1
|
Lee KG, Roca O, Casey JD, Semler MW, Roman-Sarita G, Yarnell CJ, Goligher EC. When to intubate in acute hypoxaemic respiratory failure? Options and opportunities for evidence-informed decision making in the intensive care unit. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00118-8. [PMID: 38801827 DOI: 10.1016/s2213-2600(24)00118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 05/29/2024]
Abstract
The optimal timing of intubation in acute hypoxaemic respiratory failure is uncertain and became a point of controversy during the COVID-19 pandemic. Invasive mechanical ventilation is a potentially life-saving intervention but carries substantial risks, including injury to the lungs and diaphragm, pneumonia, intensive care unit-acquired muscle weakness, and haemodynamic impairment. In deciding when to intubate, clinicians must balance premature exposure to the risks of ventilation with the potential harms of unassisted breathing, including disease progression and worsening multiorgan failure. Currently, the optimal timing of intubation is unclear. In this Personal View, we examine a range of parameters that could serve as triggers to initiate invasive mechanical ventilation. The utility of a parameter (eg, the ratio of arterial oxygen tension to fraction of inspired oxygen) to predict the likelihood of a patient undergoing intubation does not necessarily mean that basing the timing of intubation on that parameter will improve therapeutic outcomes. We examine options for clinical investigation to make progress on establishing the optimal timing of intubation.
Collapse
Affiliation(s)
- Kevin G Lee
- Department of Physiology, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Jonathan D Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Christopher J Yarnell
- Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, ON, Canada; Scarborough Health Network, Department of Critical Care Medicine, Toronto, ON, Canada; Scarborough Health Network Research Institute, Toronto, ON, Canada.
| | - Ewan C Goligher
- Department of Physiology, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada
| |
Collapse
|
2
|
Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:112-122. [PMID: 36594451 DOI: 10.1097/mcp.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Noninvasive positive pressure ventilation (NIV) is standard of care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We review the most current evidence and highlight areas of uncertainty and ongoing research. We highlight key concepts for the clinician caring for patients with AECOPD which require NIV. RECENT FINDINGS Implementation of NIV in AECOPD is not uniform in spite of the evidence and guidelines. Initiation of NIV should be done early and following protocols. Low-intensity NIV remains the standard of care, although research and guidelines are evaluating higher intensity NIV. Scores to predict NIV failure continue to be refined to allow early identification and interventions. Several areas of uncertainty remain, among them are interventions to improve tolerance, length of support and titration and nutritional support during NIV. SUMMARY The use of NIV in AECOPD is the standard of care as it has demonstrated benefits in several patient-centered outcomes. Current developments and research is related to the implementation and adjustment of NIV.
Collapse
|
3
|
High-Flow Oxygen Therapy Application in Chronic Obstructive Pulmonary Disease Patients With Acute Hypercapnic Respiratory Failure: A Multicenter Study. Crit Care Explor 2021; 3:e0337. [PMID: 33615235 PMCID: PMC7886497 DOI: 10.1097/cce.0000000000000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives To evaluate the effect of high-flow oxygen implementation on the respiratory rate as a first-line ventilation support in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Design Multicenter, prospective, analytic observational case series study. Setting Five ICUs in Argentina, between August 2018 and September 2019. Patients Patients greater than or equal to 18 years old with moderate to very severe chronic obstructive pulmonary disease, who had been admitted to the ICU with a diagnosis of hypercapnic acute respiratory failure, were entered in the study. Interventions High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation. Measurements and Main Results Forty patients were studied, 62.5% severe chronic obstructive pulmonary disease. After the first hour of high-flow nasal cannula implementation, there was a significant decrease of respiratory rate compared with baseline values, with a 27% decline (29 vs 21 breaths/min; p < 0.001). Furthermore, a significant reduction of Paco2 (57 vs 52 mm Hg [7.6 vs 6.9 kPa]; p < 0.001) was observed. The high-flow nasal cannula application failed in 18% patients. In this group, the respiratory rate, pH, and Paco2 showed no significant change during the first hour in these patients. Conclusions High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation was an effective tool for reducing respiratory rate in these chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Early determination and subsequent monitoring of clinical and blood gas parameters may help predict the outcome.
Collapse
|
4
|
Madney YM, Saeed H, Harb HS, Guia M, Abdelrahim MEA, Esquinas AM. Noninvasive ventilation usage time and survival rate in patients with acute respiratory failure: some key insights. ERJ Open Res 2020; 6:00173-2020. [PMID: 32714961 PMCID: PMC7369437 DOI: 10.1183/23120541.00173-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 11/07/2022] Open
Abstract
One of the major causes of emergency admissions is acute respiratory failure (ARF) [1]. Noninvasive ventilation (NIV) is increasingly used for ARF management because of its efficacy (particularly in hypercapnic patients), achievable goals and because it can be outside the intensive care unit [2]. The benefits of NIV are still under investigation in various hypoxaemic respiratory failure (HRF) aetiologies, such as asthma, pneumonia, immunosuppression and acute respiratory distress syndrome [1]. The possibility of avoiding adverse events by recommending early determination of mask-on proportions in the first 24 h of admission and, consequently, NIV failure in ARF patientshttps://bit.ly/2T0QYVN
Collapse
Affiliation(s)
- Yasmin M Madney
- Clinical Pharmacy Dept, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Dept, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hadeer S Harb
- Clinical Pharmacy Dept, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Miguel Guia
- Pulmonology Dept, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal
| | | | | |
Collapse
|
5
|
Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, Khatib KI, Jagiasi BG, Chanchalani G, Mishra RC, Samavedam S, Govil D, Gupta S, Prayag S, Ramasubban S, Dobariya J, Marwah V, Sehgal I, Jog SA, Kulkarni AP. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med 2020; 24:S61-S81. [PMID: 32205957 PMCID: PMC7085817 DOI: 10.5005/jp-journals-10071-g23186] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A. ACUTE HYPERCAPNIC RESPIRATORY FAILURE A1. Acute Exacerbation of COPD: Recommendations: NIV should be used in management of acute exacerbation of COPD in patients with acute or acute-on-chronic respiratory acidosis (pH = 7.25-7.35). (1A) NIV should be attempted in patients with acute exacerbation of COPD (pH <7.25 & PaCO2 ≥ 45) before initiating invasive mechanical ventilation (IMV) except in patients requiring immediate intubation. (2A). Lower the pH higher the chance of failure of NIV. (2B) NIV should not to be used routinely in normo- or mildly hyper-capneic patients with acute exacerbation of COPD, without acidosis (pH > 7.35). (2B) A2. NIV in ARF due to Chest wall deformities/Neuromuscular diseases: Recommendations: NIV may be used in patients of ARF due to chest wall deformity/Neuromuscular diseases. (PaCO2 ≥ 45) (UPP) A3. NIV in ARF due to Obesity hypoventilation syndrome (OHS): Recommendations: NIV may be used in AHRF in OHS patients when they present with acute hypercapnic or acute on chronic respiratory failure (pH 45). (3B) NIV/CPAP may be used in obese, hypercapnic patients with OHS and/or right heart failure in the absence of acidosis. (UPP) B. NIV IN ACUTE HYPOXEMIC RESPIRATORY FAILURE: B1. NIV in Acute Cardiogenic Pulmonary Oedema: Recommendations: NIV is recommended in hospital patients with ARF, due to Cardiogenic pulmonary edema. (1A). NIV should be used in patients with acute heart failure/ cardiogenic pulmonary edema, right from emergency department itself. (1B) Both CPAP and BiPAP modes are safe and effective in patients with cardiogenic pulmonary edema. (1A). However, BPAP (NIV-PS) should be preferred in cardiogenic pulmonary edema with hypercapnia. (3A) B2. NIV in acute hypoxemic respiratory failure: Recommendations: NIV may be used over conventional oxygen therapy in mild early acute hypoxemic respiratory failure (P/F ratio <300 and >200 mmHg), under close supervision. (2B) We strongly recommend against a trial of NIV in patients with acute hypoxemic failure with P/F ratio <150. (2A) B3. NIV in ARF due to Chest Trauma: Recommendations: NIV may be used in traumatic flail chest along with adequate pain relief. (3B) B4. NIV in Immunocompromised Host: Recommendations: In Immunocompromised patients with early ARF, we may consider NIV over conventional oxygen. (2B). B5. NIV in Palliative Care: Recommendations: We strongly recommend use of NIV for reducing dyspnea in palliative care setting. (2A) B6. NIV in post-operative cases: Recommendations: NIV should be used in patients with post-operative acute respiratory failure. (2A) B6a. NIV in abdominal surgery: Recommendations: NIV may be used in patients with ARF following abdominal surgeries. (2A) B6b. NIV in bariatric surgery: Recommendations: NIV may be used in post-bariatric surgery patients with pre-existent OSA or OHS. (3A) B6c. NIV in Thoracic surgery: Recommendations: In cardiothoracic surgeries, use of NIV is recommended post operatively for acute respiratory failure to improve oxygenation and reduce chance of reintubation. (2A) NIV should not be used in patients undergoing esophageal surgery. (UPP) B6d. NIV in post lung transplant: Recommendations: NIV may be used for shortening weaning time and to avoid re-intubation following lung transplantation. (2B) B7. NIV during Procedures (ETI/Bronchoscopy/TEE/Endoscopy): Recommendations: NIV may be used for pre-oxygenation before intubation. (2B) NIV with appropriate interface may be used in patients of ARF during Bronchoscopy/Endoscopy to improve oxygenation. (3B) B8. NIV in Viral Pneumonitis ARDS: Recommendations: NIV cannot be considered as a treatment of choice for patients with acute respiratory failure with H1N1 pneumonia. However, it may be reasonable to use NIV in selected patients with single organ involvement, in a strictly controlled environment with close monitoring. (2B) B9. NIV and Acute exacerbation of Pulmonary Tuberculosis: Recommendations: Careful use of NIV in patients with acute Tuberculosis may be considered, with effective infection control precautions to prevent air-borne transmission. (3B) B10. NIV after planned extubation in high risk patients: Recommendation: We recommend that NIV may be used to wean high risk patients from invasive mechanical ventilation as it reduces re-intubation rate. (2B) B11. NIV for respiratory distress post extubation: Recommendations: We recommend that NIV therapy should not be used to manage respiratory distress post-extubation in high risk patients. (2B) C. APPLICATION OF NIV: Recommendation: Choice of mode should be mainly decided by factors like disease etiology and severity, the breathing effort by the patient and the operator familiarity and experience. (UPP) We suggest using flow trigger over pressure triggering in assisted modes, as it provides better patient ventilator synchrony. Especially in COPD patients, flow triggering has been found to benefit auto PEEP. (3B) D. MANAGEMENT OF PATIENT ON NIV: D1. Sedation: Recommendations: A non-pharmacological approach to calm the patient (Reassuring the patient, proper environment) should always be tried before administrating sedatives. (UPP) In patients on NIV, sedation may be used with extremely close monitoring and only in an ICU setting with lookout for signs of NIV failure. (UPP) E. EQUIPMENT: Recommendations: We recommend that portable bilevel ventilators or specifically designed ICU ventilators with non-invasive mode should be used for delivering Non–invasive ventilation in critically ill patients. (UPP) Both critical care ventilators with leak compensation and bi-level ventilators have been equally effective in decreasing the WOB, RR, and PaCO2. (3B) Currently, Oronasal mask is the most preferred interface for non-invasive ventilation for acute respiratory failure. (3B) F. WEANING: Recommendations: We recommend that weaning from NIV may be done by a standardized protocol driven approach of the unit. (2B) How to cite this article: Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med 2020;24(Suppl 1):S61–S81.
Collapse
Affiliation(s)
- Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India, , e-mail:
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , 020-25531539 / 25539538, e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India, , e-mail:
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India, , e-mail:
| | - G C Khilnani
- Department of PSRI Institute of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India, , e-mail:
| | - Yatin Mehta
- Department of Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon-122001, Haryana, India, Extn. 3335, e-mail:
| | - Khalid Ismail Khatib
- Department of Medicine, SKN Medical College, Pune, Maharashtra, India, , e-mail:
| | - Bharat G Jagiasi
- Department of Critical Care, Reliance Hospital, Navi Mumbai, Maharashtra, India, , e-mail:
| | - Gunjan Chanchalani
- Department of Critical Care Medicine, Bhatia Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India, , e-mail:
| | - Shirish Prayag
- Department of Critical Care, Prayag Hospital, Pune, Maharashtra, India, , e-mail:
| | - Suresh Ramasubban
- Department of Critical Care, Apollo Gleneagles Hospital Limited, Kolkata, India, , e-mail:
| | - Jayesh Dobariya
- Department of critical care, Synergy Hospital Rajkot, Rajkot, Gujarat, India, , e-mail:
| | - Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India, , e-mail:
| | - Inder Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India, , e-mail:
| | - Sameer Arvind Jog
- Department of Critical Care, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India, , 91-9823018178, e-mail:
| | - Atul Prabhakar Kulkarni
- Department of Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India, , e-mail:
| |
Collapse
|
6
|
Berbenetz N, Wang Y, Brown J, Godfrey C, Ahmad M, Vital FMR, Lambiase P, Banerjee A, Bakhai A, Chong M. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2019; 4:CD005351. [PMID: 30950507 PMCID: PMC6449889 DOI: 10.1002/14651858.cd005351.pub4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-invasive positive pressure ventilation (NPPV) has been used to treat respiratory distress due to acute cardiogenic pulmonary oedema (ACPE). We performed a systematic review and meta-analysis update on NPPV for adults presenting with ACPE. OBJECTIVES To evaluate the safety and effectiveness of NPPV compared to standard medical care (SMC) for adults with ACPE. The primary outcome was hospital mortality. Important secondary outcomes were endotracheal intubation, treatment intolerance, hospital and intensive care unit length of stay, rates of acute myocardial infarction, and adverse event rates. SEARCH METHODS We searched CENTRAL (CRS Web, 20 September 2018), MEDLINE (Ovid, 1946 to 19 September 2018), Embase (Ovid, 1974 to 19 September 2018), CINAHL Plus (EBSCO, 1937 to 19 September 2018), LILACS, WHO ICTRP, and clinicaltrials.gov. We also reviewed reference lists of included studies. We applied no language restrictions. SELECTION CRITERIA We included blinded or unblinded randomised controlled trials in adults with ACPE. Participants had to be randomised to NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care (SMC) compared with SMC alone. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected articles for inclusion. We extracted data with a standardised data collection form. We evaluated the risks of bias of each study using the Cochrane 'Risk of bias' tool. We assessed evidence quality for each outcome using the GRADE recommendations. MAIN RESULTS We included 24 studies (2664 participants) of adult participants (older than 18 years of age) with respiratory distress due to ACPE, not requiring immediate mechanical ventilation. People with ACPE presented either to an Emergency Department or were inpatients. ACPE treatment was provided in an intensive care or Emergency Department setting. There was a median follow-up of 13 days for hospital mortality, one day for endotracheal intubation, and three days for acute myocardial infarction. Compared with SMC, NPPV may reduce hospital mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; participants = 2484; studies = 21; I2 = 6%; low quality of evidence) with a number needed to treat for an additional beneficial outcome (NNTB) of 17 (NNTB 12 to 32). NPPV probably reduces endotracheal intubation rates (RR 0.49, 95% CI 0.38 to 0.62; participants = 2449; studies = 20; I2 = 0%; moderate quality of evidence) with a NNTB of 13 (NNTB 11 to 18). There is probably little or no difference in acute myocardial infarction (AMI) incidence with NPPV compared to SMC for ACPE (RR 1.03, 95% CI 0.91 to 1.16; participants = 1313; studies = 5; I2 = 0%; moderate quality of evidence). We are uncertain as to whether NPPV increases hospital length of stay (mean difference (MD) -0.31 days, 95% CI -1.23 to 0.61; participants = 1714; studies = 11; I2 = 55%; very low quality of evidence). Adverse events were generally similar between NPPV and SMC groups, but evidence was of low quality. AUTHORS' CONCLUSIONS Our review provides support for continued clinical application of NPPV for ACPE, to improve outcomes such as hospital mortality and intubation rates. NPPV is a safe intervention with similar adverse event rates to SMC alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.
Collapse
Affiliation(s)
| | - Yongjun Wang
- Schulich School of Medicine & Dentistry, Western UniversityKresge Building, Rm. K1LondonONCanada
| | | | | | - Mahmood Ahmad
- Royal Free Hospital, Royal Free London NHS Foundation TrustCardiology DepartmentLondonUK
| | - Flávia MR Vital
- Cochrane Brazil Minas GeraisAv. Cristiano Ferreira Varella, 555MuriaéMinas GeraisBrazil36888‐233
| | - Pier Lambiase
- The Heart Hospital, University College London HospitalsCentre for Cardiology in the Young16‐18 Westmoreland Street,LondonUKW1G 8PH
| | - Amitava Banerjee
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Ameet Bakhai
- Royal Free London NHS Foundation TrustBarnet General Hospital Cardiology DepartmentBarnet General HospitalThames House, Wellhouse LaneBarnetEnfieldUKEN5 3DJ
| | | | | |
Collapse
|
7
|
Dos Reis IMM, Ohara DG, Januário LB, Basso-Vanelli RP, Oliveira AB, Jamami M. Surface electromyography in inspiratory muscles in adults and elderly individuals: A systematic review. J Electromyogr Kinesiol 2019; 44:139-155. [PMID: 30658230 DOI: 10.1016/j.jelekin.2019.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/21/2018] [Accepted: 01/09/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Electromyography (EMG) helps to evaluate disorders and pulmonary behavior, as impairments in respiratory muscle function are associated with the development of diseases. There is a wide range of methods and protocols used to record and analyze EMG obtained from respiratory muscles, demonstrating a lack of standardization. OBJECTIVE To identify the most common procedures used to record surface EMG (sEMG) of inspiratory muscles in adults and elderly individuals through a systematic review (primary), and to evaluate the quality of the report presented by the studies (secondary). METHOD Studies published from January 1995 until June 2018 were searched for in the Web of Science, PubMed, LILACS, EBSCO and Embase databases. Only studies evaluating sEMG of inspiratory muscles were included. RESULTS The electronic search retrieved a total of 6697 titles and 92 of them were included. A great variability on the methods applied to both recording and processing/analyzing data was found. Therefore, the synthesis of practical/clinical evidence to support immediate recommendations was impaired. In general, the descriptions presented by the studies are poor. CONCLUSION The most common procedures used for sEMG were identified. Methodological studies with objective comparisons were fundamental for improving standardization, given the impossibility of recommendations from this review.
Collapse
Affiliation(s)
- Ivanize Mariana Masselli Dos Reis
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Spirometry and Respiratory Physiotherapy Laboratory (LEFiR) at UFSCar, São Carlos/SP, Brazil.
| | - Daniela Gonçalves Ohara
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Federal University of Amapá (UNIFAP), Macapá/AP, Brazil
| | - Letícia Bergamin Januário
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Laboratory of Clinical and Occupational Kinesiology (LACO) at UFSCar, São Carlos/SP, Brazil
| | - Renata Pedrolongo Basso-Vanelli
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; University Hospital of UFSCar, São Carlos/SP, Brazil
| | - Ana Beatriz Oliveira
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Laboratory of Clinical and Occupational Kinesiology (LACO) at UFSCar, São Carlos/SP, Brazil
| | - Mauricio Jamami
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Spirometry and Respiratory Physiotherapy Laboratory (LEFiR) at UFSCar, São Carlos/SP, Brazil
| |
Collapse
|
8
|
Lin L, Guan L, Wu W, Chen R. Correlation of surface respiratory electromyography with esophageal diaphragm electromyography. Respir Physiol Neurobiol 2019; 259:45-52. [DOI: 10.1016/j.resp.2018.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 12/08/2022]
|
9
|
Spoletini G, Mega C, Pisani L, Alotaibi M, Khoja A, Price LL, Blasi F, Nava S, Hill NS. High-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial. J Crit Care 2018; 48:418-425. [PMID: 30321833 DOI: 10.1016/j.jcrc.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV). METHODS Multicenter trial including patients (n = 54) anticipated to receive NIV for ≥24 h due to acute or acute-on-chronic respiratory failure. Subjects were randomized (1:1) to SO or HFNT during breaks off NIV. Primary outcome was total time on and off NIV. Secondary outcomes were comfort and dyspnea, respiratory rate (RR), oxygen saturation (SpO2), tolerance and side effects. RESULTS Total time per patient on NIV (1315 vs 1441 min) and breaks (1362 vs 1196 min), and mean duration of each break (520 vs 370 min) were similar in the HFNT and SO arms (p > .05). Comfort score was higher on HFNT than on SO (8.3 ± 2.7 vs 6.9 ± 2.3, p = .001). Dyspnea, RR and SpO2 were similar in the two arms, but the increase in RR and dyspnea seen with SO during breaks did not occur with HFNT. CONCLUSION Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.
Collapse
Affiliation(s)
- Giulia Spoletini
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Chiara Mega
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Lara Pisani
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Mona Alotaibi
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Alia Khoja
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA; The Institute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston, MA, USA
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Ca' Granda, Milan, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, Ospedale Sant'Orsola Malpighi, Alma Mater University, Bologna, Italy
| | - Nicholas S Hill
- Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
10
|
Crisafulli E, Barbeta E, Ielpo A, Torres A. Management of severe acute exacerbations of COPD: an updated narrative review. Multidiscip Respir Med 2018; 13:36. [PMID: 30302247 PMCID: PMC6167788 DOI: 10.1186/s40248-018-0149-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
Collapse
Affiliation(s)
- Ernesto Crisafulli
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enric Barbeta
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonella Ielpo
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
Zikyri A, Pastaka C, Gourgoulianis KI. Hypercapnic COPD patients and NIV at home: is there any benefit? Using the CAT and BODE index in an effort to prove benefits of NIV in these patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2191-2198. [PMID: 30140151 PMCID: PMC6054756 DOI: 10.2147/copd.s152574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The benefits of long-term noninvasive ventilation (NIV) in stable COPD with chronic hypercapnic respiratory failure (CHRF) have been debated for many years due to the conflicting results observed in these patients. Materials and methods We investigated the effects of domiciliary NIV in stable hypercapnic COPD patients for a period of 1 year using COPD Assessment Test (CAT), BODE Index, and the number of acute exacerbations. NIV was administered in 57 stable COPD patients with CHRF in the spontaneous/timed mode. Spirometry, 6 minute walk test, Medical Research Council dyspnea scale, arterial blood gases, number of acute exacerbations, BODE Index, and CAT were assessed. Study participants were reassessed in the 1st, 6th, and 12th months after the initial evaluation. Results There was a significant improvement in COPD exacerbations (p<0.001), CAT (p<0.001), PO2 (p<0.001), PCO2 (p<0.001), and Medical Research Council dyspnea scale (p<0.001) in 1 year of follow-up. BODE Index was improved in the first 6 months (5.8±2.2 vs 4.8±2.4, p<0.001), but the improvement was not maintained. Conclusion In conclusion, domiciliary NIV in stable COPD patients with CHRF has beneficial effect on CAT, arterial blood gases, and number of acute exacerbations in a year of NIV use at home. A significant improvement in BODE Index from baseline to 12 months was found in patients aged >70 years, while for those aged <70, the improvement was not maintained after the sixth month.
Collapse
Affiliation(s)
- Andriani Zikyri
- Department of Pulmonology, University Hospital of Larissa, Larissa, Greece,
| | - Chaido Pastaka
- Department of Pulmonology, University Hospital of Larissa, Larissa, Greece,
| | | |
Collapse
|
12
|
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017. [PMID: 28860265 DOI: 10.1183/13993003.02426–2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material.This guideline committee developed recommendations for 11 actionable questions in a PICO (population-intervention-comparison-outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders.
Collapse
Affiliation(s)
- Bram Rochwerg
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Mark W Elliott
- Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - Dean Hess
- Respiratory Care Dept, Massachusetts General Hospital and Dept of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Stefano Nava
- Dept of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Massimo Antonelli
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Jan Brozek
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Giorgio Conti
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Miquel Ferrer
- Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Kalpalatha Guntupalli
- Depts of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samir Jaber
- Dept of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, Montpellier, France
| | - Sean Keenan
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.,Dept of Critical Care Medicine, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | - Sangeeta Mehta
- Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Suhail Raoof
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| |
Collapse
|
13
|
Kahlil NH, Abdel-Hamid HM, Mohammed YM. Assessment of prescription practices according to international chronic obstructive pulmonary disease guidelines on Egyptian doctors. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_75_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50:50/2/1602426. [PMID: 28860265 DOI: 10.1183/13993003.02426-2016] [Citation(s) in RCA: 695] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Abstract
Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material.This guideline committee developed recommendations for 11 actionable questions in a PICO (population-intervention-comparison-outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation.This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders.
Collapse
Affiliation(s)
- Bram Rochwerg
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Mark W Elliott
- Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - Dean Hess
- Respiratory Care Dept, Massachusetts General Hospital and Dept of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Stefano Nava
- Dept of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Massimo Antonelli
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Jan Brozek
- Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Giorgio Conti
- Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
| | - Miquel Ferrer
- Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Kalpalatha Guntupalli
- Depts of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samir Jaber
- Dept of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, Montpellier, France
| | - Sean Keenan
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.,Dept of Critical Care Medicine, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | - Sangeeta Mehta
- Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Suhail Raoof
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| |
Collapse
|
15
|
Plachi F, Vieira FN, Berton DC, Knorst M, Dias AS, Balzan FM. Effectiveness assessment of a guideline based protocol for ventilatory support management of COPD exacerbations in an emergency department. Braz J Phys Ther 2017; 21:357-364. [PMID: 28711381 PMCID: PMC5628362 DOI: 10.1016/j.bjpt.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/21/2016] [Accepted: 12/03/2016] [Indexed: 11/26/2022] Open
Abstract
Noninvasive ventilation failure confirmed longer intensive care and hospital stays. Predictors of successful noninvasive ventilation: tolerance and reduction of PaCO2. PaCO2 cutoff was 6.5 after 1 h with 87% sensitivity and 71% specificity for success.
Objectives To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a “real-life” Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation. Methods Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation). Results 117 consecutive chronic obstructive pulmonary disease exacerbation admissions (Group A = 96; Group B = 13; Group C = 8) of candidates for ventilatory support were reviewed. No differences in baseline disease severity and physiological parameters were found between the groups at Emergency Department admission. Nevertheless, Group B had higher intensive care unit admission, length of hospital stay, length of intensive care unit stay, and higher in-hospital mortality compared to Group A. Group C also had worse outcomes when compared to Group A. The only independent variable associated with the successful use of noninvasive positive pressure ventilation were improvement in arterial carbon dioxide pressure after 1 h of noninvasive positive pressure ventilation use and its tolerance. Conclusion Our data confirmed in a “real life” Emergency Department cohort that successful management of chronic obstructive pulmonary disease exacerbation with noninvasive positive pressure ventilation showed lower in-hospital mortality and Intensive Care Unit stay when compared to patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation or patients who presented an immediate need for invasive mechanical ventilation. noninvasive positive pressure ventilation tolerance and higher arterial carbon dioxide pressure reduction after 1-h of noninvasive positive pressure ventilation were predictors of successful treatment. These results should be confirmed in a prospective randomized controlled trial.
Collapse
Affiliation(s)
- Franciele Plachi
- Physical Therapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Pneumology Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernando Nataniel Vieira
- Physical Therapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Danilo Cortozi Berton
- Pneumology Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Respiratory Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Marli Knorst
- Pneumology Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Respiratory Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Alexandre Simões Dias
- Physical Therapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Pneumology Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Human Movement Science Post-graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernanda Machado Balzan
- Physical Therapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| |
Collapse
|
16
|
Osadnik CR, Tee VS, Carson‐Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 7:CD004104. [PMID: 28702957 PMCID: PMC6483555 DOI: 10.1002/14651858.cd004104.pub4] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) is commonly used to treat patients admitted to hospital with acute hypercapnic respiratory failure (AHRF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). OBJECTIVES To compare the efficacy of NIV applied in conjunction with usual care versus usual care involving no mechanical ventilation alone in adults with AHRF due to AECOPD. The aim of this review is to update the evidence base with the goals of supporting clinical practice and providing recommendations for future evaluation and research. SEARCH METHODS We identified trials from the Cochrane Airways Group Specialised Register of trials (CAGR), which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), and PsycINFO, and through handsearching of respiratory journals and meeting abstracts. This update to the original review incorporates the results of database searches up to January 2017. SELECTION CRITERIA All randomised controlled trials that compared usual care plus NIV (BiPAP) versus usual care alone in an acute hospital setting for patients with AECOPD due to AHRF were eligible for inclusion. AHRF was defined by a mean admission pH < 7.35 and mean partial pressure of carbon dioxide (PaCO2) > 45 mmHg (6 kPa). Primary review outcomes were mortality during hospital admission and need for endotracheal intubation. Secondary outcomes included hospital length of stay, treatment intolerance, complications, changes in symptoms, and changes in arterial blood gases. DATA COLLECTION AND ANALYSIS Two review authors independently applied the selection criteria to determine study eligibility, performed data extraction, and determined risk of bias in accordance with Cochrane guidelines. Review authors undertook meta-analysis for data that were both clinically and statistically homogenous, and analysed data as both one overall pooled sample and according to two predefined subgroups related to exacerbation severity (admission pH between 7.35 and 7.30 vs below 7.30) and NIV treatment setting (intensive care unit-based vs ward-based). We reported results for mortality, need for endotracheal intubation, and hospital length of stay in a 'Summary of findings' table and rated their quality in accordance with GRADE criteria. MAIN RESULTS We included in the review 17 randomised controlled trials involving 1264 participants. Available data indicate that mean age at recruitment was 66.8 years (range 57.7 to 70.5 years) and that most participants (65%) were male. Most studies (12/17) were at risk of performance bias, and for most (14/17), the risk of detection bias was uncertain. These risks may have affected subjective patient-reported outcome measures (e.g. dyspnoea) and secondary review outcomes, respectively.Use of NIV decreased the risk of mortality by 46% (risk ratio (RR) 0.54, 95% confidence interval (CI) 0.38 to 0.76; N = 12 studies; number needed to treat for an additional beneficial outcome (NNTB) 12, 95% CI 9 to 23) and decreased the risk of needing endotracheal intubation by 65% (RR 0.36, 95% CI 0.28 to 0.46; N = 17 studies; NNTB 5, 95% CI 5 to 6). We graded both outcomes as 'moderate' quality owing to uncertainty regarding risk of bias for several studies. Inspection of the funnel plot related to need for endotracheal intubation raised the possibility of some publication bias pertaining to this outcome. NIV use was also associated with reduced length of hospital stay (mean difference (MD) -3.39 days, 95% CI -5.93 to -0.85; N = 10 studies), reduced incidence of complications (unrelated to NIV) (RR 0.26, 95% CI 0.13 to 0.53; N = 2 studies), and improvement in pH (MD 0.05, 95% CI 0.02 to 0.07; N = 8 studies) and in partial pressure of oxygen (PaO2) (MD 7.47 mmHg, 95% CI 0.78 to 14.16 mmHg; N = 8 studies) at one hour. A trend towards improvement in PaCO2 was observed, but this finding was not statistically significant (MD -4.62 mmHg, 95% CI -11.05 to 1.80 mmHg; N = 8 studies). Post hoc analysis revealed that this lack of benefit was due to the fact that data from two studies at high risk of bias showed baseline imbalance for this outcome (worse in the NIV group than in the usual care group). Sensitivity analysis revealed that exclusion of these two studies resulted in a statistically significant positive effect of NIV on PaCO2. Treatment intolerance was significantly greater in the NIV group than in the usual care group (risk difference (RD) 0.11, 95% CI 0.04 to 0.17; N = 6 studies). Results of analysis showed a non-significant trend towards reduction in dyspnoea with NIV compared with usual care (standardised mean difference (SMD) -0.16, 95% CI -0.34 to 0.02; N = 4 studies). Subgroup analyses revealed no significant between-group differences. AUTHORS' CONCLUSIONS Data from good quality randomised controlled trials show that NIV is beneficial as a first-line intervention in conjunction with usual care for reducing the likelihood of mortality and endotracheal intubation in patients admitted with acute hypercapnic respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). The magnitude of benefit for these outcomes appears similar for patients with acidosis of a mild (pH 7.30 to 7.35) versus a more severe nature (pH < 7.30), and when NIV is applied within the intensive care unit (ICU) or ward setting.
Collapse
Affiliation(s)
- Christian R Osadnik
- Monash UniversityDepartment of PhysiotherapyMcMahons RoadFrankstonMelbourneVictoriaAustralia3199
- Monash HealthMonash Lung and Sleep246 Clayton RoadClaytonMelbourneVictoriaAustralia3168
- Institute for Breathing and SleepMelbourneVictoriaAustralia3084
| | - Vanessa S Tee
- The University of AdelaideDepartment of Respiratory Medicine, The Queen Elizabeth HospitalAdelaideAustralia
| | | | - Joanna Picot
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
| | | | - Brian J Smith
- The University of AdelaideSchool of MedicineAdelaideAustralia
| | | |
Collapse
|
17
|
Sellares J, Ferrer M, Anton A, Loureiro H, Bencosme C, Alonso R, Martinez-Olondris P, Sayas J, Peñacoba P, Torres A. Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: a randomised controlled trial. Eur Respir J 2017; 50:50/1/1601448. [PMID: 28679605 DOI: 10.1183/13993003.01448-2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/30/2017] [Indexed: 11/05/2022]
Abstract
We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59). The primary outcome was relapse of AHRF within 8 days after NIV discontinuation.Except for a shorter median (interquartile range) intermediate respiratory care unit (IRCU) stay in the direct discontinuation group (4 (2-6) versus 5 (4-7) days, p=0.036), no differences were observed in relapse of AHRF after NIV discontinuation (10 (17%) versus 8 (13%) for the direct discontinuation and nocturnal NIV groups, respectively, p=0.56), long-term ventilator dependence, hospital stay, and 6-month hospital readmission or survival.Prolongation of nocturnal NIV after recovery from an AHRF episode does not prevent subsequent relapse of AHRF in COPD patients without previous domiciliary ventilation, and results in longer IRCU stay. Consequently, NIV can be directly discontinued when the episode is resolved and patients tolerate unassisted breathing.
Collapse
Affiliation(s)
- Jacobo Sellares
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, (CibeRes, CB06/06/0028) Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Ferrer
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .,Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, (CibeRes, CB06/06/0028) Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Anton
- Dept of Pneumology, Hospital de Sant Pau, Barcelona, Spain
| | - Hugo Loureiro
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, (CibeRes, CB06/06/0028) Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Bencosme
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Rodrigo Alonso
- Servicio de Neumologia, Hospital 12 de Octubre, Madrid, Spain
| | - Pilar Martinez-Olondris
- Servicio de Neumologia, Hospital del Mar, Barcelona, Spain.,Hospital Plato, Barcelona, Spain
| | - Javier Sayas
- Servicio de Neumologia, Hospital 12 de Octubre, Madrid, Spain
| | | | - Antoni Torres
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, (CibeRes, CB06/06/0028) Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
18
|
DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure. PLoS One 2017; 12:e0179641. [PMID: 28671972 PMCID: PMC5495207 DOI: 10.1371/journal.pone.0179641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 06/01/2017] [Indexed: 11/19/2022] Open
Abstract
Background The assessment of the work of breathing in the definitions of respiratory failure is vague and variable. Objective Identify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients. Methods We examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation, or T-piece. A physician inspected each patient for 10 seconds, rated the level of respiratory distress, and then examined the patient for vital signs and 17 other physical signs. We used the rating of distress as a surrogate for measuring the work of breathing, constructed three multivariate models to identify the one with the smallest number of signs and largest explained variance, and validated it with bootstrap analysis. Results We performed 402 observations on 240 patients. Respiratory distress was absent in 78, mild in 157, moderate in 107, and severe in 60. Respiratory rate, hypoxia, heart rate, and frequency of most signs increased as distress increased. Respiratory rate and hypoxia explained 43% of the variance in respiratory distress. Diaphoresis, gasping, and contraction of the sternomastoid explained an additional 28%. Heart rate, blood pressure, alertness, agitation, body posture, nasal flaring, audible breathing, cyanosis, tracheal tug, retractions, paradox, scalene or abdominal muscles contraction did not increase the explained variance in respiratory distress. Conclusion Most of the variance is respiratory distress can be explained by five signs summarized by the mnemonic DiapHRaGM (diaphoresis, hypoxia, respiratory rate, gasping, accessory muscle). This set of signs may allow for efficient, standardized assessments of the work of breathing of hypoxic patients.
Collapse
|
19
|
Wedzicha JA, Miravitlles M, Hurst JR, Calverley PMA, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, Sliwinski P, Tonia T, Vestbo J, Wilson KC, Krishnan JA. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017; 49:49/3/1600791. [PMID: 28298398 DOI: 10.1183/13993003.00791-2016] [Citation(s) in RCA: 314] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/15/2016] [Indexed: 01/20/2023]
Abstract
This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.
Collapse
Affiliation(s)
- Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Peter M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Richard K Albert
- Dept of Medicine, University of Colorado, Denver, Aurora, CO, USA
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Alberto Papi
- Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Klaus F Rabe
- Dept of Internal Medicine, Christian-Albrechts University, Kiel and LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Pawel Sliwinski
- 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Kevin C Wilson
- Dept of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| |
Collapse
|
20
|
Abstract
Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. We performed this meta-analysis to investigate the utility of NPPV intervention in patients with acute respiratory failure (ARF). A comprehensive literature search identified 12 studies enrolling a total of 963 patients from Medline, PubMed, Cochrane and EMBASE databases that assessed the effectiveness of NPPV versus conventional mechanical ventilation and/or non-ventilation therapy in patients with ARF, irrespective of the underlying aetiology, as well as mortality rate and the length of intensive care unit (ICU) or hospital stay. The usage of NPPV was associated with significantly decreased intubation (pooled OR=0.23, 95% CI 0.12-0.42, p<0.001) and ICU mortality rate (pooled OR=0.34, 95% CI 0.20-0.60, p<0.001), but did not influence the hospital mortality rate (pooled OR=0.77, 95% CI 0.32-1.81, p=0.543) and the length of ICU or hospital stay (ICU stay: difference in means=0.38, 95% CI -3.01 to 3.77, p=0.825; hospital stay: difference in means=2.76, 95% CI -1.74 to 7.27, p=0.229). In conclusion, usage of NPPV in patients with ARF is associated with lower intubation and in-ICU mortality rate.
Collapse
Affiliation(s)
- Yu-Jing Liu
- Department of Medical Engineering, Army General Hospital, Beijing, China
| | - Jing Zhao
- Department of Thoracic Surgery, Army General Hospital, Beijing, China
| | - Hui Tang
- Department of Medical Engineering, Army General Hospital, Beijing, China
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW The objective of this article is to review the most recent literature regarding the management of acute hypercapnic respiratory failure (AHRF). RECENT FINDINGS In the field of AHRF management, noninvasive ventilation (NIV) has become the standard method of providing primary mechanical ventilator support. Recently, extracorporeal carbon dioxide removal (ECCO2R) devices have been proposed as new therapeutic option. SUMMARY NIV is an effective strategy in specific settings and in selected population with AHRF. To date, evidence on ECCO2R is based only on case reports and case-control trials. Although the preliminary results using ECCO2R to decrease the rate of NIV failure and to wean hypercapnic patients from invasive ventilation are remarkable; further randomized studies are needed to assess the effects of this technique on both short-term and long-term clinical outcomes.
Collapse
|
22
|
Zhang J, Luo Q, Zhang H, Chen R. Physiological Significance of Well-tolerated Inspiratory Pressure to Chronic Obstructive Pulmonary Disease Patient with Hypercapnia During Noninvasive Pressure Support Ventilation. COPD 2016; 13:734-740. [PMID: 27383083 DOI: 10.1080/15412555.2016.1196658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The inspiratory pressure is often set by tolerance of chronic obstructive pulmonary disease (COPD) patient during noninvasive pressure support ventilation (PSV). However, physiological effects of this setting remain unclear. This study was undertaken to assess the physiological effect of highest tolerated assist level on COPD patient. The baseline inspiratory pressure (PS) was titrated by tolerance in 15 severe COPD patients with hypercapnia during acute exacerbation. In addition to the baseline PS, an additional decrease by 25% (PS- = 75% PS) or increase by 25% (PS+ = 125% PS) of PS was applied to the patients. Each level lasted at least 20 minutes. Respiratory rate (RR), tidal volume (Vt), inspiratory effort (PTPpesin/min), and neuro-ventilatory coupling (VE/RMS%) were measured. Asynchrony Index (AI) was calculated. The Vt and VE/RMS% were significantly increased by PS level (Vt: 561 ± 102 ml, VE/RMS%: 1.06 ± 0.42 L/%, comfort score: 7.5 ± 1.1). The inspiratory muscles were sufficiently unloaded (PTPpesin/min 56.67 ± 32.71 cmH2O.S/min). In comparison with PS, PS+ resulted in a further increase in Vt, VE/RMS% and AI (P < 0.01), with no further reduction in neural drive (RMS) and respiratory muscle activity (P > 0.05). Increasing inspiratory pressure significantly enhances the VE/RMS% and Vt. However, the inspiratory pressure higher than COPD patient's most tolerated level cannot lead to further reduction in respiratory muscle load and RMS, but more asynchrony events. Physiological data can monitor the patient's responses and the ventilator-patient interaction, which may provide objective criterion to ventilator setting.
Collapse
Affiliation(s)
- Jianheng Zhang
- a State Key Laboratory of Respiratory Disease, Guangzhou Medical University , Guangzhou , China.,b The First Affiliated Hospital of Guangzhou Medical College , Guangdong , China
| | - Qun Luo
- a State Key Laboratory of Respiratory Disease, Guangzhou Medical University , Guangzhou , China.,b The First Affiliated Hospital of Guangzhou Medical College , Guangdong , China
| | - Huijin Zhang
- a State Key Laboratory of Respiratory Disease, Guangzhou Medical University , Guangzhou , China.,b The First Affiliated Hospital of Guangzhou Medical College , Guangdong , China
| | - Rongchang Chen
- a State Key Laboratory of Respiratory Disease, Guangzhou Medical University , Guangzhou , China.,b The First Affiliated Hospital of Guangzhou Medical College , Guangdong , China
| |
Collapse
|
23
|
Pandor A, Thokala P, Goodacre S, Poku E, Stevens JW, Ren S, Cantrell A, Perkins GD, Ward M, Penn-Ashman J. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation. Health Technol Assess 2016; 19:v-vi, 1-102. [PMID: 26102313 DOI: 10.3310/hta19420] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources. OBJECTIVES We aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research. DATA SOURCES Fourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field. REVIEW METHODS We included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure. RESULTS The literature searches identified 2284 citations. Of the 10 studies that met the inclusion criteria, eight were randomised controlled trials and two were quasi-randomised trials (six CPAP; four BiPAP; sample sizes 23-207 participants). IPD were available from seven trials (650 patients). The aggregate data NMA suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639), and reduced both mortality [odds ratio (OR) 0.41, 95% credible interval (CrI) 0.20 to 0.77] and intubation rate (OR 0.32, 95% CrI 0.17 to 0.62) compared with standard care. The effect of BiPAP on mortality (OR 1.94, 95% CrI 0.65 to 6.14) and intubation rate (OR 0.40, 95% CrI 0.14 to 1.16) compared with standard care was uncertain. The combined IPD and aggregate data NMA suggested that sex was a statistically significant treatment effect modifier for mortality. The economic analysis showed that pre-hospital CPAP was more effective and more expensive than standard care, with an incremental cost-effectiveness ratio of £20,514 per quality-adjusted life-year (QALY) and a 49.5% probability of being cost-effective at the £20,000-per-QALY threshold. Variation in the incidence of eligible patients had a marked impact on cost-effectiveness and the expected value of sample information for a future randomised trial. LIMITATIONS The meta-analysis lacked power to detect potentially important differences in outcome (particularly for BiPAP), the intervention was not always compared with the best alternative care (in-hospital NIV) in the primary studies and findings may not be generalisable. CONCLUSIONS Pre-hospital CPAP can reduce mortality and intubation rates, but cost-effectiveness is uncertain and the value of further randomised evaluation depends on the incidence of suitable patients. A feasibility study is required to determine if a large pragmatic trial of clinical effectiveness and cost-effectiveness is appropriate. STUDY REGISTRATION The study is registered as PROSPERO CRD42012002933. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John W Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Matt Ward
- West Midlands Ambulance Service NHS Foundation Trust, West Midlands, UK
| | - Jerry Penn-Ashman
- West Midlands Ambulance Service NHS Foundation Trust, West Midlands, UK
| |
Collapse
|
24
|
Demoule A, Chevret S, Carlucci A, Kouatchet A, Jaber S, Meziani F, Schmidt M, Schnell D, Clergue C, Aboab J, Rabbat A, Eon B, Guérin C, Georges H, Zuber B, Dellamonica J, Das V, Cousson J, Perez D, Brochard L, Azoulay E. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med 2015; 42:82-92. [PMID: 26464393 DOI: 10.1007/s00134-015-4087-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown. METHODS Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries. RESULTS Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality. CONCLUSION Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT01449331.
Collapse
Affiliation(s)
- Alexandre Demoule
- Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. .,UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France.
| | - Sylvie Chevret
- Département de biostatistique et d'Information médicale, et INSERM UMR-717, Hôpital Saint-Louis, Paris, France
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Achille Kouatchet
- Réanimation médicale et Médecine hyperbare, Centre Hospitalier Universitaire, Angers, France
| | - Samir Jaber
- Département d'Anesthésie et Réanimation, Hôpital Saint-Eloi, Montpellier, France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matthieu Schmidt
- Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,UMR-S 1158, INSERM et Université Pierre et Marie Curie-Paris 6, Paris, France
| | - David Schnell
- Service de Réanimation médicale, Hôpital Saint-Louis, Paris, France
| | - Céline Clergue
- Service Réanimation polyvalente, Centre Hospitalier Sud Francilien, Evry, France
| | - Jérôme Aboab
- Service de Réanimation Médicochirurgicale, Hôpital Raymond Poincaré, Garches, France
| | - Antoine Rabbat
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin, Paris, France
| | - Béatrice Eon
- UMR 7268 ADéS, Aix-Marseille Université/Espace éthique méditerranéen, Réanimation des Urgences et Médicale-Hôpital La Timone 2, Marseille, France
| | - Claude Guérin
- Service de Réanimation médicale, Hôpital de la Croix Rousse, Lyon, France
| | - Hugues Georges
- Service de Réanimation Polyvalente et Maladies Infectieuses, Centre Hospitalier, Tourcoing, France
| | - Benjamin Zuber
- Service de Réanimation Médicale, Hôpital Cochin, Paris, France
| | - Jean Dellamonica
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de l'Archet, Nice, France
| | - Vincent Das
- Service de Réanimation Polyvalente, Centre Hospitalier André Grégoire, Montreuil, France
| | - Joël Cousson
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Didier Perez
- Service de Réanimation Polyvalente, Centre Hospitalier Louis Pasteur, Dole, France
| | - Laurent Brochard
- Keenan Research Centre and Li Ka Shing Institute, Saint-Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Elie Azoulay
- Service de Réanimation médicale, Hôpital Saint-Louis, Paris, France
| | | | | |
Collapse
|
25
|
Perrin C, Rolland F, Berthier F, Duval Y, Jullien V. [Noninvasive ventilation for acute respiratory failure in a pulmonary department]. Rev Mal Respir 2015; 32:895-902. [PMID: 26050081 DOI: 10.1016/j.rmr.2015.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/11/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Noninvasive ventilation (NIV) is considered as the first choice treatment for selected patients with acute respiratory failure (ARF), but many hospitals are forced to start NIV on medical wards. METHODS The aim of this retrospective study was to assess the outcomes of NIV initiated for ARF on a respiratory ward and to find the criteria predictive of failure. All patients were treated in a four-bed ward specifically dedicated to NIV. Failure of NIV was defined as the need for intubation and transfer to ICU, or death. RESULTS Among 105 admissions with ARF, 49 episodes needed NIV. These episodes were divided into 2 groups: PaCO2<45mmHg (10) and PaCO2>45mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV. CONCLUSIONS NIV is practicable and is effective in the management of mild to moderate ARF on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure.
Collapse
Affiliation(s)
- C Perrin
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France.
| | - F Rolland
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - F Berthier
- Département d'information médicale, hôpital Princesse Grâce, Principauté de Monaco, Monaco, France
| | - Y Duval
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - V Jullien
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| |
Collapse
|
26
|
Moxon A, Lee G. Non-invasive ventilation in the emergency department for patients in type II respiratory failure due to COPD exacerbations. Int Emerg Nurs 2015; 23:232-6. [PMID: 25665756 DOI: 10.1016/j.ienj.2015.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute chronic obstructive pulmonary disease (COPD) exacerbations can cause respiratory failure and may require non-invasive ventilation (NIV). There is a paucity of studies examining their NIV implementation within the emergency department (ED). AIM OF THE STUDY The aims were (i) to establish whether NIV was beneficial for patients using arterial blood gas analysis (ABG), (ii) to observe whether current ED practice met the guidelines of obtaining ABG measurements within 15 minutes of arrival and commencement of NIV within 1 hour of clinical indication and (iii) to examine which healthcare professionals (HCPs) initiated NIV. METHODS A retrospective observational study reviewing all patients commenced on NIV in the ED due to COPD exacerbations was undertaken. RESULTS A total of 48 patients were included and the majority received NIV within 1 hour (n = 6, 75%) as recommended by the guidelines. Over 50% of the patients in the study had ABG analysis within 15 minutes and 89% (n = 43) within 30 minutes and statistically significant improvements were noted in respiratory rate, oxygen saturation and ABGs from baseline to repeat measurements undertaken 58 minutes post NIV initiation (p < 0.001). The largest healthcare group to initiate NIV was the nursing team (50% n = 24) with the majority of emergency nurses being experienced nurses [band 6 (n = 17)]. CONCLUSION From this small single centre study, early ABG analyses and NIV initiation were beneficial to COPD patients presenting in respiratory failure with the majority receiving treatment within the recommended guidelines.
Collapse
|
27
|
Comparison between noninvasive mechanical ventilation and standard oxygen therapy in children up to 3 years old with respiratory failure after extubation: a pilot prospective randomized clinical study. Pediatr Crit Care Med 2015; 16:124-30. [PMID: 25560423 DOI: 10.1097/pcc.0000000000000309] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure. DESIGN Prospective pilot study. SETTING PICU at a university-affiliated hospital. PATIENTS Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation. INTERVENTIONS Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013. MEASUREMENTS AND MAIN RESULTS Length of stay in PICU and hospital, oxygenation index, blood gas before and after tracheal extubation, failure and reason for tracheal extubation, complications, mechanical ventilation variables before tracheal extubation, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation were analyzed. One hundred eight patients were included (noninvasive positive-pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at admission, tracheal intubation, and mechanical ventilation indications. There was no statistically significant difference in reintubation rate (noninvasive positive-pressure ventilation group, 9.1%; inhaled oxygen group, 11.3%; p > 0.05) and length of stay (days) in PICU (noninvasive positive-pressure ventilation group, 3 [1-16]; inhaled oxygen group, 2 [1-25]; p > 0.05) or hospital (noninvasive positive-pressure ventilation group, 19 [7-141]; inhaled oxygen group, 17 [8-80]). CONCLUSIONS The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.
Collapse
|
28
|
Mandal S, Howes TQ, Parker M, Roberts CM. The use of a prospective audit proforma to improve door-to-mask times for acute exacerbations chronic obstructive pulmonary disease (COPD) requiring non-invasive ventilation (NIV). COPD 2014; 11:645-51. [PMID: 24945887 DOI: 10.3109/15412555.2014.898044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Non-invasive ventilation (NIV) is an evidence based management of acidotic, hypercapnic exacerbations of COPD. Previous national and international audits of clinical practice have shown variation against guideline standards with significant delays in initiating NIV. We aimed to map the clinical pathway to better understand delays and reduce the door-to-NIV time to less than 3 hours for all patients with acidotic, hypercapnic exacerbations of COPD requiring this intervention, by mandating the use of a guideline based educational management proforma.The proforma was introduced at 7 acute hospitals in North London and Essex and initiated at admission of the patient. It was used to record the clinical pathway and patient outcomes until the point of discharge or death. Data for 138 patients were collected. 48% of patients commenced NIV within 3 hours with no reduction in door-to-mask time during the study period. Delays in starting NIV were due to: time taken for review by the medical team (101 minutes) and time taken for NIV to be started once a decision had been made (49 minutes). There were significant differences in door-to-NIV decision and mask times between differing respiratory on-call systems, p < 0.05). The introduction of the proforma had no effect on door-to-mask times over the study period. Main reasons for delay were related to timely access to medical staff and to NIV equipment; however, a marked variation in practice within these hospitals was been noted, with a 9-5 respiratory on-call system associated with shorter NIV initiation times.
Collapse
Affiliation(s)
- S Mandal
- 1Colchester University Hospital Trust , Cohchester , United Kingdom
| | | | | | | |
Collapse
|
29
|
Aguilar SA, Lee J, Castillo E, Lam B, Choy J, Patel E, Pringle J, Serra J. Assessment of the Addition of Prehospital Continuous Positive Airway Pressure (CPAP) to an Urban Emergency Medical Services (EMS) System in Persons with Severe Respiratory Distress. J Emerg Med 2013; 45:210-9. [DOI: 10.1016/j.jemermed.2013.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/19/2012] [Accepted: 01/18/2013] [Indexed: 12/30/2022]
|
30
|
Carpe-Carpe B, Hernando-Arizaleta L, Ibáñez-Pérez MC, Palomar-Rodríguez JA, Esquinas-Rodríguez AM. Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010. Arch Bronconeumol 2013; 49:330-6. [PMID: 23856438 DOI: 10.1016/j.arbres.2013.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). SUBJECTS AND METHODS A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression. RESULTS We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially. CONCLUSIONS The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.
Collapse
|
31
|
Landry A, Foran M, Koyfman A. Does noninvasive positive-pressure ventilation improve outcomes in severe asthma exacerbations? Ann Emerg Med 2013; 62:594-6. [PMID: 23769808 DOI: 10.1016/j.annemergmed.2013.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Adaira Landry
- Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | | | | |
Collapse
|
32
|
Vital FMR, Ladeira MT, Atallah AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2013:CD005351. [PMID: 23728654 DOI: 10.1002/14651858.cd005351.pub3] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This is an update of a systematic review previously published in 2008 about non-invasive positive pressure ventilation (NPPV). NPPV has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary oedema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing. OBJECTIVES To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary oedema in its acute stage. SEARCH METHODS We searched the following databases on 20 April 2011: CENTRAL and DARE, (The Cochrane Library, Issue 2 of 4, 2011); MEDLINE (Ovid, 1950 to April 2011); EMBASE (Ovid, 1980 to April 2011); CINAHL (1982 to April 2011); and LILACS (1982 to April 2011). We also reviewed reference lists of included studies and contacted experts and equipment manufacturers. We did not apply language restrictions. SELECTION CRITERIA We selected blinded or unblinded randomised or quasi-randomised clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary oedema and where NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care was compared with standard medical care alone. DATA COLLECTION AND ANALYSIS Two authors independently selected articles and abstracted data using a standardised data collection form. We evaluated study quality with emphasis on allocation concealment, sequence generation allocation, losses to follow-up, outcome assessors, selective outcome reporting and adherence to the intention-to-treat principle. MAIN RESULTS We included 32 studies (2916 participants), of generally low or uncertain risk of bias. Compared with standard medical care, NPPV significantly reduced hospital mortality (RR 0.66, 95% CI 0.48 to 0.89) and endotracheal intubation (RR 0.52, 95% CI 0.36 to 0.75). We found no difference in hospital length of stay with NPPV; however, intensive care unit stay was reduced by 1 day (WMD -0.89 days, 95% CI -1.33 to -0.45). Compared with standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during its application (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.70, 95% CI 0.11 to 4.26). We identified fewer adverse events with NPPV use (in particular progressive respiratory distress and neurological failure (coma)) when compared with standard medical care. AUTHORS' CONCLUSIONS NPPV in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary oedema. The evidence to date on the potential benefit of NPPV in reducing mortality is entirely derived from small-trials and further large-scale trials are needed.
Collapse
Affiliation(s)
- Flávia M R Vital
- Department of Physiotherapy, Muriaé Cancer Hospital, Muriaé, Brazil.
| | | | | |
Collapse
|
33
|
Chipman DW, Kacmarek R. Advances in Ventilatory Support of Critically Ill Children. CURRENT PEDIATRICS REPORTS 2013. [DOI: 10.1007/s40124-012-0008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Noninvasive ventilation use in French out-of-hospital settings: a preliminary national survey. Am J Emerg Med 2012; 30:765-9. [DOI: 10.1016/j.ajem.2011.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/10/2011] [Accepted: 03/22/2011] [Indexed: 11/24/2022] Open
|
35
|
Does the application of an algorithm for non-invasive ventilation in chronic obstructive pulmonary disease improve the initiation process and patient outcomes? Physiotherapy 2012; 98:151-9. [DOI: 10.1016/j.physio.2011.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 01/31/2011] [Indexed: 01/09/2023]
|
36
|
SMITH TRACYA, DAVIDSON PATRICIAM, LAM LAWRENCET, JENKINS CHRISTINER, INGHAM JANEM. The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; a systematic review. Respirology 2012; 17:300-7. [DOI: 10.1111/j.1440-1843.2011.02085.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Roti M, Arnal JM, Delnista D, Bally J, Celerier J, Sulpice C, Carret V. Étude prospective observationnelle bicentrique sur la pratique de la ventilation mécanique aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2011. [DOI: 10.1007/s13341-011-0083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
38
|
Combes X, Jabre P, Vivien B, Carli P. Ventilation non invasive en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2011. [DOI: 10.1007/s13341-011-0076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
39
|
Schneider AG, Calzavacca P, Mercer I, Hart G, Jones D, Bellomo R. The epidemiology and outcome of medical emergency team call patients treated with non-invasive ventilation. Resuscitation 2011; 82:1218-23. [PMID: 21570762 DOI: 10.1016/j.resuscitation.2011.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/24/2011] [Accepted: 04/10/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Use of non-invasive ventilation (NIV) is normally limited to the Emergency Department, Intensive Care Unit (ICU), Coronary Care Unit (CCU) or High Dependency Unit (HDU). However, NIV is sometimes used by the Medical Emergency Team (MET) as respiratory support for ward patients. OBJECTIVES We reviewed the characteristics and outcome of ward patients treated with NIV in the setting of a MET Call and determined the clinical and prognostic significance of such treatment. METHODS We used our MET database to assess the characteristics and outcome of patients treated with NIV and compared them to a control group of patients with similar MET diagnoses but not treated with NIV. RESULTS We studied 5389 calls in 3880 patients. NIV was delivered during 483 (9.0%) calls to 426 patients (11% of the total). The four most common MET diagnoses associated with NIV were acute pulmonary edema (156 calls, 32.3%), pneumonia (84 calls, 17.4%), acute respiratory failure of unclear origin (59 calls, 12.2%) and exacerbation of chronic obstructive pulmonary disease (32 calls, 6.6%). Limitations of medical therapy (LOMT) were documented in 151 (35.4%) patients. Among NIV patients without LOMT, 115 (41.8%) were transferred to ICU and 50 (18.2%) to the coronary care or high dependency unit (CCU/HDU) compared with only 50 (18.0%) and 16 (5.8%) respectively in the control group (p<0.001). Overall, 76 NIV patients (27.6%) received endotracheal intubation (ETT) compared with 61 (21.9%) in controls. Mortality was 23.6% in the NIV group versus 18.8% in the control group. CONCLUSION One in ten MET call patients received NIV. In those without LOMT, two thirds were transferred to ICU/HDU/CCU, one in four received ETT, and one in four died. NIV use at the time of a MET call identified high risk patients for whom admission to ICU/HDU/CCU should be strongly considered.
Collapse
Affiliation(s)
- Antoine G Schneider
- Intensive Care Unit, Austin Health 145 Studley Road Heidelberg, Melbourne, Victoria 3084, Australia.
| | | | | | | | | | | |
Collapse
|
40
|
Keenan SP, Sinuff T, Burns KEA, Muscedere J, Kutsogiannis J, Mehta S, Cook DJ, Ayas N, Adhikari NKJ, Hand L, Scales DC, Pagnotta R, Lazosky L, Rocker G, Dial S, Laupland K, Sanders K, Dodek P. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ 2011; 183:E195-214. [PMID: 21324867 DOI: 10.1503/cmaj.100071] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
41
|
Ciledag A, Kaya A, Akdogan BB, Kabalak PA, Onen ZP, Sen E, Gulbay B. Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo. Arch Bronconeumol 2010; 46:538-42. [DOI: 10.1016/j.arbres.2010.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/24/2010] [Accepted: 06/26/2010] [Indexed: 10/19/2022]
|
42
|
Early Use of Noninvasive Mechanical Ventilation in Patients with Acute Hypercapnic Respiratory Failure in a Respiratory Ward: A Prospective Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(11)60007-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
43
|
Thys F, Delvau N, Verschuren F. LETTERS TO THE EDITOR: Emergency department management of exacerbation of chronic obstructive pulmonary disease: low compliance or real world? Intern Med J 2010; 40:604-5; author reply 606-7. [DOI: 10.1111/j.1445-5994.2010.02206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
TSUJINO K, SASADA S, KODAMA M, ISHIHARA H, KAWASE I. Severe bullous emphysema and hypercapnia successfully treated by bronchoscopic lung volume reduction. Respirology 2009; 14:907-9. [DOI: 10.1111/j.1440-1843.2009.01581.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
45
|
Carrera M, Marín JM, Antón A, Chiner E, Alonso ML, Masa JF, Marrades R, Sala E, Carrizo S, Giner J, Gomez-Merino E, Teran J, Disdier C, Agustí AGN, Barbé F. A controlled trial of noninvasive ventilation for chronic obstructive pulmonary disease exacerbations. J Crit Care 2009; 24:473.e7-14. [PMID: 19327308 DOI: 10.1016/j.jcrc.2008.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 08/08/2008] [Accepted: 08/25/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE This prospective, multicenter, double-blind, placebo-controlled study tested the hypothesis that noninvasive positive pressure ventilation reduces the need for endotracheal intubation in patients hospitalized in a pulmonary ward because of acute exacerbation of chronic obstructive pulmonary disease. MATERIALS AND METHODS Seventy-five consecutive patients with exacerbation (pH, 7.31 +/- 0.02; Pao(2), 45 +/- 9 mm Hg; Paco(2), 69 +/- 13 mm Hg) were randomly assigned to receive noninvasive ventilation or sham noninvasive ventilation during the first 3 days of hospitalization on top of standard medical treatment. RESULTS The need for intubation (according to predefined criteria) was lower in the noninvasive ventilation group (13.5% vs 34%, P < .01); in 31 patients with pH not exceeding 7.30, these percentages were 22% and 77%, respectively (P < .001). Arterial pH and Paco(2) improved in both groups, but changes were enhanced by noninvasive ventilation. Length of stay was lower in the noninvasive ventilation group (10 +/- 5 vs 12 +/- 6 days, P = .06). In-hospital mortality was similar in both groups. CONCLUSIONS These results demonstrate that noninvasive positive pressure ventilation, in a pulmonary ward, reduces the need for endotracheal intubation, particularly in the more severe patients, and leads to a faster recovery in patients with acute exacerbation of chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Miguel Carrera
- Servicio de Neumología of Hospital Universitario Son Dureta, 07014 Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Los Arcos M, Menéndez S. Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med 2008; 35:527-36. [PMID: 18982307 DOI: 10.1007/s00134-008-1346-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 10/19/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Identification of predictive factors for non-invasive ventilation (NIV) failure and determination of NIV characteristics. DESIGN Prospective observational study. SETTING Paediatric Intensive Care Unit in a University Hospital. PATIENTS AND MEASUREMENTS A total of 116 episodes were included. Clinical data collected were respiratory rate (RR), heart rate and FiO(2) before NIV began. Same data and expiratory and support pressures were collected at 1, 6, 12, 24 and 48 h. Conditions precipitating acute respiratory failure (ARF) were classified into two groups: type 1 (38 episodes) and type 2 (78 episodes). Ventilation-perfusion impairment was the main respiratory failure mechanism in type 1, and hypoventilation in type 2. Factors predicting NIV failure were determined by multivariate analysis. RESULTS Most common admission diagnoses were pneumonia (81.6%) in type 1 and bronchiolitis (39.7%) and asthma (42.3%) in type 2. Complications secondary to NIV were detected in 23 episodes (20.2%). NIV success rate was 84.5% (68.4% in type 1 and 92.3% in type 2). Type 1 patients showed a higher risk of NIV failure compared to type 2 (OR 11.108; CI 95%, 2.578-47.863). A higher PRISM score (OR 1.138; CI 95%, 1.022-1.267), and a lower RR decrease at 1 h and at 6 h (OR 0.926; CI 95%, 0.860-0.997 and OR 0.911; CI 95%, 0.837-0.991, respectively) were also independently associated with NIV failure. CONCLUSIONS NIV is a useful respiratory support technique in paediatric patients. Type 1 group classification, higher PRISM score, and lower RR decrease during NIV were independent risk factors for NIV failure.
Collapse
Affiliation(s)
- Juan Mayordomo-Colunga
- Departamento de Pediatría, Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
| | | | | | | | | | | | | |
Collapse
|
47
|
Vital FMR, Saconato H, Ladeira MT, Sen A, Hawkes CA, Soares B, Burns KEA, Atallah AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database Syst Rev 2008:CD005351. [PMID: 18646124 DOI: 10.1002/14651858.cd005351.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-invasive positive pressure ventilation (NPPV) has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing. OBJECTIVES To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary edema. SEARCH STRATEGY We undertook a comprehensive search of the following databases in April 2005: CENTRAL, MEDLINE, EMBASE, CINAHL, DARE and LILACS. We also reviewed reference lists of included studies and contacted experts, equipment manufacturers, and the Cochrane Heart Group. We did not apply language restrictions. SELECTION CRITERIA We selected blinded or unblinded randomized or quasi-randomized clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and where NPPV (continuous positive airway pressure (CPAP)) and/or bilevel NPPV plus standard medical care was compared with standard medical care alone. DATA COLLECTION AND ANALYSIS Two authors independently selected articles and abstracted data using a standardized data collection form. We evaluated study quality with emphasis on allocation concealment, adherence to the intention-to-treat principle and losses to follow-up. MAIN RESULTS We included 21 studies involving 1,071 participants. Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83) with numbers needed to treat of 13 and 8, respectively. We found no difference in hospital length of stay with NPPV, however, intensive care unit stay was reduced by 1 day (WMD -1.07 days, 95% CI -1.60 to -0.53). Compared to standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.82, 95% CI 0.09 to 7.54) its application. AUTHORS' CONCLUSIONS NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.
Collapse
Affiliation(s)
- Flávia M R Vital
- Muriaé Cancer Hospital , AV. Cristiano Ferreira Varella, 555, Muriaé, MG, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Damas C, Andrade C, Araújo J, Almeida J, Bettencourt P. Desmame de ventilação não invasiva: Experiência com períodos de descontinuação. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008. [DOI: 10.1016/s0873-2159(15)30218-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
49
|
Chen Y, Chen P, Hanaoka M, Huang X, Droma Y, Kubo K. Mechanical ventilation in patients with hypoxemia due to refractory heart failure. Intern Med 2008; 47:367-73. [PMID: 18310965 DOI: 10.2169/internalmedicine.47.0483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate the safety and efficacy of mechanical ventilation (MV), including noninvasive positive pressure ventilation (NPPV) and endotracheal intubation (ETI) in patients with very severe hypoxemia due to refractory heart failure (RHF). METHODS In addition to conventional treatment, eighteen patients with hypoxemia due to RHF were assigned to receive NPPV (n=10) or ETI (n=8) based on the severity of their clinical status. Arterial blood gas, PaO(2)/FiO(2), vital signs including respiratory rate (RR), heart rate (HR) and systolic blood pressure (SBP), left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) were recorded before and after MV in each group. RESULTS The patients in the ETI group showed more severe hypoxemia and respiratory acidosis in comparison with the patients in the NPPV group. Both the NPPV and ETI significantly increased PaO(2), PaO(2)/FiO(2) and arterial oxygen saturation (SaO(2)) (p <0.01) and reduced RR and HR (p <0.01) after MV in comparison to that before MV. Both the NPPV and ETI significantly increased LVEF (p <0.05) and decreased LVEDV (p <0.01) at the time of weaning from MV in comparison to that before MV. Moreover, PaO(2) correlated with LVEF (r=0.882, p=0.01 and r=0.736, p=0.037) while it also inversely correlated with LVEDV (r=-0.645, p=0.044 and r=-0.756, p=0.030) at the time of weaning from MV in the NPPV and ETI groups, respectively. There were two failed cases in the NPPV group. They were transferred immediately to be treated with ETI and were equivalent to the others in the ETI group. CONCLUSION Both NPPV and ETI are safe and effective modalities for improving hypoxemia and left heart function in patients with RHF. These results suggest that invasive MV should be applied to very severe patients with RHF as quickly as possible when an expected clinical improvement cannot be obtained by NPPV.
Collapse
Affiliation(s)
- Yan Chen
- Division of Respiratory Disease, Department of Internal Medicine, The Second Xiangya Hospital, Central-South University, Hunan, China
| | | | | | | | | | | |
Collapse
|
50
|
Pastaka C, Kostikas K, Karetsi E, Tsolaki V, Antoniadou I, Gourgoulianis KI. Non-invasive ventilation in chronic hypercapnic COPD patients with exacerbation and a pH of 7.35 or higher. Eur J Intern Med 2007; 18:524-30. [PMID: 17967333 DOI: 10.1016/j.ejim.2006.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 12/17/2006] [Accepted: 12/29/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current guidelines suggest the use of non-invasive ventilation (NIV) in hypercapnic chronic obstructive pulmonary disease (COPD) exacerbations in patients presenting with a pH of 7.25-7.35. The aim of this study was to investigate the role of NIV in COPD patients with chronic hypercapnic respiratory failure admitted to the hospital with acute exacerbations and an arterial pH of 7.35 or higher. METHODS Forty-seven COPD patients with chronic hypercapnic respiratory failure admitted for exacerbations and with a pH of 7.35 or higher were randomized to receive standard medical therapy (control group) or medical therapy plus NIV (NIV group). Arterial blood gases were measured at baseline, after 1 h, 6 h, 12 h, 24 h, 48 h, and at discharge. Need for admission to intensive care unit (ICU), death, and duration of hospitalization were recorded. The final analysis included 42 patients (21 controls and 21 NIV patients). RESULTS NIV resulted in a shorter hospital stay (5.5+/-2.6 vs 10.1+/-4.4 days for controls, p=0.0004). Two patients from the control group were admitted to the ICU and one eventually died, whereas all NIV patients were successfully discharged. The NIV group showed a faster improvement in PaCO(2) and pH. At discharge, the NIV group had a lower PaCO(2) (6.5+/-0.6 kPa vs 7.5+/-1.1 kPa, p=0.01) but a comparable pH (7.43+/-0.03 vs 7.43+/-0.04, p=0.93). PaO(2) and PaO(2)/FiO(2) levels showed similar improvement in both groups at discharge. CONCLUSION Early administration of NIV in COPD patients with chronic hypercapnic respiratory failure admitted for acute exacerbations with a pH of 7.35 or higher results in a reduced hospital stay and faster improvement of arterial blood gases.
Collapse
Affiliation(s)
- Chaido Pastaka
- Respiratory Medicine Department, University of Thessaly Medical School, Greece
| | | | | | | | | | | |
Collapse
|