Bone Metabolism in OSAS Patients and the Effect of One Year Treatment with Non-Invasive Ventilation

Background. Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. Methods. A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. Results. Fifteen patients were included in the study: 10 males, mean age 68 ± 12. APACHE-II score was 17.6 ± 6.5. pH and pCO2 before NIV were 7.22 ± 0.11 and 110 ± 72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. Conclusions. NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.

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Utilisation of RAM cannula for non-invasive respiratory support for infants in the cardiac ICU

Cardiology in the Young ◽

10.1017/s1047951121001062 ◽

2021 ◽

pp. 1-7

Author(s):

Ashish Saini ◽

Kevin O. Maher ◽

Shriprasad R. Deshpande

Keyword(s):

Ventilatory Support ◽

Respiratory Support ◽

Pulmonary Insufficiency ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Additional Burden ◽

Chest X Ray ◽

One Year

Abstract Background: Children with CHD carry an additional burden of pulmonary insufficiency, often necessitating prolonged ventilatory support, especially in the peri-operative phase. There has been an increase in the utilisation of non-invasive ventilatory support for these children. The objective of this study was to evaluate the utilisation, safety, and outcomes of RAM cannula as a tool for escalation and de-escalation of respiratory support in paediatric cardiac patients less than one year of age. Methods: A single-centre retrospective cohort study of patients supported with RAM cannula. Results: A total of 275 instances of RAM use were included in the study, 81.1% being post-operative. Patients were stratified into escalation and de-escalation cohorts based on the indication of non-invasive ventilation. The success rate of using RAM cannula was 69.5% overall, 66.1% in the escalation group, and 72.8% in the de-escalation group. At baseline, age at cardiac ICU admission >30 days, FiO2 ≤ 40%, PaCO2 ≤ 50 mmHg; and after 12 hours of non-invasive ventilation support respiratory rate ≤ 60/min, PaO2 ≥ 50 mmHg, PaCO2 ≤ 50 mmHg; and absence of worsening on follow-up chest X-ray predicted the success with a sensitivity of 95% in the logistic regression model. Successful support was associated with a significantly shorter unit stay. Conclusions: RAM cannula can be safely used to provide non-invasive support to infants in the cardiac ICU for escalation and de-escalation of respiratory support. Factors associated with success can be used to make decisions about candidacy and appropriate timing of non-invasive ventilation use to maximise effectiveness.

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