Disorders of the thoracic cage and diaphragm

2020 ◽  
pp. 4328-4337
Author(s):  
John M. Shneerson ◽  
Michael I. Polkey
Keyword(s):  
Respiratory Failure ◽  
Blood Gases ◽  
Face Mask ◽  
Pleural Thickening ◽  
Non Invasive ◽  
Arterial Blood ◽  
Non Invasive Ventilation ◽  
Tuberculous Osteomyelitis ◽  
Cricoarytenoid Arthritis

Disorders of the thoracic skeleton can lead to a severe restrictive ventilatory defect, the risk of respiratory failure being highest with (1) scoliosis—particularly if the following characteristics are present: early onset, severe angulation, high in the thorax, respiratory muscle weakness, low vital capacity; (2) kyphosis—but only if of very sharp angulation (gibbus), most commonly seen following tuberculous osteomyelitis; and (3) after thoracoplasty—historically performed as treatment for pulmonary tuberculosis. While not a disorder of the skeleton, a similar pathophysiological pattern is seen in extreme obesity, and this is the fastest growing cause of referral to home ventilation centres. Arterial blood gases and quality of life can both be readily improved with non-invasive ventilation, usually using a nasal or face mask. Survival in most skeletal disorders after starting ventilation leads to apical bullae, pleural thickening/effusions, and cricoarytenoid arthritis, but rarely causes respiratory failure in the absence of other comorbidities.

scholarly journals Outcome of Non-Invasive Ventilation in Patients of Acute Respiratory Failure.

2021 ◽  
Vol 4 (1) ◽  
pp. 21-26
Author(s):  
Anusmriti Pal ◽  
Manoj Kumar Yadav ◽  
Chiranjeevi Pant
Keyword(s):  
Intensive Care Unit ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Face Mask ◽  
Invasive Ventilation ◽  
Failure Group ◽  
Non Invasive ◽  
Arterial Blood ◽  
Copd Patients ◽  
Non Invasive Ventilation

Introduction: Non-invasive ventilation (NIV) is a method of ventilator support or delivery of positive pressure into the lungs usually through a face mask, mostly initiated before severe acidosis occurs. NIV failure requiring invasive mechanical ventilation in decompensated chronic obstructive pulmonary disease (COPD) patients is low, but, in critical patients, it is as high as 60%. Acute respiratory failure (ARF) is the common reason for admission to the intensive care unit. This study assesses the outcome of NIV among patients with acute respiratory failure, the duration of use, stay in ICU, and failure rate of NIV. Such type of study result is scarce in our country. Methods:  Arterial blood gases were assessed prior, after, and at discontinuation of NIV. NIV was delivered by ventilator via face mask. All patients above age 15 years who presented to the hospital, diagnosed to have ARF by ABG were included and admitted to Medical Intensive Care Unit (MICU). . Appropriate statistical tests (Chi-square) were performed and the statistical significance of the results was assessed. Results: 35 patients with the median age of 73 years (range: 39- 89 years), of 60.0 % females among which 74.3 % were current smokers. Arterial blood pH prior to admission ranged from 7.11-7.39 and 7.06-7.41 among NIV success and failure, respectively. Similarly, PCo2 ranged from 54.0-127.5 and 29.5-105.9 among them, respectively. Two hours after ventilation pH ranged from 7.12-7.43 and 7.05-7.30 respectively in the success and failure group. The most common disease condition requiring NIV was 77.1% COPD.  Out of NIV failure group (n=19) ,57.8 % were intubated and 42.1% patients left the intervention.  Conclusions: Usage of NIV among ARF patients was associated with lower intubation and ICU mortality rate. COPD patients showed the most benefit with NIV, whereas patients suffering from interstitial lung disease, lung cancer had less benefit.

scholarly journals Use of Non Invasive Ventilation in Patients with Respiratory Failure in Nepal

2012 ◽  
Vol 9 (4) ◽  
pp. 256-259 ◽  
Author(s):  
R Pandey ◽  
R Chokhani ◽  
N B K C
Keyword(s):  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Arterial Blood ◽  
Non Invasive Ventilation

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59

scholarly journals Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Gerrit J. Muller ◽  
Renee Hovenier ◽  
Jip Spijker ◽  
Monica van Gestel ◽  
Rozalinde Klein-Blommert ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Pediatric Intensive Care ◽  
Daily Practice ◽  
Face Mask ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
3D Printed ◽  
Fitting In

Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.

THE EARLY USE OF NON-INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN ICU

2018 ◽  
Vol 8 (4) ◽  
pp. 23-27
Author(s):  
Ha Vo Viet ◽  
Minh Nguyen Van ◽  
Thinh Tran Xuan
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Face Mask ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Non Invasive Ventilation ◽  
Early Use

Background: The noninvasive ventilation (NIV) can prevent the need for intubation and the mortality associated with episodes of chronic obstructive pulmonary disease (COPD), pneumonia, asthma... The aim of this study was to find whether the introduction of NPPV early after the admission was effective at reducing the need for intubation and the mortality rate. Methods: Patients were recruited from 9/2017 to 5/2018. CPAP mode delivered through a face mask may be used. Blood gas was tested after 3 hrs. Results: 31 patients were recruited, The use of NIV significantly reduced the need for intubation. The failure rate must set an local management in the research group is 19,8%. Conclusions: The early use of NIV in ICU improved arterial blood gas, decreases the rate of need for intubation and reduces the mortality in patients with moderate respiratory failure. Key words: noninvasive ventilation (NIV), failure in ICU

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