scholarly journals Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

BMJ ◽  
2020 ◽  
pp. m2446 ◽  
Author(s):  
Thomas W Nicholson ◽  
Nick P Talbot ◽  
Annabel Nickol ◽  
Andrew J Chadwick ◽  
Oliver Lawton
Keyword(s):  
Primary Care ◽  
Respiratory Failure ◽  
Primary Care Physicians ◽  
Respiratory Support ◽  
Non Invasive ◽  
Hospital Doctors

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.

Do-not-attempt-resuscitation (DNAR) orders: understanding and interpretation of their use in the hospitalised patient in Ireland. A brief report

2017 ◽  
Vol 44 (3) ◽  
pp. 201-203 ◽  
Author(s):  
Helen O’Brien ◽  
Siobhan Scarlett ◽  
Anne Brady ◽  
Kieran Harkin ◽  
Rose Anne Kenny ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Staff Nurses ◽  
University Teaching ◽  
Hard Copy ◽  
Do Not Resuscitate ◽  
Nasogastric Feeding ◽  
Care Plans ◽  
Hospital Doctors

Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5% (187/527), 19.8% (292/1477) in the nurses group but 68.8% (150/218) in the specialist nurses group and 40% (40/100) in the primary care physician group.Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences (p<0.001). Furthermore, a higher percentage of staff nurses (26.8%) and primary care physicians (22.5%) believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups (p<0.001). Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans.

scholarly journals Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

2020 ◽  
Vol 15 ◽  
Author(s):  
Valentina Di Lecce ◽  
Giovanna Elisiana Carpagnano ◽  
Paola Pierucci ◽  
Vitaliano Nicola Quaranta ◽  
Federica Barratta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
Non Invasive ◽  
Baseline Characteristics ◽  
Almost All

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

Non-invasive ventilation in intensive care unit: yesterday, today, tomorrow (literature review)

2021 ◽  
pp. 42-51
Author(s):  
A. V. Vlasenko ◽  
A. G. Koryakin ◽  
E. A. Evdokimov ◽  
I. S. Klyuev
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Negative Effects ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The One

The development of medical technologies and the emergence of new methods of respiratory support with extensive capabilities to control positive pressure on the inhale and exhale made it possible to implement non-invasive ventilation. The integration of microprocessors in modern respiratory interfaces, on the one hand, and a deeper understanding of the mechanisms of the pathogenesis of respiratory failure, on the other hand, made it possible to improve and implement various methods of non-invasive respiratory support in everyday clinical practice. The experience gained in recent decades with the use of non-invasive ventilation made it possible to widely use this method of respiratory support in a wide variety of clinical situations. However, the selection of patients for mask ventilation, the choice of method and algorithm for its application, prognosis of effectiveness, prevention of negative effects, as before, remain relevant. This dictates the need to continue studying the clinical efficacy of non-invasive ventilation in patients with respiratory failure of various origins. The review presents the possibilities and limitations of the use of non-invasive respiratory support in patients with respiratory failure in the intensive care unit.

scholarly journals Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1053
Author(s):  
Shayan Kassirian ◽  
Ravi Taneja ◽  
Sanjay Mehta
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
The Right

Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.

scholarly journals Gas Exchange and Outcomes from Non-Invasive Respiratory Support in COVID-19 Respiratory Failure

2021 ◽  
pp. 106481
Author(s):  
Ciara Gough ◽  
Michelle Casey ◽  
Thomas A. McCartan ◽  
Alessandro N. Franciosi ◽  
Derek Nash ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Gas Exchange ◽  
Respiratory Support ◽  
Non Invasive
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