive positive pressure ventilation within 72 hours. Among the thirty-five time-dependent covariates, the following conditions significantly predict the success of the treatment: the slope of the airway resistance change was between -1.30 and 0.04 (HR=25.34), the change in FiO2 used was<10% (HR=12.03), mean value of lung compliance before the successful detachment was greater than 86.58 ml/cm H2O (HR=4.91), the average respiratory rate was between 26.86 ~ 40.66 breaths/min (HR=3.23), the value of lung compliance closest to successful detachment was between 40.38 and 105.77 ml/cm H2O (HR=3.04), the initial respirator-set oxygen concentration<38% (HR=2.34), the initial rapid shallow breathing index ranged from 81.57 to 146.61 breaths/min/L (HR=2.27), scores for the coma scale closest to the successful detachment was greater than 12.18 (HR=3.68). On the other hand, those with higher initial respiratory rate (HR=0.9) and those with higher respiratory rate closest to successful detachment (HR=0.8) were more likely to fail. Conclusions Noninvasive positive pressure ventilation is increasingly used in intensive care unit for the care of acute respiratory failure patients. In this study, we explored factors that can predict success of this treatment in a timely and non-invasive fashion, that is, using respiratory parameters to predict whether a patient will successfully wean from noninvasive positive pressure ventilation within 72 hours. This study provides several simple and objective indicators to help clinicians identify high-risk cases to avoid delaying intubation.

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42

Krause, Anke. "Effekte von Proportional Assist Ventilation und variabler Pressure Support Ventilation auf Lungenfunktion und Lungenschädigung an einem tierexperimentellen Modell des akuten Lungenversagens am Schwein." 2020. https://tud.qucosa.de/id/qucosa%3A74500.

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Klinischer Hintergund: Patienten mit akutem Lungenversagen (Acute respiratory distress syndome, ARDS) bedürfen intensivmedizinischer Behandlung. Die maschinelle Beatmung spielt dabei eine zentrale Rolle. Um einer zusätzlichen ventilatorassoziierten Lungenschädigung (ventiator induced lung injury, VILI) vorzubeugen, wird vom ARDS network die Beatmung mit niedrigem Atemzugvolumen empfohlen. Das Zulassen von Spontanatmung und Variabilität in der Druckunterstützung sind weitere Beatmungsstrategien, welchen in verschiedenen Studien positive Effekte im Bezug auf pulmonale Entzündungsreaktion, Schädigung des Lungengewebes und Gasaustausch zugeschrieben werden. Eine weit verbreitete Form der assistierten Spontanatmung ist die druckunterstützte Beatmung (Pressure Support Ventilation, PSV), bei der jede inspiratorische Atembemühung mit stets demselben Druck unterstützt wird. Es resultiert eine relative geringe Atemvariabilität. Eine weitere häufig angewandte Form der assistierten Spontanatmung ist die proportionale Druckunterstützung (Proportional Assist Ventilation, PAV). Hier verhält sich das Maß der Druckunterstützung proportional zu den inspiratorischen Bemühungen des Patienten. Entsprechend führt PAV, abhängig von der intrinsischen Variabilität des Patienten, zu einer höheren Variabilität an Atemzugvolumen und Atemfrequenz. Eine neuere Form der assistierten Spontanatmung ist die variable druckunterstützte Beatmung (noisy PSV), welche ebenfalls die Variabilität von Atemzugvolumen und Atemfrequenz erhöht. Im Unterschied zu PAV ist die Variabilität der Druckunterstützung extrinsisch und wird durch das Beatmungsgerät vorgegeben. Fragestellung /Hypothesen: Die vorliegende Studie untersucht die Therapieeffekte von noisy PSV, PAV und PSV auf pulmonale Entzündungsreaktion, Schädigung des Lungengewebes sowie Ventilationsverteilung im ARDS-Modell Surfactant depletierter Schweinelungen. Folgende Hypothesen wurden dazu formuliert: 1. Unter Noisy PSV zeigt sich eine Umverteilung der regionalen Ventilation von ventral nach dorsal. 2. Unter Anwendung von noisy PSV kommt es zu einer geringeren Schädigung des Lungengewebes im Vergleich zu PAV und PSV. 3. Noisy PSV kann die Entzündungsreaktion gegenüber PAV und PSV senken. Material und Methoden: 24 Jungschweine mit einem mittleren Körpergewicht von 31,3 kg (26,8 – 34,4 kg) wurden anästhesiert, intubiert und mechanisch beatmet. Die Lungenschädigung wurde mittels wiederholter Kochsalzlavagen herbeigeführt bis ein stabiles Verhältnis von arteriellem Sauerstoffpartialdruck zur inspiratorischen Sauerstofffraktion von unter 200 mmHg erreicht war. Dies entspricht der Definition eines moderaten ARDS. Nach Spontanisierung der Atmung folgte die Randomisierung der Versuchstiere zu einer der drei assistierten Beatmungsmodi noisy PSV, PAV oder PSV. Die Beatmung erfolgte jeweils mit einem mittleren Atemzugvolumen von 6 ml /kg KG über einen Zeitraum von sechs Stunden. Es wurden impedanztomographische Messungen zur regionalen Ventilationsverteilung durchgeführt. Untersuchungen zur pulmonalen Entzündungsreaktion und histologischen Schädigung des Lungengewebes wurden post mortem vorgenommen Zusätzlich erfolgten Messungen zu Hämodynamik, Atemmechanik und Gasaustausch. Außerdem wurden Atemmuster und die Variabilität der Atmung analysiert. Die Ergebnisse dieser Messungen sind jedoch nicht Gegenstand dieser Dissertation und werden an anderer Stelle diskutiert. Ergebnisse: PAV, nicht jedoch noisy PSV, führte zu einer Umverteilung der regionalen Ventilation von zentral nach dorsal im Vergleich zu PSV. Für den kumulierten DAD Score ließen sich keine signifikanten Unterschiede zwischen den Gruppen nachweisen. In schwerkraftunabhängigen Lungenabschnitten zeigten sich weniger interstitielles Ödem für PAV und noisy PSV im Vergleich zu PSV sowie weniger Hämorrhagie für PAV und PSV im Vergleich zu noisy PSV. Auch ergab sich ein geringeres Maß an Überdehnung für PAV im Vergleich zu PSV. In schwerkraftabhängigen Lungenabschnitten kam es unter noisy PSV zu einer Reduktion von interstitiellem Ödem im Vergleich zu PSV. Insgesamt, für schwerkraftabhängige und schwerkraftunabhängige Regionen zusammen betrachtet, zeigten sich weniger Hämorrhagie für PAV im Vergleich zu noisy PSV sowie weniger interstitielles Ödem für PAV und noisy PSV im Vergleich zu PSV. Unabhängig von der Therapieform war weniger Hämorrhagie in schwerkraftunabhängigen im Vergleich zu schwerkraftabhängigen Lungenabschnitten zu beobachten. Für den Gehalt an mRNA für IL-1, IL-6, IL-8, TNF-α, TGF-ß, Amphiregulin und Tenascin-c im Gewebe sowie für die Konzentration TNF-α und IL-8 im Lungengewebe, TNF-α im Blutplasma sowie IL-8 in den Proben der BAL ließen sich ebenso keine signifikanten Unterschiede zwischen den Gruppen nachweisen wie für die Proteinkonzentration in der BAL-Flüssigkeit und die Wet-/Dry-Ratio des Lungengewebes. Schlussfolgerungen: In diesem Modell des akuten Lungenversagens am Schwein resultierte eine 6-stündige Beatmungstherapie mit variabler Druckunterstützung, proportionaler Druckunterstützung oder konstanter Druckunterstützung in einer vergleichbaren Schädigung des Lungengewebes ohne wesentliche Unterschiede in der Entzündungsreaktion.

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43

Mortamet, Guillaume. "Évaluation du travail respiratoire dans l’insuffisance respiratoire aiguë de l’enfant." Thèse, 2018. http://hdl.handle.net/1866/20260.

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