scholarly journals Delivery of CPAP respiratory support for COVID-19 using repurposed technologies

2020 ◽  
Author(s):  
P. Culmer ◽  
A. Keeling ◽  
C. Osnes ◽  
W. Davis Birch ◽  
D. Jones ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Sleep Apnoea ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
Positive End Expiratory Pressure ◽  
Valve Design ◽  
Non Invasive ◽  
Patient Pathway ◽  
Non Invasive Ventilation ◽  
Crucial Part

The COVID-19 pandemic has placed a dramatic increase in demand on healthcare providers to provide respiratory support for patients with moderate to severe symptoms. In conjunction, the pandemic has challenged existing supply-chains to meet demands for medical equipment and resources. In response to these challenges, we report our work to repurpose two existing non-invasive ventilation (NIV) systems to provide solutions for the delivery of oxygen-enriched CPAP ventilation which are inherently resource and oxygen-efficient. We consider adaptation of CPAP systems typically used for sleep apnoea, together with a new Venturi-valve design which can be readily produced through 3D printing. Our aim in both cases was to support Positive end-expiratory pressure (PEEP) of ≥10cmH2O while achieving ≥40% FiO2. This supports a crucial part in the patient pathway for COVID-19 treatment, helping to provide early respiratory support prior to invasive ventilation options in the ICU.

Sleep apnoea: treatment options and sleep/cardiovascular outcome

ESC CardioMed ◽  
2018 ◽  
pp. 1065-1069
Author(s):  
Holger Woehrle ◽  
Michael Arzt
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Invasive Ventilation ◽  
Adaptive Servo Ventilation ◽  
Central Sleep Apnoea ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
New Treatment

In addition to lifestyle interventions, treatments for obstructive sleep apnoea focus on maintaining upper airway patency. Continuous positive airway pressure (CPAP) is recommended as first-line therapy. Beneficial cardiovascular effects of CPAP include increased intrathoracic pressure, reduced left ventricular preload and afterload, and reduced transmural cardiac pressure gradients. CPAP also reduces nocturnal ischaemia and blood pressure, and decreases the risk of post-treatment atrial fibrillation recurrence. However, secondary prevention with CPAP did not significantly reduce the rate of major cardio- and cerebrovascular events in the SAVE study. Mandibular advancement devices, surgery, and upper airway stimulation are options for patients unwilling to use or tolerate CPAP. Central sleep apnoea and Cheyne–Stokes respiration are common in patients with heart disease, especially heart failure. Adaptive servo-ventilation is the most effective therapy for alleviating central sleep apnoea with Cheyne–Stokes respiration. However, it is now contraindicated in heart failure patients with an ejection fraction of 45% or lower and predominant central sleep apnoea because of an increased risk of cardiovascular death, based on SERVE-HF study results. However, adaptive servo-ventilation may still have a role in other settings, including heart failure with preserved ejection fraction. Phrenic nerve stimulation is a new treatment modality that has shown promising results in a feasibility study. Hypoventilation is another breathing disorder that needs effective management. Data in cardiovascular disease are lacking, but CPAP and non-invasive ventilation have been shown to be effective in patients with obesity hypoventilation syndrome. Furthermore, effective reduction of chronic hypercapnia during home non-invasive ventilation treatment in patients with chronic obstructive pulmonary disease has been shown to significantly improve survival.

scholarly journals Use of Nasal Non-Invasive Ventilation with a RAM Cannula in the Outpatient Home Setting

2017 ◽  
Vol 11 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Wilfredo De Jesus Rojas ◽  
Cheryl L. Samuels ◽  
Traci R. Gonzales ◽  
Katrina E. McBeth ◽  
Aravind Yadav ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Lung Disease ◽  
Chest Wall ◽  
Chronic Respiratory Failure ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Successful Implementation ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Background: Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings. Objective: To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure. Methods: We performed a retrospective case series of 18 children (4 months to 19 years old) using the Nasal NIV/RAM Cannula in the Pediatric Pulmonary Clinic at the McGovern Medical School, UTHealth (2014-16). Consideration for Nasal NIV/RAM Cannula utilization included: inability to wean-off in-patient respiratory support, comfort for dyspnea, intolerability of conventional mask interfaces and tracheostomy avoidance. Results: Average age was 7 years. 50% were Caucasian, 38% African-American and 11% Hispanics. Pulmonary disorders included: chest wall weakness (38%), central control abnormalities (33%), obstructive lung disease (16%) and restrictive lung disease (11%). Indications for Nasal NIV/RAM Cannula initiation included: CPAP/BPAP masks intolerability (11%), dyspnea secondary to chest wall weakness (38%) and tracheostomy avoidance (50%). Average length of use of Nasal NIV/RAM Cannula was 8.4 months. Successful implementation of Nasal NIV/Ram Cannula was 94%. One patient required a tracheostomy following the use of Nasal NIV/RAM Cannula. Significant decrease in arterial PaCO2 pre and post Nasal NIV/RAM cannula initiation was notable (p=0.001). Conclusion: Outpatient use of Nasal NIV/RAM Cannula may prove to be a feasible and save treatment alternative for children with chronic respiratory failure, chest wall weakness, dyspnea and traditional nasal/face mask intolerance to avoid tracheostomy.

scholarly journals Protocolized Post-Extubation Respiratory Support to prevent reintubation: protocol and statistical analysis plan for a clinical trial

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030476 ◽  
Author(s):  
Jonathan Dale Casey ◽  
Erin R Vaughan ◽  
Bradley D Lloyd ◽  
Peter A Bilas ◽  
Eric J Hall ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Usual Care ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients

IntroductionFollowing extubation from invasive mechanical ventilation, nearly one in seven critically ill adults requires reintubation. Reintubation is independently associated with increased mortality. Postextubation respiratory support (non-invasive ventilation or high-flow nasal cannula applied at the time of extubation) has been reported in small-to-moderate-sized trials to reduce reintubation rates among hypercapnic patients, high-risk patients without hypercapnia and low-risk patients without hypercapnia. It is unknown whether protocolised provision of postextubation respiratory support to every patient undergoing extubation would reduce the overall reintubation rate, compared with usual care.Methods and analysisThe Protocolized Post-Extubation Respiratory Support (PROPER) trial is a pragmatic, cluster cross-over trial being conducted between 1 October 2017 and 31 March 2019 in the medical intensive care unit of Vanderbilt University Medical Center. PROPER compares usual care versus protocolized post-extubation respiratory support (a respiratory therapist-driven protocol that advises the provision of non-invasive ventilation or high-flow nasal cannula based on patient characteristics). For the duration of the trial, the unit is divided into two clusters. One cluster receives protocolised support and the other receives usual care. Each cluster crosses over between treatment group assignments every 3 months. All adults undergoing extubation from invasive mechanical ventilation are enrolled except those who received less than 12 hours of mechanical ventilation, have ‘Do Not Intubate’ orders, or have been previously reintubated during the hospitalisation. The anticipated enrolment is approximately 630 patients. The primary outcome is reintubation within 96 hours of extubation.Ethics and disseminationThe trial was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registration numberNCT03288311.

scholarly journals High Flow Nasal Cannula Oxygenation

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Tajamul Hussain Shah ◽  
Suhail Mantoo ◽  
Rafi Ahmad Jan
Keyword(s):  
Face Mask ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Low Flow ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Flow Devices

High Flow Nasal Cannula Oxygenation The current pandemic of COVID-19 caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested the healthcare infrastructure throughout the globe at all possible levels. Early reports suggest about 20% of patients infected with SARS-CoV-2 require hospitalization and 5-8% require admission to intensive care unit (ICU) due to severe disease.Supplementation of oxygen provided by various conventional oxygen therapy (COT) devices (like nasal prongs, face mask, venture mask or non-rebreather mask) may not be sufficient in cases of worsening respiratory failure. One form of escalating respiratory support in such patients is a high flow nasal oxygenation device. High flow nasal cannula oxygenation (HFNC) is a form of non invasive respiratory support. It acts as a bridge between low flow devices and non invasive ventilation and may reduce the need for intubation.

scholarly journals Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: Evidence from critically ill COVID-19 patients

2021 ◽  
Author(s):  
Michael Hultström ◽  
Ola Hellkvist ◽  
Lucian Covaciu ◽  
Filip Fredén ◽  
Robert Frithiof ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
University Hospital ◽  
Respiratory Support ◽  
Arterial Oxygen ◽  
Invasive Ventilation ◽  
Steady State Condition ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Abstract Introduction The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC. Methods This was a sub-study of a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden for critical COVID-19. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV). Results A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio (up to 48 mmHg, from HFNC to MV). Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mm Hg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible. Conclusion HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio precludes using ARDS grade as a measure of pulmonary damage during HFNC.

scholarly journals Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039655
Author(s):  
Christopher Gerdung ◽  
Sara Rodriguez-Lopez ◽  
Stefan Palkowski ◽  
Diana Keto-Lambert ◽  
Meghan Sebastianski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Invasive Ventilation ◽  
Metabolic Markers ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Obstructive Sleep

IntroductionObstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA.Methods and analysisA systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed.Ethics and disseminationThere are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.

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