scholarly journals Our Success in the Treatment of Acute Respiratory Failure in Coronovirus Patients Using Non-invasive Ventilation

2021 ◽  
Vol 2021 (1) ◽  
pp. 51-57
Author(s):  
R.Sh. Polukhov ◽  
◽  
E.M. Nasibova ◽  
A.E. Polukhova ◽  
A.M. Rustamkhanly ◽  
...  
Keyword(s):  
Water Column ◽  
Treatment Time ◽  
Respiratory Muscles ◽  
Best Supportive Care ◽  
Neurological Dysfunction ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Number Of Patients ◽  
Novel Coronavirus

The novel coronavirus infection (COVID-19) pandemic, caused by the highly contagious severe acute respiratory syndrome coronavirus (SARS-CoV-2), is still at its peak, causing thousands of deaths every week. Since the beginning of the coronavirus (just a few months ago), our understanding of the disease has grown rapidly. While there are several large randomized drug trials currently underway, current survival from severe COVID-19 is entirely dependent on providing the best supportive care possible. To determine the benefits of NIV in ARF in patients with COVID-19. The study included 25 patients admitted to the intensive care unit of the AMU surgical clinic during the period from April 1 to August 1, 2020. Our experience with NIV has shown that the majority of patients undergoing NIV tolerate this procedure relatively well at the initial stage. However, in a number of patients during the first minutes or hours of NIV, there is no improvement in their condition (clinical parameters and gas exchange) or the procedure is poorly tolerated; the proportion of such patients is usually about 15–35%. Non-invasive ventilation of the lungs was carried out with an oral-nasal mask using an ELISA ventilator. The parameters were set and adjusted according to the general state and according to blood gas data 4 times a day: RR <35, pH> 7.30, neurological dysfunction according to the Kelly scale> 3-5, modified with a scale for determining the participation of auxiliary respiratory muscles <3 points. With hypercapnia, the following parameters were set: Ps – 12, PEEP – 6 cm water column, FiO2 -30-40%, and with hypoxemia – Ps – 12, PEEP – 5 cm water column, FiO2 -50-60 %. The median treatment period with NIV was 12 days. The average daily treatment time with NIV on the first day was 16.5 hours, on the second day – 17.2 hours and on the third day 15.7 hours. The patient was discharged on the 18th day with improvement.

scholarly journals Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial

Thorax ◽  
2019 ◽  
Vol 75 (3) ◽  
pp. 244-252 ◽  
Author(s):  
Marieke L Duiverman ◽  
Judith M Vonk ◽  
Gerrie Bladder ◽  
Joost P van Melle ◽  
Jellie Nieuwenhuis ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Mean Difference ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Number Of Patients ◽  
Related Quality ◽  
Registration Number ◽  
Randomised Controlled

IntroductionChronic non-invasive ventilation (NIV) has become evidence-based care for stable hypercapnic COPD patients. While the number of patients increases, home initiation of NIV would greatly alleviate the healthcare burden. We hypothesise that home initiation of NIV with the use of telemedicine in stable hypercapnic COPD is non-inferior to in-hospital NIV initiation.MethodsSixty-seven stable hypercapnic COPD patients were randomised to initiation of NIV in the hospital or at home using telemedicine. Primary outcome was daytime arterial carbon dioxide pressure (PaCO2) reduction after 6 months NIV, with a non-inferiority margin of 0.4 kPa. Secondary outcomes were health-related quality of life (HRQoL) and costs.ResultsHome NIV initiation was non-inferior to in-hospital initiation (adjusted mean difference in PaCO2 change home vs in-hospital: 0.04 kPa (95% CI −0.31 to 0.38 kPa), with both groups showing a PaCO2 reduction at 6 months compared with baseline (home: from 7.3±0.9 to 6.4±0.8 kPa (p<0.001) and in-hospital: from 7.4±1.0 to 6.4±0.6 kPa (p<0.001)). In both groups, HRQoL improved without a difference in change between groups (Clinical COPD Questionnaire total score-adjusted mean difference 0.0 (95% CI −0.4 to 0.5)). Furthermore, home NIV initiation was significantly cheaper (home: median €3768 (IQR €3546–€4163) vs in-hospital: median €8537 (IQR €7540–€9175); p<0.001).DiscussionThis is the first study showing that home initiation of chronic NIV in stable hypercapnic COPD patients, with the use of telemedicine, is non-inferior to in-hospital initiation, safe and reduces costs by over 50%.Trial registration numberNCT02652559.

scholarly journals What is optimal in patients with myasthenic crisis: Invasive or non-invasive ventilation?

2014 ◽  
Vol 01 (02) ◽  
pp. 116-120
Author(s):  
Hemant Bhagat ◽  
Vinod Grover ◽  
Kiran Jangra
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Respiratory Muscles ◽  
Myasthenic Crisis ◽  
Invasive Ventilation ◽  
Immune Disorder ◽  
Non Invasive ◽  
Advanced Form ◽  
Non Invasive Ventilation

AbstractMyasthenia gravis is an immune disorder involving the neuromuscular junction. The consequent weakness of respiratory muscles leads to variable disorders of ventilation in patients with myasthenia gravis. This article reviews the options of invasive and non-invasive ventilation in patients with advanced form of the disease.

scholarly journals Non-invasive ventilation in patients with novel coronavirus infection COVID-19

2020 ◽  
Vol 30 (5) ◽  
pp. 679-687
Author(s):  
Sergey N. Avdeev
Keyword(s):  
Viral Infections ◽  
Lung Damage ◽  
Protective Equipment ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hypoxemic Acute Respiratory Failure ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Support Methods

In the early stages of the COVID-19 pandemic, many guidelines for the management of patients with new coronavirus infection did not include recommendations for the use of non-invasive ventilation (NIV) due to the concerns that NIV could be accompanied by high tidal volumes that could cause lung damage. In addition, there was an opinion that NIV increases the risk of spreading bioaerosol containing the SARS-CoV-2 virus. At the same time, NIV was widely used in real clinical practice in the management of severe patients with COVID-19 (in some countries, up to 60% of all respiratory support methods). The accumulated experience demonstrates that when applying NIV, the risk of contamination with viral infections is minimized with adequate use of personal protective equipment. To date, the results of a limited number of studies about effectiveness of NIV in hypoxemic acute respiratory failure (ARF) in patients with COVID-19 are available. In most studies, the need for tracheal intubation and hospital mortality, were on average, 20 – 30%, that suggests a fairly high effectiveness of NIV in ARF in patients with COVID-19.

scholarly journals Early extubation with immediate non-invasive ventilation versus standard weaning in intubated patients for coronavirus disease 2019: a retrospective multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gianmaria Cammarota ◽  
Rosanna Vaschetto ◽  
Danila Azzolina ◽  
Nello De Vita ◽  
Carlo Olivieri ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Early Extubation ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Icu Length Of Stay ◽  
Non Invasive Ventilation ◽  
Hypoxemic Acute Respiratory Failure ◽  
Novel Coronavirus

AbstractIn patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6–11] days in early extubated patients versus 11 [6–15] days in standard weaning group (p = 0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p = 0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p = 0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.

scholarly journals Home Hospitalization (HH): An Alternative For The Initiation And Control Of Mechanical Non-Invasive Ventilation (NIV)

2020 ◽  
Vol 7 (3) ◽  
pp. 1-6
Author(s):  
Rosalía Doménech-Clar ◽  
Keyword(s):  
Good Alternative ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Number Of Patients ◽  
And Control

In view of the large number of patients undergoing long-term NIV, there is a need for alternatives to conventional hospitalization. Our goal has been to prove that HH is at least as efficient as conventional Hospitalization. HH represents a good alternative to conventional hospitalization.

scholarly journals Pneumomediastinum in patients with SARS-CoV-2 treated with non-invasive ventilation

2021 ◽  
Vol 14 (3) ◽  
pp. e241809
Author(s):  
Onn Shaun Thein ◽  
Muhammad Niazi ◽  
Abdisamad Ali ◽  
Adeel Sahal
Keyword(s):  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Best Supportive Care ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Bridging Therapy ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Common Causes ◽  
Poor Outcomes

SARS-CoV-2, causing the pandemic COVID-19, has rapidly spread, overwhelming healthcare systems. Non-invasive positive pressure ventilation (NIV) can be used as a bridging therapy to delay invasive mechanical ventilation or as a standalone therapy. Spontaneous pneumomediastinum is rare and self-limiting, but there is an increased incidence documented in COVID-19.Here we document two cases of pneumomediastinum-related prolonged NIV therapy in severe COVID-19. Patient 1, a 64-year-old man, who developed symptoms after NIV therapy was weaned and survived. Patient 2, an 82-year-old woman, failed to improve despite NIV therapy, on investigation was found to have a pneumomediastinum. After review, the patient was placed on best supportive care and died 3 days later.We highlight the importance of recognising less common causes of deterioration in severe COVID-19 treated with NIV. In addition, pneumomediastinum in these cases may not always lead to poor outcomes.

OUTCOME OF NON-INVASIVE VENTILATION IN COVID-19 PATIENTS

2021 ◽  
pp. 45-47
Author(s):  
Kalyani Sri Koneru ◽  
Bhanurekha Bokam ◽  
Chetana Gondi
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Disease Process ◽  
Secondary Outcome ◽  
Invasive Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Number Of Patients

Introduction: In covid-19, signicant number of patients developed severe respiratory symptoms and Acute Hypoxemic Respiratory Failure(AHRF) that required oxygen support. Initially treatment included early intubation and invasive ventilation, but Non-invasive ventilation(NIV) has been proven to be an effective bridging adjunct in early part of disease process and may prevent the need for invasive mechanical ventilation, which also decreases the risks to health care workers. Aims & Objectives: To study the outcome of non-invasive ventilation in covid-19 patients ;Primary outcome is number of patients recovered and death, Secondary outcome is the need for invasive mechanical ventilation Materials & Methods: This prospective study was conducted in the Department of Pulmonary Medicine, Dr.PSIMS & RF, which included 84 patients of covid-19 admitted in intensive care unit (ICU) during the period of May 2020 to November 2020. All patients were treated with NIV as per the requirement and followed up with laboratory parameters , CXR and outcome was studied during the course of hospital stay. Observation And Conclusion: out of 84 patients studied,67% recovered , 33% died . 19 patients required invasive mechanical ventilation. Age of < 65yrs ;SPO2 of 88-92% at the time of presentation, absence of obesity ;Normal C-Reactive protein(CRP) and Ferritin with Mild involvement on chest x-ray and longer duration of NIVhas better recovery rate. So, by our study we conclude that NIVhas a denite role in management of COVID-19 and also decrease the need for invasive ventilation .

scholarly journals Interfaces, Circuits and Humidifiers

2020 ◽  
Vol 8 ◽  
Author(s):  
Rosario Ferreira
Keyword(s):  
Skin Lesions ◽  
Invasive Ventilation ◽  
Facial Growth ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Number Of Patients ◽  
Close Supervision ◽  
Cleaning And Disinfection

Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.

scholarly journals Improving Home Oxygen Therapy In Patients With Interstitial Lung Diseases (ILDs): Application Of A Portable Non-Invasive Ventilation (NIV) Device

2020 ◽  
Author(s):  
Sandra Cuerpo ◽  
Maria Palomo ◽  
Fernanda Hernández-González ◽  
Joel Francesqui ◽  
Nuria Albacar ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Exercise Tolerance ◽  
Oxygen Therapy ◽  
Arterial Oxygen Saturation ◽  
Respiratory Muscles ◽  
Interstitial Lung Diseases ◽  
Arterial Oxygen ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Background: Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in interstitial lung disease (ILD) patients requiring long-term oxygen therapy (LTOT) is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may not be enough. As demonstrated previously in COPD patients, the use of a portable non-invasive ventilation (NIV) device combined with oxygen therapy may prevent the falling of oxygen saturation during exercise, due to an increased activation of respiratory muscles that could lead to an improvement of exercise tolerance. We sought to assess in patients diagnosed with ILD who are in need of oxygen therapy, the effect of associating a portable NIV to improve oxygen parameters and the distance covered during the 6 minutes walking test (6MWT).Methods: We conducted a prospective observational study in patients with ILDs. After a clinical characterization, we performed 6MWT in two different situations: using a portable oxygen concentrator with the regular flow used by the patient during their daily life activities and afterwards adding the additional support of a NIV. The oxygen saturation parameters were registered with a portable oximeter. Results: We included 16 patients with different ILDs who have oxygen therapy prescribed. The use of NIV associated with oxygen therapy in comparison with the use of oxygen therapy alone showed an increase of the average SaO2 [91% (88-93) vs 88% (86-90); p=0.0005] and a decrease in the percentage of time with oxygen saturation<90% (CT90): 36% (6-56) vs 58% (36-77); p<0.0001. There were no changes in the 6MWT distance: 307m (222-419) vs 316m (228-425); p=0.10Conclusions: In our study the use of a portable NIV system associated with LTOT during exercise showed benefitial effects, especially improvement of oxygen saturation.

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