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Lai J, Li A, Yue L, Zhong H, Xu S, Liu X. Participation of ASK-1 in the cardiomyocyte-protective role of mechanical ventilation in a rat model of myocardial infarction. Exp Biol Med (Maywood) 2023; 248:1579-1587. [PMID: 37786374 PMCID: PMC10676125 DOI: 10.1177/15353702231191205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 10/04/2023] Open
Abstract
Non-invasive positive-pressure ventilation (NIPPV) has been demonstrated to exhibit a cardioprotective function in a rat model of myocardial infarction (MI). However, the mechanism underlying NIPPV-mediated MI progression requires further investigation. We aimed to investigate the effectiveness and corresponding mechanism of NIPPV in an acute MI-induced heart failure (HF) rat model. Thirty each of healthy wild type (WT) and apoptosis signal-regulating kinase 1 (ASK-1)-deficient rats were enrolled in this study. MI models were established via anterior descending branch ligation of the left coronary artery. The corresponding data indicated that NIPPV treatment reduced the heart infarct area, myocardial fibrosis degree, and cardiac function loss in MI rats, and ameliorated apoptosis and reactive oxygen species (ROS) levels in the heart tissue. Furthermore, the expression level of ASK-1 level, a key modulator of the ROS-induced extrinsic apoptosis pathway, was upregulated in the heart tissues of MI rats, but decreased after NIPPV treatment. Meanwhile, the downstream cleavage of caspase-3, caspase-9, and PARP, alongside p38 phosphorylation and FasL expression, exhibited a similar trend to that of ASK-1 expression. The involvement of ASK-1 in NIPPV-treated MI in ASK-1-deficient rats was examined. Although MI modeling indicated that cardiac function loss was alleviated in ASK-1-deficient rats, NIPPV treatment did not confer any clear efficiency in cardiac improvement in ASK-1-knockdown rats with MI modeling. Nonetheless, NIPPV inhibited ROS-induced extrinsic apoptosis in the heart tissues of rats with MI by regulating ASK-1 expression, and subsequently ameliorated cardiac function loss and MI-dependent pathogenic changes in the heart tissue.
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Affiliation(s)
- Jiying Lai
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Ailin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Linlin Yue
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Huifeng Zhong
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
| | - Shuo Xu
- Department of Respiratory and Critical Care Medicine, Ganzhou People’s Hospital, Ganzhou 341000, China
| | - Xin Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
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Faraone A, Beltrame C, Crociani A, Carrai P, Lovicu E, Filetti S, Sbaragli S, Alessi C, Cameron Smith M, Angotti C, Fortini A. Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience. Intern Emerg Med 2021; 16:1183-1190. [PMID: 33222116 PMCID: PMC7680552 DOI: 10.1007/s11739-020-02562-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/31/2020] [Indexed: 01/09/2023]
Abstract
The role of noninvasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain, as no direct evidence exists to support NIPPV use in such patients. We retrospectively assessed the effectiveness and safety of NIPPV in a cohort of COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing nasopharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology. Overall, 50 patients (mean age 74.6 years) received NIPPV, of which 22 (44%) were successfully weaned, avoiding endotracheal intubation (ETI) and AHRF-related death. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a "do not intubate" (DNI) order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients without treatment limitations, 16 (64%) were successfully weaned, 9 (36%) underwent delayed ETI and, of these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, CI 1.79-132.57, p 0.013) and the increase in the PaO2/FiO2 ratio measured 24-48 h after NIPPV initiation (OR 1.02, CI 1-1.03, p 0.015), while it was inversely correlated with the presence of a DNI order (OR 0.03, CI 0.001-0.57, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with SARS-CoV-2 infection. Apart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low.
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Affiliation(s)
- Antonio Faraone
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy.
| | - Chiara Beltrame
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Andrea Crociani
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Paolo Carrai
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Elena Lovicu
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Simona Filetti
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Serena Sbaragli
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Chiara Alessi
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Michela Cameron Smith
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Chiara Angotti
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
| | - Alberto Fortini
- Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143, Florence, Italy
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Abstract
Amyotrophic lateral sclerosis is a progressive neurodegenerative disease involving upper and lower motor neurons and has limited treatment options. The weakness progresses to involve the diaphragms, resulting in respiratory failure and death. Home noninvasive ventilation has been shown to improve survival and quality of life, especially in those with intact bulbar function. Once initiated, close monitoring with nocturnal oximetry, remote downloads from the home noninvasive ventilation machine, and measurement of serum bicarbonate should be conducted. Additionally, transcutaneous CO2 monitoring can be considered if available. This article discusses the indications, timing, initiation, and management of noninvasive ventilation in amyotrophic lateral sclerosis.
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Affiliation(s)
- Jessica A Cooksey
- Northwestern University, 1475 East Belvidere Road, Suite 185, Grayslake, IL 60030, USA
| | - Amen Sergew
- Division of Pulmonary, Critical Care and Sleep Medicine, Section of Critical Care Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, B140, Denver, CO 80207, USA.
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Li SN, Li L, Li CL, Zhou SP, Lu WC. The safety and effectiveness of heated humidified high-flow nasal cannula as an initial ventilation method in the treatment of neonatal respiratory distress syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23243. [PMID: 33181713 PMCID: PMC7668501 DOI: 10.1097/md.0000000000023243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment. METHODS The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data. RESULTS Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals. CONCLUSION Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS. OSF REGISTRATION NUMBER September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).
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Affiliation(s)
| | - Li Li
- Department of Pediatrics Area One
| | - Chun-Lei Li
- Department of Neonatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO.19 Xiuhua Road, Xiuying District, Haikou, Hainan, PR China
| | | | - Wei-Cheng Lu
- Department of Neonatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO.19 Xiuhua Road, Xiuying District, Haikou, Hainan, PR China
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Macrea M, Oczkowski S, Rochwerg B, Branson RD, Celli B, Coleman JM, Hess DR, Knight SL, Ohar JA, Orr JE, Piper AJ, Punjabi NM, Rahangdale S, Wijkstra PJ, Yim-Yeh S, Drummond MB, Owens RL. Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e74-e87. [PMID: 32795139 PMCID: PMC7427384 DOI: 10.1164/rccm.202006-2382st] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) is used for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. However, evidence for clinical efficacy and optimal management of therapy is limited. Target Audience: Patients with COPD, clinicians who care for them, and policy makers. Methods: We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to evaluate the certainty in evidence and generate actionable recommendations. Recommendations were formulated by a panel of pulmonary and sleep physicians, respiratory therapists, and methodologists using the Evidence-to-Decision framework. Recommendations:1) We suggest the use of nocturnal NIV in addition to usual care for patients with chronic stable hypercapnic COPD (conditional recommendation, moderate certainty); 2) we suggest that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV (conditional recommendation, very low certainty); 3) we suggest not initiating long-term NIV during an admission for acute-on-chronic hypercapnic respiratory failure, favoring instead reassessment for NIV at 2–4 weeks after resolution (conditional recommendation, low certainty); 4) we suggest not using an in-laboratory overnight polysomnogram to titrate NIV in patients with chronic stable hypercapnic COPD who are initiating NIV (conditional recommendation, very low certainty); and 5) we suggest NIV with targeted normalization of PaCO2 in patients with hypercapnic COPD on long-term NIV (conditional recommendation, low certainty). Conclusions: This expert panel provides evidence-based recommendations addressing the use of NIV in patients with COPD and chronic stable hypercapnic respiratory failure.
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Slubowski D, Ruttan T. High-flow nasal cannula and noninvasive ventilation in pediatric emergency medicine. Pediatr Emerg Med Pract 2020; 17:1-24. [PMID: 32678565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
The use of high-flow nasal cannula and noninvasive ventilation has become increasingly common in emergency medicine as a first-line treatment of pediatric patients with respiratory distress secondary to asthma and bronchiolitis. When implemented in clinical practice, close monitoring of vital signs and ventilation parameters is warranted to identify possible signs of respiratory failure. This issue provides evidence-based recommendations for the appropriate use of noninvasive ventilation modalities in pediatric patients including high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure in the setting of acute respiratory distress. Contraindications and complications associated with these modalities are also discussed.
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Affiliation(s)
- Daniel Slubowski
- Assistant Professor of Clinical Emergency Medicine and Pediatrics, Indiana University School of Medicine, Department of Emergency Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Timothy Ruttan
- Assistant Professor of Pediatrics, University of Texas at Austin Dell Medical School, Department of Pediatrics, Dell Children's Medical Center of Central Texas, Pediatric Emergency Medicine, Austin, TX
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7
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Mokhlesi B, Masa JF, Afshar M, Almadana Pacheco V, Berlowitz DJ, Borel JC, Budweiser S, Carrillo A, Castro-Añón O, Ferrer M, Gagnadoux F, Golpe R, Hart N, Howard ME, Murphy PB, Palm A, Perez de Llano LA, Piper AJ, Pépin JL, Priou P, Sánchez-Gómez JF, Soghier I, Tamae Kakazu M, Wilson KC. The Effect of Hospital Discharge with Empiric Noninvasive Ventilation on Mortality in Hospitalized Patients with Obesity Hypoventilation Syndrome. An Individual Patient Data Meta-Analysis. Ann Am Thorac Soc 2020; 17:627-637. [PMID: 32023419 DOI: 10.1513/annalsats.201912-887oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/05/2020] [Indexed: 11/20/2022] Open
Abstract
Rationale: Hospitalized patients with acute-on-chronic hypercapnic respiratory failure due to obesity hypoventilation syndrome (OHS) have increased short-term mortality. It is unknown whether prescribing empiric positive airway pressure (PAP) at the time of hospital discharge reduces mortality compared with waiting for an outpatient evaluation (i.e., outpatient sleep study and outpatient PAP titration).Objectives: An international, multidisciplinary panel of experts developed clinical practice guidelines on OHS for the American Thoracic Society. The guideline panel asked whether hospitalized adult patients with acute-on-chronic hypercapnic respiratory failure suspected of having OHS, in whom the diagnosis has not yet been made, should be discharged from the hospital with or without empiric PAP treatment until the diagnosis of OHS is either confirmed or ruled out.Methods: A systematic review with individual patient data meta-analyses was performed to inform the guideline panel's recommendation. Grading of Recommendations, Assessment, Development, and Evaluation was used to summarize evidence and appraise quality.Results: The literature search identified 2,994 articles. There were no randomized trials. Ten studies met a priori study selection criteria, including two nonrandomized comparative studies and eight nonrandomized noncomparative studies. Individual patient data on hospitalized patients who survived to hospital discharge were obtained from nine of the studies and included a total of 1,162 patients (1,043 discharged with PAP and 119 discharged without PAP). Empiric noninvasive ventilation was prescribed in 91.5% of patients discharged on PAP, and the remainder received empiric continuous PAP. Discharge with PAP reduced mortality at 3 months (relative risk 0.12, 95% confidence interval 0.05-0.30, risk difference -14.5%). Certainty in the estimated effects was very low.Conclusions: Hospital discharge with PAP reduces mortality following acute-on-chronic hypercapnic respiratory failure in patients with OHS or suspected of having OHS. Well-designed clinical trials are needed to confirm this finding.
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Affiliation(s)
- Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Juan Fernando Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | - Majid Afshar
- Department of Health Informatics and Data Science, Loyola University, Chicago, Illinois
| | | | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | | | - Stephan Budweiser
- Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Andres Carrillo
- Intensive Care Unit, Hospital J.M. Morales Meseguer, Murcia, Spain
| | | | - Miquel Ferrer
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Frédéric Gagnadoux
- Department of Respiratory Diseases, and
- INSERM U1063, Angers University Hospital, Angers, France
| | - Rafael Golpe
- Pneumology Service, Lucus Augusti University Hospital, Galicia, Spain
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick B Murphy
- Lane Fox Respiratory Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andreas Palm
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Amanda J Piper
- Royal Prince Alfred Hospital, and
- University of Sydney, Camperdown, New South Wales, Australia
| | - Jean Louis Pépin
- HP2 Laboratory, INSERM U1042, University of Grenoble Alpes, Grenoble, France
| | - Pascaline Priou
- Department of Respiratory Diseases, and
- INSERM U1063, Angers University Hospital, Angers, France
| | | | - Israa Soghier
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Maximiliano Tamae Kakazu
- Division of Pulmonary and Critical Care Medicine Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Kevin C Wilson
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and
- American Thoracic Society, New York, New York
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Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné M, Egea Santaolalla C, Masa Jiménez JF, García Fernández J, Carratalá Perales JM, Heili-Frades SB, Ferrer Monreal M, de Andrés Nilsson JM, Lista Arias E, Sánchez Rocamora JL, Garrote JI, Zamorano Serrano MJ, González Martínez M, Farrero Muñoz E, Mediano San Andrés O, Rialp Cervera G, Mas Serra A, Hernández Martínez G, de Haro López C, Roca Gas O, Ferrer Roca R, Romero Berrocal A, Ferrando Ortola C. [Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection]. Med Intensiva 2020; 44:429-438. [PMID: 32312600 PMCID: PMC7270576 DOI: 10.1016/j.medin.2020.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/08/2023]
Abstract
La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una unidad de cuidados intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos.
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Affiliation(s)
- César Cinesi Gómez
- Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud. Director del Máster Oficial en Medicina de Urgencias y Emergencias, Murcia, España
| | - Óscar Peñuelas Rodríguez
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe. CIBER de Enfermedades Respiratorias, CIBERES, Getafe, Madrid, España.
| | - Manel Luján Torné
- Servicio de Neumología, Hospital de Sabadell, Corporació Parc Taulí, Universitat Autònoma de Barcelona. Centro de Investigación Biomédica en Red, CIBERES, Sabadell, Barcelona, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara. CIBER de Enfermedades Respiratorias (CIBERES). Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro, Madrid, España
| | - José Manuel Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Sarah Béatrice Heili-Frades
- Unidad de Neumología, Responsable de la UCIR, Hospital Universitario Fundación Jiménez Díaz. CIBERES, REVA, EMDOS, Madrid, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic de Barcelona, IDIBAPS, CIBERES (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | | | - Eva Lista Arias
- Servicio de Urgencias, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | | | | | | | - Mónica González Martínez
- Unidad de Sueño y Ventilación, Neumología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - Arantxa Mas Serra
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi y Hospital General d'Hospitalet, Sant Joan Despí, Barcelona, España
| | | | - Candelaria de Haro López
- Área de Críticos, Corporació Sanitària i Universitària Parc Taulí. CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Sabadell, Barcelona, España
| | - Oriol Roca Gas
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona. CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Barcelona, España
| | - Ricard Ferrer Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron. Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institut de Recerca. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, España
| | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Carlos Ferrando Ortola
- Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
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9
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Zhu Y, Yin H, Zhang R, Ye X, Wei J. High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis. Crit Care 2019; 23:180. [PMID: 31101127 PMCID: PMC6525416 DOI: 10.1186/s13054-019-2465-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/02/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes. METHOD We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs) and crossover studies were included. The main outcome was postextubation respiratory failure. RESULTS Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen therapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce postextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized mean differences (SMD), - 0.70; 95% CI, - 1.16, - 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay, comfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group. CONCLUSIONS Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.
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Affiliation(s)
- Youfeng Zhu
- 0000 0004 1790 3548grid.258164.cDepartment of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220 Guangdong China
| | - Haiyan Yin
- 0000 0004 1790 3548grid.258164.cDepartment of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220 Guangdong China
| | - Rui Zhang
- 0000 0004 1790 3548grid.258164.cDepartment of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220 Guangdong China
| | - Xiaoling Ye
- 0000 0004 1790 3548grid.258164.cDepartment of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220 Guangdong China
| | - Jianrui Wei
- 0000 0004 1790 3548grid.258164.cDepartment of Cardiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220 Guangdong China
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10
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Vaschetto R, Longhini F, Persona P, Ori C, Stefani G, Liu S, Yi Y, Lu W, Yu T, Luo X, Tang R, Li M, Li J, Cammarota G, Bruni A, Garofalo E, Jin Z, Yan J, Zheng R, Yin J, Guido S, Della Corte F, Fontana T, Gregoretti C, Cortegiani A, Giarratano A, Montagnini C, Cavuto S, Qiu H, Navalesi P. Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Med 2018; 45:62-71. [PMID: 30535516 DOI: 10.1007/s00134-018-5478-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. METHODS Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic episodes, pneumothorax or pulmonary embolism), ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), tracheotomy, percent of patients receiving sedation after study enrollment, hospital LOS, and ICU and hospital mortality. RESULTS We enrolled 130 consecutive patients, 65 treatments and 65 controls. Duration of i-MV was shorter in the treatment group than for controls [4.0 (3.0-7.0) vs. 5.5 (4.0-9.0) days, respectively, p = 0.004], while ICU LOS was not significantly different [8.0 (6.0-12.0) vs. 9.0 (6.5-12.5) days, respectively (p = 0.259)]. Incidence of VAT or VAP (9% vs. 25%, p = 0.019), rate of patients requiring infusion of sedatives after enrollment (57% vs. 85%, p = 0.001), and hospital LOS, 20 (13-32) vs. 27(18-39) days (p = 0.043) were all significantly reduced in the treatment group compared with controls. There were no significant differences in ICU and hospital mortality or in the number of treatment failures, severe events, and tracheostomies. CONCLUSIONS In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.
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Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
- Università del Piemonte Orientale, via Solaroli 17, Novara, Italy
| | - Federico Longhini
- Ospedale Sant'Andrea, Anestesia e Rianimazione, Corso Abbiate 21, Vercelli, Italy
| | - Paolo Persona
- Emergency Department, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padua, Italy
| | - Carlo Ori
- Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Giulia Stefani
- Department of Medicine, DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Songqiao Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yang Yi
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Weihua Lu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Tao Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Xiaoming Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Rui Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Maoqin Li
- Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Jiaqiong Li
- Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Andrea Bruni
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Eugenio Garofalo
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Zhaochen Jin
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, 212002, Jiangsu, China
| | - Jun Yan
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, 212002, Jiangsu, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225000, Jiangsu, China
| | - Jingjing Yin
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225000, Jiangsu, China
| | - Stefania Guido
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
- Università del Piemonte Orientale, via Solaroli 17, Novara, Italy
| | - Tiziano Fontana
- Azienda Sanitaria Locale del Verbano Cusio Ossola, Anestesia e Rianimazione, Piazza Vittime dei Lager Nazifascisti 1, Domodossola, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Claudia Montagnini
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini 18, Novara, Italy
| | - Silvio Cavuto
- Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, S.C. Infrastruttura Ricerca e Statistica, Via Amendola 2, Reggio Emilia, Italy
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Paolo Navalesi
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Viale Europa (Loc. Germaneto), Catanzaro, Italy.
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11
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Marchioni A, Castaniere I, Tonelli R, Fantini R, Fontana M, Tabbì L, Viani A, Giaroni F, Ruggieri V, Cerri S, Clini E. Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation. Crit Care 2018; 22:109. [PMID: 29703214 PMCID: PMC5921560 DOI: 10.1186/s13054-018-2033-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ultrasound (US) evaluation of diaphragmatic dysfunction (DD) has proved to be a reliable technique in critical care. In this single-center prospective study, we investigated the impact of US-assessed DD on noninvasive ventilation (NIV) failure in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its correlation with the transdiaphragmatic pressure assessed using the invasive sniff maneuver (Pdi sniff). METHODS A population of 75 consecutive patients with AECOPD with hypercapnic acidosis admitted to our respiratory intensive care unit (RICU) were enrolled. Change in diaphragm thickness (ΔTdi) < 20% during tidal volume was the predefined cutoff for identifying DD+/- status. Correlations between ΔTdi < 20% NIV failure and other clinical outcomes were investigated. Correlation between ΔTdi and Pdi sniff values was analyzed in a subset of ten patients. RESULTS DD+ patients had a higher risk for NIV failure than DD- patients (risk ratio, 4.4; p < 0.001), and this finding was significantly associated with higher RICU, in-hospital, and 90-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer RICU stay. Huge increases in NIV failure (HR, 6.2; p < 0.0001) and 90-day mortality (HR, 4.7; p = 0.008) in DD+ patients were found by Kaplan-Meier analysis. ΔTdi highly correlated with Pdi sniff (Pearson's r = 0.81; p = 0.004). ΔTdi < 20% showed better accuracy in predicting NIV failure than baseline pH value and early change in both arterial blood pH and partial pressure of carbon dioxide following NIV start (AUCs 0.84 to DTdi < 20%, 0.51 to pH value at baseline, 0.56 to early change in arterial blood pH following NIV start, and 0.54 to early change in partical pressure of carbon dioxide following NIV start, respectively; p < 0.0001). CONCLUSIONS Early and noninvasive US assessment of DD during severe AECOPD is reliable and accurate in identifying patients at major risk for NIV failure and worse prognosis.
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Affiliation(s)
- Alessandro Marchioni
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Matteo Fontana
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Andrea Viani
- University Hospital of Modena, School of Medicine, University of Modena Reggio Emilia, Modena, Italy
| | - Francesco Giaroni
- University Hospital of Modena, School of Medicine, University of Modena Reggio Emilia, Modena, Italy
| | - Valentina Ruggieri
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Stefania Cerri
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, Modena, Italy
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12
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Gursel G, Zerman A, Basarik B, Gonderen K, Aydogdu M, Memmedova S. Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients. Intern Emerg Med 2018; 13:359-365. [PMID: 29512020 DOI: 10.1007/s11739-018-1821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/01/2018] [Indexed: 12/29/2022]
Abstract
Auto-titrating noninvasive ventilation (NIV) has been developed as a new mode applying variable expiratory-positive airway pressure (EPAP) in addition to variable inspiratory pressures (IPAP), both to deliver targeted tidal volume (VT) and to eliminate upper airway resistance. The purpose of this study is to evaluate whether NIV with auto-titrating mode will decrease more PaCO2 within a shorter time compared to volume-assured mode in hypercapnic intensive care unit (ICU) patients. The hypercapnic respiratory failure patients treated with average volume assured pressure support- automated EPAP mode (group1) were compared with those treated with average volume-assured pressure support mode (group2). Two groups were matched with each other according to baseline diagnoses, demographic characteristics, arterial blood gas values, target VT settings and daily NIV usage times. Built-in software was used to gather the ventilatory parameters. Twenty-eight patients were included in group 1, and 22 in group 2. The decrease in PaCO2 had been achieved within a shorter time period in group 1 (p < 0.05). This response was more pronounced within the first 6 h (mean reduction in PaCO2 was 7 ± 7 mmHg in group 1 and 2 ± 5 mmHg in group 2, p = 0.025), and significantly greater reductions in PaCO2 (18 ± 11 mmHg in group 1 and 9 ± 8 mmHg in group 2, p = 0.008) and plasma HCO3 levels (from 32 to 30 mEq and from 35 to 35 mEq, p = 0.007) took place within first 4 days. While mean IPAP was similar in both groups, maximum EPAP, mean VT and leak were significantly higher in group 1 than in group 2 (p < 0.05). Results of this preliminary study suggest that, this new auto-titrating NIV mode may provide additional benefit on volume-assured mode in decreasing PaCO2 more efficiently and rapidly in hypercapnic ICU patients.
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Affiliation(s)
- Gul Gursel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey
| | - Avsar Zerman
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey
| | - Burcu Basarik
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey
| | - Kamil Gonderen
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey
| | - Muge Aydogdu
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey.
| | - Serriyye Memmedova
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 11th Floor, Besevler, Ankara, Turkey
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13
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Garramone A, Cangemi R, Bresciani E, Carnevale R, Bartimoccia S, Fante E, Corinti M, Brunori M, Violi F, Bertazzoni G, Pignatelli P. Early decrease of oxidative stress by non-invasive ventilation in patients with acute respiratory failure. Intern Emerg Med 2018; 13:183-190. [PMID: 28914417 DOI: 10.1007/s11739-017-1750-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/05/2017] [Indexed: 01/07/2023]
Abstract
Oxidative stress plays an important role in chronic respiratory diseases where the use of non-invasive ventilation seems to reduce the oxidative damage. Data on acute respiratory failure are still lacking. The aim of the study is to investigate the interplay between oxidative stress and acute respiratory failure, and the role of non-invasive ventilation in this setting. We enrolled 60 patients suffering from acute respiratory failure (PaO2/FiO2 ratio <300): 30 consecutive patients treated with non-invasive ventilation and 30 consecutive patients treated with conventional oxygen therapy. Serum levels of soluble Nox2-derived peptide (sNOX2-dp), a marker of NADPH-oxidase activation, and 8-iso-PGF2α and H2O2, markers of oxidative stress, were evaluated at baseline and after 3 h of treatment. At baseline, higher values of sNOX2-dp, 8-iso-PGF2α and H2O2 are associated with lower values of PaO2/FiO2 ratio (p < 0.001). After 3 h, serum levels of sNOX2-dp, H2O2, and 8-iso-PGF2α significantly decrease in patients treated with non-invasive ventilation, but not in patients treated with conventional oxygen therapy. Delta changes of oxidative stress parameters correlate inversely with the delta changes of PaO2/FiO2 (R = -0.623, p < 0.001 for sNOX2-dp; R = -0.428, p < 0.001 for H2O2; R = -0.548, p < 0.001 for 8-iso-PGF2α). In the acute respiratory failure setting, treatment with non-invasive ventilation reduces the levels of oxidative stress in the first hours. This reduction is associated with an improvement of PaO2/FiO2 ratio as well as in a reduction of NADPH-oxidase activity.
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Affiliation(s)
- Alessia Garramone
- UOC Emergency Medicine, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Cangemi
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Emanuela Bresciani
- UOC Emergency Medicine, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Carnevale
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Simona Bartimoccia
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Elisa Fante
- Department of Emergency, M.G. Vannini Hospital, Rome, Italy
| | - Marco Corinti
- UOC Emergency Medicine, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Brunori
- Respiratory Pathophysiology and Rehabilitation Unit, Policlinico Umberto I, Rome, Italy
| | - Francesco Violi
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Giuliano Bertazzoni
- UOC Emergency Medicine, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Pasquale Pignatelli
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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14
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Cheng LTW, Sim TB, Kuan WS. Noninvasive Ventilation as a Temporizing Measure in Critical Fixed Central Airway Obstruction: A Case Report. J Emerg Med 2018; 54:615-618. [PMID: 29482923 DOI: 10.1016/j.jemermed.2017.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/30/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Critical central airway obstruction (CAO) requires emergent airway intervention, but current guidelines lack specific recommendations for airway management in the emergency department (ED) while awaiting rigid bronchoscopy. There are few reports of the use of noninvasive ventilation (NIV) in tracheomalacia, but its use as a temporizing treatment option in fixed, malignant CAO has not, to the best of our knowledge, been reported. CASE REPORT An 84-year-old woman presented to the ED in respiratory distress, too breathless to speak and using her accessory muscles of respiration, with bilateral rhonchi throughout the lung fields. Point-of-care arterial blood gas revealed severe hypercapnia, and NIV was initiated to treat a presumed bronchitis with hypercapnic respiratory failure. Chest radiography revealed a paratracheal mass with tracheal deviation and compression. A diagnosis of critical CAO was made. While arranging for rigid bronchoscopic stenting, the patient was kept on NIV to good effect. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recommendations for emergent treatment of life-threatening, critical CAO before bronchoscopic intervention are not well established. Furthermore, reports of NIV use in CAO are rare. We suggest that emergency physicians consider NIV as a temporizing measure for critical CAO while awaiting availability of bronchoscopy.
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Affiliation(s)
- Lenard Tai Win Cheng
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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15
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Maraffi T, Brambilla AM, Cosentini R. Non-invasive ventilation in acute cardiogenic pulmonary edema: how to do it. Intern Emerg Med 2018; 13:107-111. [PMID: 28952011 DOI: 10.1007/s11739-017-1751-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Tommaso Maraffi
- Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cosentini
- EAS Emergenza ad Alta Specializzazione, ASST-Papa Giovanni XXIII, SIMEU (Società Italiana di Medicina d'Emergenza e Urgenza), Bergamo, Italy.
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16
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Girault C, Gacouin A. [Weaning from mechanical ventilation. Role of conventional methods and non-invasive ventilation for weaning]. Rev Mal Respir 2017; 34:450-464. [PMID: 28502363 DOI: 10.1016/j.rmr.2017.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- C Girault
- Service de réanimation médicale, institut de recherche et d'innovation biomédicale (IRIB), hôpital Charles-Nicolle, hôpitaux de Rouen, groupe de recherche sur le Handicap ventilatoire (GRHV), UPRES EA 3830, faculté de médecine et de pharmacie, université de Rouen, CHU de Rouen, 76031 Rouen cedex, France
| | - A Gacouin
- Inserm-CIC, service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35043 Rennes, France.
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17
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Akashiba T, Ishikawa Y, Ishihara H, Imanaka H, Ohi M, Ochiai R, Kasai T, Kimura K, Kondoh Y, Sakurai S, Shime N, Suzukawa M, Takegami M, Takeda S, Tasaka S, Taniguchi H, Chohnabayashi N, Chin K, Tsuboi T, Tomii K, Narui K, Hasegawa N, Hasegawa R, Ujike Y, Kubo K, Hasegawa Y, Momomura SI, Yamada Y, Yoshida M, Takekawa Y, Tachikawa R, Hamada S, Murase K. The Japanese Respiratory Society Noninvasive Positive Pressure Ventilation (NPPV) Guidelines (second revised edition). Respir Investig 2017; 55:83-92. [PMID: 28012501 DOI: 10.1016/j.resinv.2015.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/07/2015] [Accepted: 11/04/2015] [Indexed: 06/06/2023]
Affiliation(s)
- Tsuneto Akashiba
- Division of Sleep and Respiratory Medicine, Nihon University School of Medicine
| | - Yuka Ishikawa
- Department of Pediatrics, National Hospital Organization Yakumo National Hospital
| | - Hideki Ishihara
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
| | - Hideaki Imanaka
- Department of ER/Disaster Medical Care, Tokushima University Hospital
| | - Motoharu Ohi
- Respiratory and Sleep Medicine Center, Osaka Kaisei Hospital
| | - Ryoichi Ochiai
- Anesthesiology and Intensive Care Medicine of Toho University Omori Medical Center
| | - Takatoshi Kasai
- Cardio-Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine
| | - Kentaro Kimura
- Former Director of Osaka Anti-tuberculosis Association, Osaka Hospital
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, School of Medicine, Iwate Medical University; Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Nobuaki Shime
- Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | | | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Shinhiro Takeda
- Department of Intensive Care Medicine, Nippon Medical School Hospital; Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Sadatomo Tasaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine; Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital; Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Naohiko Chohnabayashi
- Division of Pulmonary Medicine in Thoracic Center, St. Luke's International Hospital; Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University.
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital
| | - Koji Narui
- The Department of Sleep and Respiratory Medicine, Toranomon Hospital
| | | | - Ryuichi Hasegawa
- Department of Emergency and Critical Care Med, Mito Clinical Education and Training Center, Tsukuba University Hospital / Mito Kyodo General Hospital
| | - Yoshihito Ujike
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | | | - Yoshinori Hasegawa
- Division of Respiratory Medicine, Nagoya University Graduate School of Medicine
| | | | - Yoshitsugu Yamada
- Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute, Kaken Hospital
| | - Yukie Takekawa
- Certified Nurse Specialist for Chronic Care Nursing, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Satoshi Hamada
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
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Coggins AR, Cummins EN, Burns B. Management of critical illness with non-invasive ventilation by an Australian HEMS. Emerg Med J 2016; 33:807-811. [PMID: 27371641 PMCID: PMC5136697 DOI: 10.1136/emermed-2015-205377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service. METHODS We reviewed patients receiving NIV during interhospital retrieval at the Greater Sydney Area Helicopter Medical Services (GSA-HEMS) over a 14-month period. The main objectives were to describe the number of retrievals using NIV, the need for intubation in NIV patients and the effect of the therapy on mission duration. RESULTS Over the study period, 3018 missions were reported; 106 cases (3.51%) involved administration of NIV therapy during the retrieval. The most common indication for NIV was pneumonia (34.0%). 86/106 patients received a successful trial of NIV therapy prior to interhospital transfer. 58 patients were transferred on NIV, while 28 patients had NIV removed during transport. None of these 86 patients required intubation or died, although 17/86 ultimately required intubation within 24 hours at the receiving centre. 20/106 patients required intubation at the referring hospital after a failed trial of NIV therapy. NIV was successfully used in all available transport platforms including rotary wing. Patients receiving NIV were found to have prolonged mission durations compared with other GSA-HEMS patients (222.5 vs 193 min). This increase in mission duration was largely attributable to NIV failure, resulting in a need for Rapid Sequence Intubation at the referring hospital. CONCLUSIONS With careful patient selection, the use of interhospital NIV is feasible and appears to be safe in a retrieval system with care provided by a critical care physician.
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Affiliation(s)
- Andrew R Coggins
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin N Cummins
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Brian Burns
- Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Ambulance Service of New South Wales, Greater Sydney Area HEMS, Sydney, New South Wales, Australia
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19
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Sainaghi PP, Re A, Bellan M, Navalesi P, Pirisi M. Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations. Intern Emerg Med 2016; 11:1029-30. [PMID: 27485126 DOI: 10.1007/s11739-016-1516-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Pier Paolo Sainaghi
- Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.
| | - Azzurra Re
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Navalesi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
- CRRF Mons. L. Novarese, Moncrivello, VC, Italy
| | - Mario Pirisi
- Internal Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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20
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Freymond N, Perrot E, Regal O, Fayet JM, Ragué P, Mottard N, Wallet F. [Patient's course requiring NIPPV in Centre Hospitalier Lyon-Sud]. Rev Pneumol Clin 2016; 72:35-40. [PMID: 25727659 DOI: 10.1016/j.pneumo.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/03/2014] [Indexed: 06/04/2023]
Abstract
Non-invasive positive pressure ventilation (NIPPV) has become a major therapeutic of acute respiratory failure. Thanks to technical progress, its use has become widespread in intensive care units and now in emergency and pneumology departments, for indications recognized and validated as decompensation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema. Patients with this conditions transit in the hospital, from the emergency or pulmonology departments, sometimes through intensive care units. Knowledge of the NIPPV, its indications, contraindications, terms of use and surveillance requires trained teams. This training covers not only the technical but also the hardware, multiple ventilation modes, and interfaces. Other indications being evaluated, such as ventilation in the perioperative period, also require coordination between different actors. The establishment of a specific group of thinking and working around the NIPPV is clearly needed, allowing teams of hospital (emergency department, intensive care unit, pulmonology, anesthesia) to work together. This work deals with different areas: training, equipment, condition of receiving patients in the different services within the constraints of personnel and equipment. In this article, we trace the point of view of each of the professionals in this group and some of the actions implemented.
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Affiliation(s)
- N Freymond
- Service de pneumologie, pavillon médical, centre hospitaliser Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - E Perrot
- Service de pneumologie, pavillon médical, centre hospitaliser Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - O Regal
- Service d'accueil des urgences, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - J M Fayet
- Service d'accueil des urgences, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - P Ragué
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - N Mottard
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - F Wallet
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
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21
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Abstract
Noninvasive ventilation (NIV) is a proved and effective therapeutic option for some patients with respiratory failure. During an epidemic, NIV can free up respirators and other intensive care unit equipment for patients with respiratory insufficiency whose survival depends exclusively on invasive ventilation. Some guidelines have indicated that NIV is potentially hazardous and should not be recommended for use during epidemics, given the perceived potential risk of transmission from aerosolized pathogen dispersion to other patients or medical staff. Conversely, some reports of previous epidemics describe NIV as a very efficient and safe modality of respiratory support, if strict infection control measures are implemented. We discuss NIV use during epidemics and indicate the need for prospective randomized clinical studies on the efficacy of NIV in epidemic conditions to provide important information to the current body of literature. Meanwhile, the use of NIV under strict infection control guidelines should be incorporated into epidemic preparedness planning.
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Affiliation(s)
- Jasminka Kopić
- Anesthesiology and Intensive Care Ward, Dr. Josip Benčević General Hospital
| | - Maja Tomić Paradžik
- Department of Microbiology, Institute for Public Health, Brodska-Posavina County, Slavonski Brod, Croatia
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22
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Hansen EF. [Non-invasive ventilation in pneumonia: effective ventilation support or delaying treatment]. Ugeskr Laeger 2014; 176:V66135. [PMID: 25291996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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23
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Le Cong M, Robertson A. A 3-year retrospective audit of the use of noninvasive positive pressure ventilation via the Oxylog 3000 transport ventilator during air medical retrievals. Air Med J 2013; 32:126-128. [PMID: 23632220 DOI: 10.1016/j.amj.2012.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 07/07/2012] [Accepted: 10/21/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The purpose of this study was to describe the safety profile of noninvasive positive pressure ventilation (NIPPV) using the Oxylog 3000 transport ventilator (Drager Medical, Lübeck, Germany) by air medical retrieval teams from the Queensland Section of the Royal Flying Doctor Service of Australia. METHODS Over a 3-year period, patients identified in clinical transport records to have NIPPV via the Oxylog 3000 transport ventilator during air medical transfer were systematically reviewed on the clinical indication and adverse effects. RESULTS A total of 29 patients were identified to have had treatment with NIPPV during air medical retrieval. Three patients suffered serious adverse effects of cardiorespiratory arrest during treatment. The main reported adverse event was intolerance of the facemask. There were no documented episodes of vomiting or hypotension. CONCLUSION The use of NIPPV via the Oxylog 3000 transport ventilator during air medical retrieval requires careful patient selection. The application and management do not differ from standard hospital-based practice.
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Affiliation(s)
- Minh Le Cong
- Royal Flying Doctor Service, Cairns, Queensland, Australia.
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