P196 A Local Domiciliary Non-invasive Ventilation (NIV) Service Reduces Length of Hospital Stay for Patients Unable to Wean From NIV: Abstract P196 Table 1

Background: Exercise training (ET) is well established to improve functional capacity and quality of life in patients (pts) with chronic heart failure. However, the ET benefits in acute heart failure (AHF) are unknown. Purpose: We aimed to study the safety and efficacy of ET alone or combined with non-invasive ventilation (NIV) compared to standard medical treatment in hospitalized pts with AHF. Methods: Twenty-nine pts with AHF (68% ischemic), 56±7 years, left ventricle ejection fraction of 25±5%, NTproBNP of 2456±730, 6-minute walk test distance (6MWD = 225±39meters) were randomized into 3 groups: ET + NIV with sub therapeutic positive airway pressure (PAP) (ET,n=9), ET + NIV set to 14 of inspiratory and 8 cmH2O of expiratory PAP, respectively (EV,n=11) and standard treatment (CO,n=9). The ET and EV groups performed a daily session of unloaded exercise on cycle ergometer for 20 min or tolerance limit, for 8 consecutives days. In EV and ET, oxygen pulse saturation (SpO2), heart rate (HR), respiratory rate (RR), blood pressure (BP), blood lactate were measured at baseline (D1), during exercise, and at day 10 (D10). Serious adverse events (death or worsening heart failure) were also assessed on D10. Results: Length of hospital stay was shorter in EV group (17±10 days) compared to ET (23±8 days) and CO (39±15 days) (p<0,05). There were more serious adverse events in CO (66,6%) compared to both EV and ET (15%). Dobutamine use at D10 was less frequent in EV (18,2%) and ET (22,2%) groups than in CO (33,3%) (p<0.05). There was a marked improvement in Δ6MWD between D1 and D10 in EV (Δ127±72 meters), though increase in Δ6MWD was also seen in ET (Δ72±26 meters) and CO (Δ41±19meters), p<0,05. The EV group also showed higher endurance and lower peak HR at end-exercise than ET at D10 (128±10 vs. 92±8 min and 73±12 vs. 104±25 bpm, respectively; p<0,05). There was a similar reduction in NTproBNP levels but no differences were found in BP, SpO2, RR and blood lactate. Conclusion: Aerobic exercise in AHF was safe, reduced length of hospital stay and need for inotropics at D10. NIV + ET increased exercise endurance with lower cardiovascular stress.

Download Full-text

Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19

PLoS ONE ◽

10.1371/journal.pone.0262315 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262315

Author(s):

Christian Karagiannidis ◽

Corinna Hentschker ◽

Michael Westhoff ◽

Steffen Weber-Carstens ◽

Uwe Janssens ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Invasive Mechanical Ventilation ◽

Length Of Hospital Stay ◽

Local Health ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Local Health Care ◽

Overall Mortality

Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

Download Full-text

Effects of non-invasive ventilation in subjects undergoing cardiac surgery on length of hospital stay and cardiac-pulmonary complications: a systematic review and meta-analysis

Journal of Thoracic Disease ◽

10.21037/jtd.2020.02.30 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1507-1519

Author(s):

Qinhan Wu ◽

Guiling Xiang ◽

Jieqiong Song ◽

Liang Xie ◽

Xu Wu ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Hospital Stay ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Download Full-text

Non-Invasive Ventilation in Infants Attending a Tertiary Care Center: A Retrospective Review

Integrative Journal of Medical Sciences ◽

10.15342/ijms.2021.405 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shafiqa Alsharif

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Electronic System ◽

Shortness Of Breath ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Bronchiolitis was found to be the greatest worldwide cause of infant hospitalization presenting with symptoms of cough, wheezes, difficulty in breathing, decreased feeding, and apneas. It is estimated that 1-3% of hospitalized infants will require treatment in an intensive care unit especially when risk factors are present. This study analyzes the use of Non-invasive ventilation (NIV) in severe bronchiolitis and its role in reducing the rate of ventilator associated pneumonia (VAP), and the duration of oxygen requirement. Data were collected retrospectively through PHENIX; hospital electronic system for infants less than one year old. Shortness of breath, cough, apnea, cyanosis, N-CPAP immediate or later after few hours, mechanical ventilation (MV), length of hospital stay, and survival status were the outcome variables. Mann-Whitney U test was performed via SPSS version 25.0.Fifty-five infants with bronchiolitis were admitted with forty-nine episodes receiving NIV or MV. A total of thirty-seven infants were treated with NIV while 15 infants were treated with MV. Fever was the major indication for initiating NIV among infants followed by cough, apnea, and shortness of breath. Insignificant evidence was reported between baseline respiratory parameters and infants receiving NIV and MV. Changes in respiratory variables in the first four hours showed significant increase for infants receiving NIV than those receiving MV. Infants receiving NIV had significantly fewer days in NIV and PICU, but insignificant fewer days in hospital stay. The experience for using NIV in infants admitted for bronchiolitis recommends that NIV might be adjunct to mechanical ventilation. This strategy was related with a lower rate of pneumonia and a shorter duration of oxygen therapy.

Download Full-text

Non-Invasive Ventilation in People With Acute Lung Edema

Advances in Medical Diagnosis, Treatment, and Care - Noninvasive Ventilation Technologies and Healthcare for Geriatric Patients ◽

10.4018/978-1-7998-3531-8.ch006 ◽

2020 ◽

pp. 87-95

Author(s):

Pedro Nunes Raposo ◽

Isabel Pedrosa Simões ◽

Catarina Varão Simão

Keyword(s):

Patient Satisfaction ◽

Hospital Stay ◽

Endotracheal Intubation ◽

Lung Edema ◽

Invasive Ventilation ◽

Review Of The Literature ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Health Gains ◽

Reduction Of Mortality

The objective of this study is to identify the health gains obtained with the use of non-invasive ventilation in patients with acute lung edema. A narrative review of the literature was carried out with bibliographic research carried out in the CINAHL, MEDLINE, and COCHRANE databases, in May 2019, with defined inclusion criteria and descriptors. This review highlighted a set of conclusive studies on the place of operation as the first line, as well as the contribution to the reduction of mortality, the need for endotracheal intubation, and a reduction in hospital stay. These results can contribute to the improvement of healthcare, practices, and patient satisfaction.

Download Full-text

Ventilatory support and hospital stay after liver transplant in cirrhotic patients with hepatopulmonary syndrome

Einstein (São Paulo) ◽

10.1590/s1679-45082017ao4081 ◽

2017 ◽

Vol 15 (3) ◽

pp. 322-326

Author(s):

José Leonardo Faustini Pereira ◽

Lucas Homercher Galant ◽

Eduardo Garcia ◽

Luis Henrique Telles da Rosa ◽

Ajácio Bandeira de Mello Brandão ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Stay ◽

Hepatopulmonary Syndrome ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Cirrhotic Patients ◽

Mechanical Ventilation Time

ABSTRACT Objective To compare mechanical ventilation time, need for non-invasive ventilation, length of intensive care unit stay, and hospital stay after liver transplant in cirrhotic patients with and with no diagnosis of hepatopulmonary syndrome. Methods This was a prospective cohort study with a convenience sample of 178 patients (92 with hepatopulmonary syndrome) who were diagnosed as alcoholic or hepatitis C virus cirrhosis. The statistical analysis included Kolmogorov-Smirnov test and Students t test. Data were analyzed using SPSS version 16.0, and p values <0.05 were considered significant. Results Out of 178 patients, 90 underwent transplant (48 with no hepatopulmonary syndrome). The Group diagnosed with Hepatopulmonary Syndrome had longer mechanical ventilation time (19.5±4.3 hours versus 12.5±3.3 hours; p=0.02), an increased need for non-invasive ventilation (12 versus 2; p=0.01), longer intensive care unit stay (6.7±2.1 days versus 4.6±1.5 days; p=0.02) and longer hospital stay (24.1±4.3 days versus 20.2±3.9 days; p=0.01). Conclusion Cirrhotic patients Group diagnosed with Hepatopulmonary Syndrome had higher mechanical ventilation time, more need of non-invasive ventilation, as well as longer intensive care unit and hospital stay.

Download Full-text

Factors associated with non-invasive ventilation failure and mortality in oncologic patients outside the intensive care unit

Research Society and Development ◽

10.33448/rsd-v10i11.19625 ◽

2021 ◽

Vol 10 (11) ◽

pp. e211101119625

Author(s):

Gustavo Telles Silva ◽

Bianca Paraiso Araujo ◽

Eduarda Martins Faria ◽

Camila Martins de Bessa ◽

Anke Bergmann ◽

...

Keyword(s):

Hospital Mortality ◽

Pulmonary Infection ◽

Length Of Hospital Stay ◽

Invasive Ventilation ◽

Factors Associated ◽

Non Invasive ◽

Hematological Neoplasms ◽

Non Invasive Ventilation ◽

Oncologic Patients ◽

New Treatments

Introduction: New treatments have been introduced with the objective to increase the survival rate of oncologic patients. As a result of these approaches, there was an increase in the number of cases of toxicity and complications, which can lead to acute respiratory failure (ARF). One of the most frequent ways to treat ARF is non-invasive ventilation (NIV). Despite the proven benefits in several clinical conditions, NIV results in cancer patients are controversial. Objective: To evaluate risk factors associated with NIV failure and hospital mortality in oncologic patients. Methods: Retrospective cohort study including patients with solid tumors and hematological neoplasms admitted for hospitalization at National Cancer Institute between January 1, 2017 and December 31, 2019, who underwent NIV. The association between the variables of exposure and the outcome was performed by gross and adjusted logistic regression. The Kaplan-Meier method was used to analyze the length of hospital stay. Results: Sixty-three patients who underwent NIV in hospitalization were evaluated, and 26 failed NIV. The patients had a mean age of 58.5 years (±15.6), most were male (57.1%), under 60 years old (58.7%) and had comorbidities (55.5%). The patients with pulmonary infection (OR 6.53; 95% CI 1.21-35.12; p=0.02) had a higher risk of failure in NIV. In relation to hospital mortality, patients older than 60 years (OR 6.90; 95% CI, 2.12-22.45; p=0.001) had a higher risk. Conclusion: Patients who presented pulmonary infection were more likely to fail in NIV. Higher hospital mortality was observed among elderly patients.

Download Full-text

Extubation success without using high-flow nasal cannula and non-invasive ventilation for patients with coronavirus disease 2019 (COVID-19): A retrospective observational study

10.21203/rs.3.rs-64389/v1 ◽

2020 ◽

Author(s):

Akira Inoue ◽

Kazuhiro Shirakawa ◽

Nonoka Fujita ◽

Kunio Kanao ◽

Yutaka Saito ◽

...

Keyword(s):

Hospital Stay ◽

Spontaneous Breathing Trial ◽

High Flow ◽

Nasal Cannula ◽

World Health ◽

Invasive Ventilation ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Respiratory Status ◽

Non Invasive Ventilation

Abstract Background In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) to be a global pandemic. It was also reported that approximately 20%-23% of patients with COVID-19 admitted to the hospital required mechanical ventilation (MV). Reintubation rates ranged from 13–19%, leading to increased mortality. Moreover, exposure of health care workers is a serious problem and intubation is a high-risk procedure because of aerosol generation. To reduce reintubation, preventive high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) after extubation are recommended. However, using HFNC and NIV in patients with COVID-19 may lead to the spread of infection. Without using HFNC and NIV, conventional spontaneous breathing trial (SBT) may overestimate a patient’s respiratory status. A highly demanding SBT accurately assesses a patient’s reserve capacity and may reduce reintubation. We did not use preventive HFNC or NPPV and extubated with a highly demanding SBT protocol. This study aimed to evaluate whether our protocol can be performed safely.Methods This single-centre study was conducted at the Kawasaki Municipal Hospital from February 2020 to June 2020. Patients with COVID-19 requiring MV were screened for their eligibility for the weaning procedure every day. Patients were extubated after administering methylprednisolone if SBT was well tolerated. SBT was performed with 3 cmH2O pressure support, 3 cmH2O positive end-expiratory pressure, and ≤ 0.30 fraction of inspired oxygen. In extubated patients, the reintubation rate, duration of MV, length of intensive care unit (ICU) and hospital stay, and rate of ventilator-associated pneumonia (VAP) were analyzed.Results Ten patients received MV. Two of 10 patients had no improvement in their respiratory status and did not qualify for the extubation criteria and died. Eight patients were extubated. No reintubations were performed (0%). The median durations of MV, ICU stay, and hospital stay were 13 (interquartile range [IQR], 10–16) days, 17 (IQR, 13–27) days, and 22 (IQR, 16–26), and 3 patients (37.5%) was diagnosed VAP.Conclusions Extubation was performed with a highly demanding SBT protocol, and no patients were reintubated. All patients did not require HFNC and NIV. Further research is required in critically ill patients.

Download Full-text