scholarly journals Twenty-Four Hour Noninvasive Ventilation in Duchenne Muscular Dystrophy: A Safe Alternative to Tracheostomy

2013 ◽  
Vol 20 (1) ◽  
pp. e5-e9 ◽  
Author(s):  
Douglas A McKim ◽  
Nadia Griller ◽  
Carole LeBlanc ◽  
Andrew Woolnough ◽  
Judy King
Keyword(s):  
Respiratory Failure ◽  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Noninvasive Ventilation ◽  
Gas Analysis ◽  
Blood Gas ◽  
Safe Alternative ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Mean

BACKGROUND: Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative.METHODS: The authors’ experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported.RESULTS: The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2and, predominantly, by end-tidal CO2. While the results suggested improved CO2levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years).CONCLUSIONS: Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.

Accuracy of transcutaneous carbon dioxide monitoring in hypotensive patients

2013 ◽  
Vol 31 (4) ◽  
pp. 323-326 ◽  
Author(s):  
Jung-Youn Kim ◽  
Young-Hoon Yoon ◽  
Sung-Woo Lee ◽  
Sung-Hyuk Choi ◽  
Young-Duck Cho ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mean Difference ◽  
Blood Gas ◽  
Limits Of Agreement ◽  
Arterial Blood Gas ◽  
Blood Gas Monitoring ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
The Mean

ObjectivesContinuous blood gas monitoring is frequently necessary in critically ill patients. Our aim was to assess the accuracy of transcutaneous CO2 tension (PtcCO2) monitoring in the emergency department (ED) assessment of hypotensive patients by comparing it with the gold standard of arterial blood gas analysis (ABGA).MethodsAll patients receiving PtcCO2 monitoring in the ED were included. We excluded paediatric patients, patients with no ABGA results during a hypotensive event, patients whose ABGA was not performed simultaneously with PtcCO2 monitoring, and patients who received sodium bicarbonate for resuscitation. The included patients were classified into hypotensive patients and normotensive patients. A hypotensive patient was defined as a patient showing a mean arterial pressure under 60 mm Hg. The agreement in measurement between PaCO2 tension (PaCO2) and PtcCO2 were investigated in both groups.ResultsThe mean difference between PaCO2 and PtcCO2 was 2.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −15.6 to 19.7 mm Hg in the 28 normotensive patients. The mean difference between PaCO2 and PtcCO2 was 1.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −19.5 to 21.7 mm Hg in the 26 hypotensive patients. The weighted κ values were 0.64 in the normotensive patients and 0.60 in the hypotensive patients.ConclusionsPtcCO2 monitoring showed wider limits of agreement with PaCO2 in urgent situations in the ED environment. However, acutely developed hypotension does not affect the accuracy of PtcCO2 monitoring.

THE EARLY USE OF NON-INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN ICU

2018 ◽  
Vol 8 (4) ◽  
pp. 23-27
Author(s):  
Ha Vo Viet ◽  
Minh Nguyen Van ◽  
Thinh Tran Xuan
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Face Mask ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Non Invasive Ventilation ◽  
Early Use

Background: The noninvasive ventilation (NIV) can prevent the need for intubation and the mortality associated with episodes of chronic obstructive pulmonary disease (COPD), pneumonia, asthma... The aim of this study was to find whether the introduction of NPPV early after the admission was effective at reducing the need for intubation and the mortality rate. Methods: Patients were recruited from 9/2017 to 5/2018. CPAP mode delivered through a face mask may be used. Blood gas was tested after 3 hrs. Results: 31 patients were recruited, The use of NIV significantly reduced the need for intubation. The failure rate must set an local management in the research group is 19,8%. Conclusions: The early use of NIV in ICU improved arterial blood gas, decreases the rate of need for intubation and reduces the mortality in patients with moderate respiratory failure. Key words: noninvasive ventilation (NIV), failure in ICU

SECTION ON TRANSPORT MEDICINE 1996 ANNUAL MEETING PROGRAM

PEDIATRICS ◽  
1996 ◽  
Vol 98 (3) ◽  
pp. 589-590
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Long Distance ◽  
Arterial Pco2 ◽  
Arterial Blood Gas ◽  
Meeting Program ◽  
Arterial Blood ◽  
Total Transport ◽  
The Mean

Background: Transcutaneous CO2 (PtcCO2) monitoring has become a more useful tool in the management of respiratory disorders in the newborn ICU. The application of PtcCO2 monitoring to transport is appealing as blood gas analysis in not routinely available during transport. This is especially true when transports occur over long distances or when the use of surfactants rapidly change pulmonary compliance. Methods: Prospectively over a 6 month period, alternating long distance (> 30 mile) transports utilized PtcCO2 monitoring using a Radiometer Model TCM-3 -TINA. During transport, ventilator adjustments were made to keep the PtcCO2 between 35 and 45 torr. Arterial blood gas results at the end of the transport and the number of ventilator changes served as the major outcome variables. Results: Of 105 total transports, 96 involved a distance of more than 30 miles and 24 of these were ventilated. Of the 24, 11 were monitored and 13 randomized to the nonmonitored group. No parents refused to participate in the study. No differences were found between the groups with regard to gestational age, birth-eight, diagnoses, or pre-transport pH or PCO2. Monitored neonates were more likely to have a post-transport arterial PCO2 between 35 and 45 torr (10/11 vs. 5/13, p <.01). The mean pH in the monitored group was 7.34(06) vs. 7.28(.06) in the nonmonitored group after transport (p < .02). Infants in the monitored group underwent a mean of 4.7(2.4) ventilator changes in transport vs. 1.6(1.9) in the nonmonitored group. No increase in total transport time was seen between the two groups indicating no substantial delays awaiting monitor stabilization.

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