Beyond the mask: a multidisciplinary reflection on palliating patients with COVID-19 receiving continuous positive airway pressure ventilation

2020 ◽  
Vol 26 (7) ◽  
pp. 336-340
Author(s):  
Amy Hough ◽  
Georgia Daisy Dell ◽  
Michael Blaber ◽  
Diana Kavanagh ◽  
Anna Lock
Keyword(s):  
Palliative Care ◽  
Continuous Positive Airway Pressure ◽  
Mortality Rate ◽  
Inner City ◽  
Support System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Assisted Ventilation ◽  
Positive Airway Pressure Ventilation ◽  
The Impact

This narrative describes the experiences of an inner city respiratory unit that was transformed to treat COVID-19 patients with continuous positive airway pressure (CPAP) ventilation who were not scheduled for any further escalation in treatment. The high mortality rate and unconventional way of dying led to the creation of local guidance for removing assisted ventilation when the treatment ceased to be effective. We reflect on the specific challenges that caring for these patients holistically has presented and how we have learnt to deliver good palliative care in a unique set of circumstances. We also consider the impact of the pandemic on our team and how the development of a multidisciplinary support system has improved team dynamics and ultimately patient care.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

scholarly journals Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea

2014 ◽  
Vol 40 (6) ◽  
pp. 658-668 ◽  
Author(s):  
Rafaela Garcia Santos de Andrade ◽  
Vivien Schmeling Piccin ◽  
Juliana Araújo Nascimento ◽  
Fernanda Madeiro Leite Viana ◽  
Pedro Rodrigues Genta ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Treatment Effectiveness ◽  
Obstructive Sleep ◽  
Pubmed Database ◽  
Osa Treatment ◽  
The Impact

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

Application of equal loudness contour in assessing the impact of random noise: Case study in continuous positive airway pressure systems with helmet

2014 ◽  
Vol 76 ◽  
pp. 100-106
Author(s):  
Francisco Fernández Zacarías ◽  
Ricardo Hernández Molina ◽  
José Luis Cueto Ancela ◽  
Simón Lubián López ◽  
Isabel Benavente Fernández
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Random Noise ◽  
The Impact

Evaluation of the Effect of Prehospital Application of Continuous Positive Airway Pressure Therapy in Acute Respiratory Distress

2010 ◽  
Vol 25 (1) ◽  
pp. 87-91 ◽  
Author(s):  
G. Scott Warner
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Data Collection ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Prehospital Setting ◽  
Rural Setting ◽  
Icu Length Of Stay ◽  
The Impact

AbstractObjective:The impact of the use of mask continuous positive airway pressure (CPAP) on patients with acute respiratory distress in the prehospital, rural setting has not been defined. The goal was to test the use of CPAP using the Respironics® WhisperFlow® CPAP in patients presenting with acute respiratory distress. This was a collaborative evaluation of CPAP involving a rural EMS agency and the regional medical center. Patient outcomes including the overall rate of intubation-both in the field and in the emergency department (ED), and length of stay in the hospital and Intensive Care Unit (ICU) were tracked.Methods:The study was an eight-month, crossover, observational, non-blinded study.Results:During the four months of baseline data collection, 7.9% of patients presenting with respiratory distress were intubated within the first 48 hours of care. Their average ICU length of stay was 8.0 days. During the four months of data collection when CPAP was available in the prehospital setting, intubation was not required for any patients in the field or in the ED. Admissions to the ICU decreased. Those patients admitted to the ICU, the average ICU length of stay deceased to 4.3 days.Conclusions:The use of the CPAP in the prehospital setting is beneficial for patients in acute respiratory distress.

PCEP Specialized Newborn Care (Book IV)

2012 ◽  
Keyword(s):  
Blood Pressure ◽  
At Risk ◽  
Continuous Positive Airway Pressure ◽  
Education Program ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Blood Pressure Measurement ◽  
Skills Training ◽  
Assisted Ventilation ◽  
Continuing Care

New 2nd edition features step-by-step skill instruction, and practice-focused exercises. Developed by a distinguished editorial board, the Perinatal Continuing Education Program (PCEP) is a comprehensive, self-paced education program in four volumes. The PCEP workbooks have been significantly revised and brought up-to-date with leading-edge procedures and techniques. The revised volumes are filled with clear explanations, step-by-step skill instruction, and practice-focused exercises. They offer time- saving, low-cost solutions for self-paced learning or as adjuncts to instructor-led skills training. New 2nd edition features 6 units dealing with complex neonatal therapies, such as assisted ventilation, as well as a unit regarding Continuing Care for at-risk babies and those with special problems, following intensive care. Contents include: Unit 1: Direct Blood Pressure Measurement Skill Unit: Transducer Blood Pressure Monitoring Unit 2: Exchange, Reduction, and Direct Transfusions Skill Unit: Exchange Tranfusions Unit 3: Continuous Positive Airway Pressure Skill Unit: Delivery of Continuous Positive Airway Pressure Unit 4: Assisted Ventilation With Mechanical Ventilators Skill Unit: Endotracheal Tubes Unit 5: Surfactant Therapy Skill Unit: Surfactant Administration Unit 6: Continuing Care for At-Risk Babies Subsection: Babies With Special Problems Pretest Answer Key Index

scholarly journals Continuous Positive Airway Pressure Ventilation for Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (4) ◽  
pp. 1137-1139 ◽  
Author(s):  
Jens Minnerup ◽  
Martin Andreas Ritter ◽  
Heike Wersching ◽  
André Kemmling ◽  
Angelika Okegwo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Continuous Positive Airway Pressure ◽  
Acute Ischemic Stroke ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Positive Airway Pressure Ventilation

Respiratory therapy techniques

2011 ◽  
Author(s):  
Carl Waldmann ◽  
Neil Soni ◽  
Andrew Rhodes
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Prone Position ◽  
High Frequency ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
High Frequency Ventilation ◽  
Frequency Ventilation ◽  
Positive Airway Pressure Ventilation

Oxygen therapy 2Ventilatory support: indications 6IPPV—description of ventilators 8IPPV—modes of ventilation 10IPPV—adjusting the ventilator 12IPPV—barotrauma 14IPPV—weaning techniques 16High-frequency ventilation 18Positive end-respiratory pressure 22Continuous positive airway pressure ventilation (CPAP) 24Recruitment manoeuvres 26Prone position ventilation 28...

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