NEUROMUSCULAR VENTILATORY INSUFFICIENCY Effect of Home Mechanical Ventilator Use v Oxygen Therapy on Pneumonia and Hospitalization Rates

BackgroundThe Swedish Registry of Respiratory Failure (Swedevox) collects nationwide data on patients starting continuous positive airway pressure (CPAP) treatment, long-term mechanical ventilator (LTMV) and long-term oxygen therapy (LTOT). We validated key information in Swedevox against source data from medical records.MethodsThis was a retrospective validation study of patients starting CPAP (n=175), LTMV (n=177) or LTOT (n=175) across seven centres 2013–2017. Agreement with medical record data was analysed using differences in means (standard deviation) and proportion (%) of a selection of clinically relevant variables. Variables of interest included for CPAP: Apnea Hypopnea Index (AHI), height, weight, body mass index (BMI) and Epworth Sleepiness Scale (ESS) score; for LTMV: date of blood gas, PaCO2 (breathing air), weight and diagnosis group; and for LTOT: blood gases breathing air and oxygen, spirometry and main diagnosis.ResultsData on CPAP and LTOT had very high validity across all evaluated variables (all <5% discrepancy). For LTMV, variability was higher against source information for PaCO2 (>0.5 kPa in 25.9%), weight (>5 kg in 47.5%) and diagnosis group. Inconsistency was higher for patients starting LTMV acutely versus electively (PaCO2 –difference >0.5 kPa in 36% versus 21%, p<0.05, respectively). However, there were no signs of systematic bias (mean differences close to zero) across the evaluated variables.ConclusionValidity of Swedevox data, compared with medical records, was very high for CPAP, LTMV and LTOT. The large sample size and lack of systematic differences support that Swedevox data are valid for health care quality assessment and research.

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Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

Journal of Korean Medical Science ◽

10.3346/jkms.2016.31.6.976 ◽

2016 ◽

Vol 31 (6) ◽

pp. 976 ◽

Cited By ~ 1

Author(s):

Seong-Woong Kang ◽

Won Ah Choi ◽

Han Eol Cho ◽

Jang Woo Lee ◽

Jung Hyun Park

Keyword(s):

Mechanical Ventilator ◽

Korean Government ◽

Ventilatory Insufficiency

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Speech Production and Speech With a Phrenic Nerve Pacer

American Journal of Speech-Language Pathology ◽

10.1044/1058-0360.0502.53 ◽

1996 ◽

Vol 5 (2) ◽

pp. 53-60 ◽

Cited By ~ 3

Author(s):

Jeannette D. Hoit ◽

Steven A. Shea

Keyword(s):

Speech Production ◽

Phrenic Nerve ◽

Positive Pressure Ventilation ◽

Ventilatory Support ◽

Positive Pressure ◽

Mechanical Ventilator ◽

Physical Mechanisms ◽

Speech Output ◽

Ventilatory Insufficiency

A phrenic nerve pacer is a neural prosthesis used by some individuals with ventilatory insufficiency. This report provides a description of the phrenic nerve pacer and contains a case study of a young man in whom speech production during phrenic nerve pacing was examined and contrasted to that during mechanical (positive-pressure) ventilation. Results revealed that the physical mechanisms used to produce speech and the resultant speech output differed under these two ventilatory conditions. Listener judgments indicated that speech produced with a phrenic nerve pacer was strongly preferred over that produced with a mechanical ventilator, primarily because it was more continuous and contained fewer and shorter pauses. This continuity was due, in part, to a conservation-of-air strategy employed by the speaker. These observations have important clinical implications for speech-language pathologists responsible for enhancing spoken communication skills in clients requiring ventilatory support.

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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