scholarly journals Trimming the need for invasive ventilation: pragmatic critical care during the COVID-19 pandemic

2020 ◽  
Vol 13 (9) ◽  
pp. e237597
Author(s):  
Connor P Oates ◽  
Sarah A Goldman ◽  
Gennaro Giustino ◽  
Martin E Goldman
Keyword(s):  
Critical Care ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Medical Professionals ◽  
Religious Leaders ◽  
Invasive Ventilation ◽  
Facial Hair ◽  
Non Invasive ◽  
Hypoxic Respiratory Failure ◽  
Religious Reasons

COVID-19 has challenged all medical professionals to optimise non-invasive positive pressure ventilation (NIV) as a means of limiting intubation. We present a case of a middle-aged man with a voluminous beard for religious reasons who developed progressive hypoxic respiratory failure secondary to COVID-19 infection which became refractory to NIV. After gaining permission to trim the patient’s facial hair by engaging with the patient, his family and religious leaders, his mask fit objectively improved, his hypoxaemia markedly improved and an unnecessary intubation was avoided. Trimming of facial hair should be considered in all patients on NIV who might have any limitations with mask fit and seal that would hamper ventilation, including patients who have facial hair for religious reasons.

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service

2015 ◽  
Vol 30 (3) ◽  
pp. 239-243 ◽  
Author(s):  
James S. Lee ◽  
Domhnall O’Dochartaigh ◽  
Mark MacKenzie ◽  
Darren Hudson ◽  
Stephanie Couperthwaite ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Positive Pressure Ventilation ◽  
Helicopter Emergency Medical Service ◽  
Positive Pressure ◽  
Factors Associated ◽  
Non Invasive ◽  
Emergency Medical ◽  
The Impact

AbstractIntroductionNon-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.Hypothesis/ProblemThe authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.MethodsA retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.ResultsFrom a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS) <15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).ConclusionPatients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.LeeJS, O’DochartaighD, MacKenzieM, HudsonD, CouperthwaiteS, Villa-RoelC, RoweBH. Factors associated with failure of non-invasive positive pressure ventilation in a critical care helicopter Emergency Medical Service. Prehosp Disaster Med2015; 30(2): 1–5

scholarly journals Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation

2021 ◽  
Vol 14 (3) ◽  
pp. e241809
Author(s):  
Onn Shaun Thein ◽  
Muhammad Niazi ◽  
Abdisamad Ali ◽  
Adeel Sahal
Keyword(s):  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Best Supportive Care ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Bridging Therapy ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Common Causes ◽  
Poor Outcomes

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.

scholarly journals Application Effect and Nursing of Non-Invasive Ventilation in Acute Exacerbation of Chronic Obstruction Pulmonary Disease Patients

2015 ◽  
Vol 4 (4) ◽  
pp. 8
Author(s):  
Zongying Li
Keyword(s):  
Acute Exacerbation ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Control Group ◽  
Blood Gas ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Significant Difference ◽  
Experimental Group

<p><strong>Objective:</strong> To study the application methods, summarize the nursing experience and discuss the clinical effect of non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease (COPD). <strong>Methods:</strong> 152 cases of AECOPD patients, who received treatment in our hospital from January 2011 to December 2013, were selected and divided into the experimental group and control group randomly. Patients in control group received conventional treatment, whereas besides conventional treatment, experimental group received non-invasive positive pressure ventilation and relevant nursing management. The changes in arterial blood gas and clinical indicators before and after treatment for both groups were observed. <strong>Results:</strong> After 7 days treatment, all the results of blood gas analysis were significantly improved (<em>p</em> &lt; 0.05). For the respiratory status (based on Borg scale), two groups were significantly improved after treatment, however, experimental group shown better than control group (<em>p</em> &lt; 0.05). The two groups had statistically significant difference (<em>p</em> &lt; 0.05) in the aspects of prognosis, endotracheal intubation and hospitalization time. As for the death index, there was no significant difference between two groups. No special treatment was needed for adverse reactions, they would be relieved slowly. <strong>Conclusion:</strong> Non-invasive positive pressure ventilation able to improve the recovery rate and quality of life of patients with acute exacerbation of COPD.</p>

scholarly journals The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

2021 ◽  
Author(s):  
Saurabh Singh ◽  
Thomas John ◽  
Prashant Kumar ◽  
Syed Rehan Quadery
Keyword(s):  
Critical Care ◽  
Respiratory Failure ◽  
Standard Therapy ◽  
High Dose ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Dose Oral ◽  
Hypoxic Respiratory Failure ◽  
The Impact

ABSTRACTBackgroundCOVID-19 can be fatal in a significant proportion of people who develop critical illness, resulting in hypoxic respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) which is thought to be mediated by a cytokine storm syndrome. Steroids have been shown to be of some benefit, but the mainstay of treatment remains supportive.MethodsThe data was collected retrospectively from consecutive, newly diagnosed patients presenting to the critical care facility of I Q City Medical College Hospital, Durgapur, India between June and November 2020 with critical COVID-19 on non-invasive ventilation treated with high dose oral cotrimoxazole (CTX) in addition to standard therapy (ST) and compared with patients with critical COVID-19 receiving standard therapy alone.Results201 patients were identified. Of which 151 patients received CTX in addition to ST (mean age ± SD 59 ± 13 years, 81% male and mean BMI ± SD 28 ± 2) and 50 patients received ST alone (mean age ± SD 63 ± 12, 64% male and mean BMI ± SD 27 ± 2). We observed that the patients with critical COVID-19 receiving CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (13% versus 40%, p <0.001), length of hospital and critical care unit stay (mean, 11 versus 15 days (p <0.001) and 6 versus 11 days (p <0.001) respectively), and the need for mechanical ventilation (16% versus 42%, p <0.001) with improved CRP at day 7 (mean, 38mg/L versus 62mg/L, p = 0.001).ConclusionThese results may be due to the antibiotic and anti-cytokine effects of CTX. Clinical trials are currently underway to test our observations.

scholarly journals Short-term effects of synchronized vs. non-synchronized NIPPV in preterm infants: study protocol for an unmasked randomized crossover trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Francesco Cresi ◽  
Federica Chiale ◽  
Elena Maggiora ◽  
Silvia Maria Borgione ◽  
Mattia Ferroglio ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Work Of Breathing ◽  
Respiratory Rhythm ◽  
Assisted Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Short Term Effects

Abstract Background Non-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management has not yet been established. Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant’s breathing efforts. The aim of the study is to evaluate the short-term effects of SNIPPV vs. NIPPV on the cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support. Methods An unmasked randomized crossover study with three treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frames of 4 h each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining continuous assisted ventilation without patient discomfort. During the whole duration of the study, the patient’s cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer. The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are the number of the cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index, and thoracoabdominal asynchrony. The calculated sample size was of 30 patients. Discussion It is known that NIPPV produces a percentage of ineffective acts due to asynchronies between the ventilator and the infant’s breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation. Trial registration ClinicalTrials.gov NCT03289936. Registered on September 21, 2017.

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