Abstract 15821: Safety and Efficacy of Non-invasive Ventilation During Exercise Training in Patients With Acute Heart Failure. A Randomized Prospective Controlled Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mayron F Oliveira ◽  
Rita L Santos ◽  
Vanessa M Mendez ◽  
Priscila A Sperandio ◽  
Iracema I Umeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Adverse Events ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Invasive Ventilation ◽  
Serious Adverse Events ◽  
Safety And Efficacy ◽  
Non Invasive ◽  
Non Invasive Ventilation

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.

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

PLoS ONE ◽  
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.

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

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.

Non-Invasive Ventilation in People With Acute Lung Edema

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.

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.

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