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Wang Y, Liu Y, Liu K, He Y, Ding H. Noninvasive Positive Pressure Ventilation versus High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease: An Updated Narrative Review. Int J Chron Obstruct Pulmon Dis 2024; 19:2415-2420. [PMID: 39539251 PMCID: PMC11559195 DOI: 10.2147/copd.s487994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 11/01/2024] [Indexed: 11/16/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most common clinical respiratory illnesses, defined by permanent pathological deterioration that leads to respiratory failure. Regarding COPD treatment, oxygen therapy is very important. Non-invasive positive pressure ventilation (NPPV) is a technique for non-invasive mechanical ventilation that enables patients to get positive pressure support without the need of an artificial airway. Instead, it merely employs the mask by covering the mouth and nose, or simply the nose of patients. NPPV has been shown to be beneficial for COPD patients experiencing respiratory failure. High-flow nasal cannula (HFNC) oxygen therapy shows some advantages, including the reduction of anatomical dead space, the prompt correction of low oxygen levels as well as the improvement of patients' tolerance. Owing to its continuous progress, ventilation technology strongly improves COPD treatment. In this study, the authors analyze the application of NPPV and HFNC in COPD so as to provide recommendations for mechanical ventilation treatment.
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Affiliation(s)
- Yuting Wang
- Department of Pulmonary and Critical Care Medicine, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, Jiangsu Province, 214200, People’s Republic of China
| | - Yan Liu
- Department of Pulmonary and Critical Care Medicine, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, Jiangsu Province, 214200, People’s Republic of China
| | - Kan Liu
- Department of Pulmonary and Critical Care Medicine, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, Jiangsu Province, 214200, People’s Republic of China
| | - Yuan He
- Department of Pulmonary and Critical Care Medicine, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, Jiangsu Province, 214200, People’s Republic of China
| | - Hui Ding
- Department of Pulmonary and Critical Care Medicine, Yixing People’s Hospital Affiliated to Jiangsu University, Yixing, Jiangsu Province, 214200, People’s Republic of China
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Zheng X, Lu L, Ma M, Lei X. Effect of prophylactic noninvasive oxygen therapy after planned extubation on extubation failure in high-risk patients: a retrospective propensity score-matched cohort study. Front Med (Lausanne) 2024; 11:1481083. [PMID: 39391038 PMCID: PMC11464286 DOI: 10.3389/fmed.2024.1481083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 09/11/2024] [Indexed: 10/12/2024] Open
Abstract
Background Extubation failure (EF) is common in the intensive care unit (ICU) and is associated with poor prognosis, especially in high-risk patients. However, the efficacy of prophylactic noninvasive oxygen therapy (NIT), including noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), in reducing EF in high-risk patients remains controversial. Therefore, we aimed to evaluate the effect of post-extubation prophylactic NIT on EF in high-risk patients. Methods This was a retrospective observational study conducted in the ICU from March 2018 to December 2023. We included adult patients at high risk for reintubation who were mechanically ventilated for over 24 h and successfully passed the spontaneous breathing trial (SBT). Immediately after extubation, patients underwent NIT or conventional oxygenation therapy (COT). The primary outcome was the EF rate within 7 days after extubation. Results There were 440 patients in the NIT group and 274 in the COT group. After propensity-score matching, 227 subjects were enrolled in each group. NIT reduced the rate of EF (18.0% vs. 34.3%, p < 0.001) and reintubation (10.5% vs. 18.2% p = 0.003) compared with COT, which was confirmed in propensity-matched cohort (17.6% vs. 32.2%, p < 0.001; 11.5% vs. 19.8%, p = 0.014). Multivariate logistic regression analysis indicated that prophylactic NIT (p = 0.001) and higher ROX index (p = 0.022) were associated with reduced risk of EF. While higher fluid balance (p = 0.013), higher RSBI (p < 0.001), and the occurrence of delirium (p = 0.032) may be the risk factors for EF. Subgroup analysis showed that post-extubation NIT was more effective in elderly patients, and HFNC was non-inferior to NIV in reducing EF. While HFNC had a tendency to reduce the incidence of delirium. Conclusion Post-extubation prophylactic NIT is effective in reducing EF in high-risk patients, especially in the elderly patients. HFNC is an alternative treatment to NIV. Fluid balance, RSBI, ROX index, and delirium are associated with the occurrence of EF.
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Affiliation(s)
- Xiaozhuo Zheng
- Department of Anesthesiology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Lixiong Lu
- Department of Anesthesiology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Mengyi Ma
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofeng Lei
- Department of Anesthesiology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
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Vasconcelos RS, Nogueira ANC, Montenegro Junior RM, Peixoto Junior AA, Ferreira LA, Sousa CEM, Ricca DEP, da Silveira JAN, Ribeiro FC, Cavalcanti FRP, Lobo Filho JG. A New Full-Face Mask for Multifunctional Non-Invasive Ventilation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1410. [PMID: 37629700 PMCID: PMC10456252 DOI: 10.3390/medicina59081410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023]
Abstract
Background: Noninvasive ventilation (NIV) provides positive pressure through different interfaces. A multifunctional full-face mask prototype was developed to provide NIV from three sources: ICU ventilators, portable ventilators, and high-flow medical gas pipeline systems. This study aimed to evaluate the usability of this prototype mask. Methods: This was a quantitative experimental study, conducted in two phases: the development of a full-face mask prototype NIV interface, and the evaluation of its usability by health professionals (evaluators) using a heuristic approach. The Wolf Mask prototype is a multifunctional full-face mask that makes it possible to deliver positive pressure from three different sources: microprocessor-controlled ICU ventilators, portable ventilators with single-limb circuits, and high-flow medical gas. The evaluation was conducted in three stages: presentation of the prototype to the evaluators; skills testing via simulation in a clinical environment; and a review of skills. Results: The prototype was developed by a multidisciplinary team and patented in Brazil. The evaluators were 10 health professionals specializing in NIV. Seven skills related to handling the prototype were evaluated. Three of the ten evaluators called for (non-urgent) changes to improve recognition of the components of the prototype. Only one evaluator called for (non-urgent) changes to improve recognition of the pieces, assembly, and checking the mask. Conclusions: The newly developed multifunctional full-face mask prototype demonstrated excellent usability for providing noninvasive ventilation from multiple sources. Minor modifications may further improve the design.
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Affiliation(s)
- Renata Santos Vasconcelos
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil; (A.N.C.N.); (R.M.M.J.); (A.A.P.J.); (L.A.F.)
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/EBSERH, Fortaleza 60416-000, Brazil
| | - Andréa Nóbrega Cirino Nogueira
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil; (A.N.C.N.); (R.M.M.J.); (A.A.P.J.); (L.A.F.)
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/EBSERH, Fortaleza 60416-000, Brazil
| | - Renan Magalhães Montenegro Junior
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil; (A.N.C.N.); (R.M.M.J.); (A.A.P.J.); (L.A.F.)
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/EBSERH, Fortaleza 60416-000, Brazil
| | - Arnaldo Aires Peixoto Junior
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil; (A.N.C.N.); (R.M.M.J.); (A.A.P.J.); (L.A.F.)
| | - Lucas Alves Ferreira
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-140, Brazil; (A.N.C.N.); (R.M.M.J.); (A.A.P.J.); (L.A.F.)
| | - Carlos Eugênio Moreira Sousa
- Department of Architecture and Urbanism and Design, Federal University of Ceará, Fortaleza 60020-181, Brazil; (C.E.M.S.); (D.E.P.R.)
| | - Diego Eneas Peres Ricca
- Department of Architecture and Urbanism and Design, Federal University of Ceará, Fortaleza 60020-181, Brazil; (C.E.M.S.); (D.E.P.R.)
| | - Jarbas Aryel Nunes da Silveira
- Computer Systems Engineering Laboratory, Federal University of Ceará, Fortaleza 60455-970, Brazil; (J.A.N.d.S.); (F.C.R.)
| | - Fábio Cisne Ribeiro
- Computer Systems Engineering Laboratory, Federal University of Ceará, Fortaleza 60455-970, Brazil; (J.A.N.d.S.); (F.C.R.)
| | | | - José Glauco Lobo Filho
- Department of Surgery, Faculty of Medicine, Federal University of Ceará, Fortaleza 60416-200, Brazil;
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Hryciw BN, Hryciw N, Tran A, Fernando SM, Rochwerg B, Burns KEA, Seely AJE. Predictors of Noninvasive Ventilation Failure in the Post-Extubation Period: A Systematic Review and Meta-Analysis. Crit Care Med 2023; 51:872-880. [PMID: 36995099 DOI: 10.1097/ccm.0000000000005865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To identify factors associated with failure of noninvasive ventilation (NIV) in the post-extubation period. DATA SOURCES We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to February 28, 2022. STUDY SELECTION We included English language studies that provided predictors of post-extubation NIV failure necessitating reintubation. DATA EXTRACTION Two authors conducted data abstraction and risk-of-bias assessments independently. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios (ORs) mean difference (MD), respectively. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty. DATA SYNTHESIS We included 25 studies ( n = 2,327). Illness-related factors associated with increased odds of post-extubation NIV failure were higher critical illness severity (OR, 3.56; 95% CI, 1.96-6.45; high certainty) and a diagnosis of pneumonia (OR, 6.16; 95% CI, 2.59-14.66; moderate certainty). Clinical and biochemical factors associated with moderate certainty of increased risk of NIV failure post-extubation include higher respiratory rate (MD, 1.54; 95% CI, 0.61-2.47), higher heart rate (MD, 4.46; 95% CI, 1.67-7.25), lower Pa o2 :F io2 (MD, -30.78; 95% CI, -50.02 to -11.54) 1-hour after NIV initiation, and higher rapid shallow breathing index (MD, 15.21; 95% CI, 12.04-18.38) prior to NIV start. Elevated body mass index was the only patient-related factor that may be associated with a protective effect (OR, 0.21; 95% CI, 0.09-0.52; moderate certainty) on post-extubation NIV failure. CONCLUSIONS We identified several prognostic factors before and 1 hour after NIV initiation associated with increased risk of NIV failure in the post-extubation period. Well-designed prospective studies are required to confirm the prognostic importance of these factors to help further guide clinical decision-making.
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Affiliation(s)
- Brett N Hryciw
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Hryciw
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Tran
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karen E A Burns
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew J E Seely
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Abrard S, Rineau E, Seegers V, Lebrec N, Sargentini C, Jeanneteau A, Longeau E, Caron S, Callahan JC, Chudeau N, Beloncle F, Lasocki S, Dupoiron D. Postoperative prophylactic intermittent noninvasive ventilation versus usual postoperative care for patients at high risk of pulmonary complications: a multicentre randomised trial. Br J Anaesth 2023; 130:e160-e168. [PMID: 34996593 DOI: 10.1016/j.bja.2021.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pulmonary complications are an important cause of morbidity and mortality after surgery. We evaluated the clinical effectiveness of noninvasive ventilation (NIV) in preventing postoperative acute respiratory failure. METHODS This is an open, multicentre randomised trial that included patients at high risk of postoperative pulmonary complications after elective or semi-urgent surgery with an Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score ≥45. Patients were randomly assigned to intermittent prophylactic face-mask NIV for 6-8 h day-1 or usual postoperative care. The primary outcome was in-hospital acute respiratory failure within 7 days after surgery. Patients who underwent surgery and postoperative extubation were included in the modified intended-to-treat analysis. Results are presented as n (%) and odds ratios (ORs) with 95% confidence intervals. RESULTS Between November 2017 and October 2019, 266 patients were randomised and 253 included in the main analysis. Of these, 203 (80.2%) were male with a mean age of 68 (11) yr and an ARISCAT score of 53 (6); 237 subjects (93.7%) underwent cardiac or thoracic surgery. There were 125 patients allocated to prophylactic NIV and 128 to usual care. Unplanned treatment termination occurred in 58 subjects in the NIV group, which was linked to NIV discomfort for 36 subjects. There was no difference in the incidence of the primary outcome of postoperative acute respiratory failure between treatment groups (NIV: 30 of 125 subjects [24.0%] vs usual care: 35 of 128 subjects [27.3%]; OR 0.97 [0.90-1.04]; P=0.54). CONCLUSIONS Prophylactic NIV was difficult to implement after high-risk surgery because of low patient compliance. Prophylactic NIV did not prevent acute respiratory failure. CLINICAL TRIAL REGISTRATION NCT03629431 and EudraCT 2017-001011-36.
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Affiliation(s)
- Stanislas Abrard
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France; MITOVASC Institute, INSERM 1083, CNRS 6015, University of Angers, Angers, France; Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France; MITOVASC Institute, INSERM 1083, CNRS 6015, University of Angers, Angers, France
| | - Valerie Seegers
- Department of Clinical Research, Integrated Center for Oncology Paul Papin, Angers, France
| | - Nathalie Lebrec
- Anesthesiology and Pain Medicine Department, Integrated Center for Oncology Paul Papin, Angers, France
| | - Cyril Sargentini
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Audrey Jeanneteau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Emmanuelle Longeau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Sigrid Caron
- Department of Anesthesiology, Le Mans Hospital, Le Mans, France
| | | | - Nicolas Chudeau
- Department of Intensive Care, Le Mans Hospital, Le Mans, France
| | - François Beloncle
- Medical Intensive Care Department, University Hospital of Angers, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Denis Dupoiron
- Anesthesiology and Pain Medicine Department, Integrated Center for Oncology Paul Papin, Angers, France
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