Predicting Failure of Non-Invasive Ventilation With RAM Cannula in Bronchiolitis

Introduction: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. Methods: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children’s hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student’s t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. Results: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. Conclusion: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.

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Response to Letter to the Editor re: ‘Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study’

Physiotherapy ◽

10.1016/j.physio.2019.07.005 ◽

2020 ◽

Vol 107 ◽

pp. 328-329

Author(s):

Ianthe Boden ◽

Jane Lockstone

Keyword(s):

High Risk ◽

Pulmonary Complications ◽

Implementation Study ◽

Invasive Ventilation ◽

Postoperative Pulmonary Complications ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Before And After ◽

Risk Patients ◽

Upper Abdominal

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Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study

Physiotherapy ◽

10.1016/j.physio.2018.12.003 ◽

2020 ◽

Vol 106 ◽

pp. 77-86 ◽

Cited By ~ 3

Author(s):

Jane Lockstone ◽

Selina M. Parry ◽

Linda Denehy ◽

Iain K. Robertson ◽

David Story ◽

...

Keyword(s):

High Risk ◽

Pulmonary Complications ◽

Implementation Study ◽

Invasive Ventilation ◽

Postoperative Pulmonary Complications ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Before And After ◽

Risk Patients ◽

Upper Abdominal

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Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department

Emergency Medicine Journal ◽

10.1136/emermed-2020-209744 ◽

2020 ◽

Vol 37 (9) ◽

pp. 565-566 ◽

Cited By ~ 3

Author(s):

Davide Bastoni ◽

Erika Poggiali ◽

Andrea Vercelli ◽

Elena Demichele ◽

Valentina Tinelli ◽

...

Keyword(s):

Emergency Department ◽

Pain Control ◽

Airway Pressure ◽

Lung Ultrasound ◽

Positive Airway Pressure ◽

Prone Positioning ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Before And After

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.

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Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris

Critical Care ◽

10.1186/s13054-021-03780-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Matthieu Schmidt ◽

Elise Langouet ◽

David Hajage ◽

Sarah Aissi James ◽

Juliette Chommeloux ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cox Regression ◽

Lung Damage ◽

University Hospital ◽

Invasive Ventilation ◽

Non Invasive ◽

Membrane Oxygenation ◽

Frequent Use ◽

Non Invasive Ventilation ◽

Before And After

Abstract Background Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. Methods We included consecutive adults diagnosed with COVID-19 in Paris–Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. Results Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27–47%) and 48% (37–60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02–5.07). ECMO-related complications did not differ between study periods. Conclusions 90-day mortality of ECMO-supported COVID-19–ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.

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IMPACT OF NON-INVASIVE VENTILATION IMMEDIATELY AFTER EXTUBATION ON CLINICAL AND FUNCTIONAL OUTCOMES IN PATIENTS SUBMITTED TO CORONARY ARTERY BYPASS GRAFTING: CLINICAL TRIAL

10.22541/au.160813098.85693657/v1 ◽

2020 ◽

Author(s):

André Luiz Lisboa Cordeiro ◽

Carolina Silva ◽

Mayana Santana ◽

Kênia Lima ◽

André Guimarães ◽

...

Keyword(s):

Clinical Trial ◽

Coronary Artery ◽

Functional Capacity ◽

Artery Bypass ◽

Bypass Grafting ◽

Invasive Ventilation ◽

Post Intervention ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Before And After

Introduction: The application of non-invasive ventilation(NIV) after coronary artery bypass grafting(CABG) brings the possibility of reducing loss of functional capacity and complications in the patient. However, the evidence is controversial about immediate or conventional use. Objective: Assess the impact of immediate NIV after extubation on oxygenation and functional capacity of patients undergoing to CABG. Methods: Randomized clinical trial. Patients were assessed before and after surgery using the Functional Independence Measure(FIM), six-minute walk test(6MWT) and peripheral muscle strength(MRC). On the first day after the surgery, two groups formed immediate NIV(NIVI) and conventional NIV(NIVC). Hemogasometry was collected before and after NIV. Complication rates were also assessed. NIVI performed ventilation after one hour of orotracheal extubation, at NIVC performed NIV on the first postoperative day, 24 hours after extubation. After discharge, the above variables were reevaluated. Results: 79 patients were evaluated, 46(58.22%) men, mean age 65±9 years. NIVI reduced the reintubation rate, only 1 (3%) compared to NIVC with 5 (12%) patients, p=0.01. In the post-Intervention the inspired oxygen fraction (FiO2) was 0.43±0.07 in the conventional group and 0.30±0.10 in the intervention group, p=0.01. The post-intervention PaO2/FiO2 ratio was 191±45 and NIVI 266±29(p <0.001) and one day later in the NIVC it was 210±39 and NIVI 279±37(p <0.001). VNII lost 51±36 meters in the 6MWT compared to the NIVC that lost 95±40 meters(p <0.01). Conclusion: NIVI after extubation of patients undergoing to CABG, reduced the loss of functional capacity, improved blood gases and decreased the rate of reintubation.

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