scholarly journals New Developments in Mechanical Ventilation

2017 ◽  
Vol 12 (02) ◽  
pp. 21
Author(s):  
Daniel R Ouellette ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
New Developments ◽  
Ventilatory Insufficiency ◽  
The 1950S ◽  
New Guidelines

Positive pressure ventilation was developed in the 1950s as a way to treat respiratory failure due to ventilatory insufficiency. While lifesaving, mechanical ventilation, especially when prolonged, can be associated with a host of complications. Current advances focus on strategies to liberate patients from the ventilator. New guidelines have been published to aid practitioners in this area.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Rule-Based Cohort Definitions for Acute Respiratory Failure: Electronic Phenotyping Algorithm

10.2196/18402 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e18402 ◽  
Author(s):  
Patrick Essay ◽  
Jarrod Mosier ◽  
Vignesh Subbian
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
High Flow ◽  
Positive Pressure ◽  
Rule Based ◽  
Research Questions

Background Acute respiratory failure is generally treated with invasive mechanical ventilation or noninvasive respiratory support strategies. The efficacies of the various strategies are not fully understood. There is a need for accurate therapy-based phenotyping for secondary analyses of electronic health record data to answer research questions regarding respiratory management and outcomes with each strategy. Objective The objective of this study was to address knowledge gaps related to ventilation therapy strategies across diverse patient populations by developing an algorithm for accurate identification of patients with acute respiratory failure. To accomplish this objective, our goal was to develop rule-based computable phenotypes for patients with acute respiratory failure using remotely monitored intensive care unit (tele-ICU) data. This approach permits analyses by ventilation strategy across broad patient populations of interest with the ability to sub-phenotype as research questions require. Methods Tele-ICU data from ≥200 hospitals were used to create a rule-based algorithm for phenotyping patients with acute respiratory failure, defined as an adult patient requiring invasive mechanical ventilation or a noninvasive strategy. The dataset spans a wide range of hospitals and ICU types across all US regions. Structured clinical data, including ventilation therapy start and stop times, medication records, and nurse and respiratory therapy charts, were used to define clinical phenotypes. All adult patients of any diagnoses with record of ventilation therapy were included. Patients were categorized by ventilation type, and analysis of event sequences using record timestamps defined each phenotype. Manual validation was performed on 5% of patients in each phenotype. Results We developed 7 phenotypes: (0) invasive mechanical ventilation, (1) noninvasive positive-pressure ventilation, (2) high-flow nasal insufflation, (3) noninvasive positive-pressure ventilation subsequently requiring intubation, (4) high-flow nasal insufflation subsequently requiring intubation, (5) invasive mechanical ventilation with extubation to noninvasive positive-pressure ventilation, and (6) invasive mechanical ventilation with extubation to high-flow nasal insufflation. A total of 27,734 patients met our phenotype criteria and were categorized into these ventilation subgroups. Manual validation of a random selection of 5% of records from each phenotype resulted in a total accuracy of 88% and a precision and recall of 0.8789 and 0.8785, respectively, across all phenotypes. Individual phenotype validation showed that the algorithm categorizes patients particularly well but has challenges with patients that require ≥2 management strategies. Conclusions Our proposed computable phenotyping algorithm for patients with acute respiratory failure effectively identifies patients for therapy-focused research regardless of admission diagnosis or comorbidities and allows for management strategy comparisons across populations of interest.

scholarly journals Efficacy of Noninvasive Positive Pressure Ventilation in Limiting Re-Intubation of COPD Patients After Extubation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G A A Elkady ◽  
A H Rabie ◽  
A H Hamza ◽  
M N Mohamed
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Intensive Care Units ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Study Groups ◽  
Positive Pressure ◽  
Arterial Blood ◽  
Copd Patients

Abstract Background Mechanical ventilation is the most widely used supportive therapy in intensive care units (ICU). Several forms of external support for respiration have been described to assist the failing ventilator pump and had constituted a major advance in the management of patients with respiratory distress. More recently, new noninvasive positive pressure ventilation (NIPPV) techniques, using patient/ ventilator interfaces in the form of facial masks, have been designed. Noninvasive ventilation (NIV) is one of the most important developments in respiratory medicine over the past 15 years and is increasingly used in many countries, but with a highly variable frequency of use. Objective The aim of this study is to clarify the role of non-invasive ventilation in preventing re-intubation if was used immediately following planned extubation in patients suffered respiratory failure in COPD patients and requiring invasive mechanical ventilation for 5 to 7 days. Methodology Forty consecutive patients, who are invasively mechanically ventilated and classified as difficult to wean from the ventilator in the intensive care units of Ain Shams main university hospital between the 1st April and 1st of September 2018, were included. The mean age in the present study for oxygen group was 56.20±5.56 years, while in NIV group was 57.75±5.17 years, 70% of patients in this present study were males. Results APACHE II score, PaO2 and mean arterial blood pressure which might have a role in respiratory failure showed no statistically significant differences between both study groups. Meanwhile, respiratory rate, pulse rate and arterial blood gases showed high significance between both study groups Conclusion The use of NIV is associated with a marked reduction in the need for endotracheal intubation after planned extubation.

Mechanical ventilation

2021 ◽  
pp. 284-305
Author(s):  
Luigi Camporota ◽  
Francesco Vasques
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Gas Flow ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Positive Pressure ◽  
International Consensus ◽  
Mechanically Ventilated ◽  
Ventilation Modes

Acute respiratory failure is the most common cause of admission to critical care. Many patients presenting to ICU have pre-existing heart disease and 13.1% will be diagnosed with chronic, NYHA IV heart failure. In addition, global left ventricular hypokinesia frequently occurs in adults with septic shock and around 20% of patients with acute respiratory distress syndrome (ARDS) have acute pulmonary hypertension and right heart failure. The presence of heart failure adds significant challenges for the management of mechanically ventilated patients and increases their morbidity and mortality. Furthermore, positive pressure ventilation can exert profound cardiovascular effects through heart-lung interactions. It is thus essential for the cardiologist to have an appreciation of the assessment and management of patients with respiratory failure, particularly if mechanically ventilated. Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious and most commonly used in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. This chapter provides an introduction on mechanisms of respiratory failure, principles of physiological assessment, modes and strategies of invasive mechanical ventilation. Whenever possible we discuss the heart-lung interactions of relevance to the cardiologist.

Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

Respiration ◽  
2006 ◽  
Vol 73 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Samir Jaber ◽  
Gérald Chanques ◽  
Mustapha Sebbane ◽  
Farida Salhi ◽  
Jean-Marc Delay ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Severe Acute Pancreatitis ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure

scholarly journals Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: clinical experience of a respiratory ward

2004 ◽  
Vol 61 (2) ◽  
Author(s):  
R. Scala ◽  
M. Naldi ◽  
I. Archinucci ◽  
G. Coniglio
Keyword(s):  
Clinical Practice ◽  
Respiratory Failure ◽  
Standard Therapy ◽  
Positive Pressure Ventilation ◽  
Controlled Trial ◽  
Positive Pressure ◽  
Hypercapnic Respiratory Failure ◽  
Non Invasive ◽  
Arterial Blood ◽  
Acute Hypercapnic Respiratory Failure

Background: Although a controlled trial demonstrated that non-invasive positive pressure ventilation (NIV) can be successfully applied to a respiratory ward (RW) for selected cases of acute hypercapnic respiratory failure (AHRF), clinical practice data about NIV use in this setting are limited. The aim of this observational study is to assess the feasibility and efficacy of NIV applied to AHRF in a RW in everyday practice. Methods: Twenty-two percent (216/984) of patients consecutively admitted for AHRF to our RW in Arezzo (years: 1996-2003) received NIV in addition to standard therapy, according to pre-defined routinely used criteria. Tolerance, effects upon arterial blood gases (ABG), success rate (avoidance a priori criteria for intubation) and predictors of failure of NIV were analysed. Results: Nine patients (4.2%) were found to be intolerant to NIV, while the remaining 207 (M: 157, F: 50; mean (SD) age: 73.2 (8.9) yrs; COPD: 71.5%) were ventilated for >1 hour. ABG significantly improved after two hours of NIV (pH: 7.32 (0.06) versus median (Interquartiles) 7.28 (7.24-7.31), p<0.0001; PaCO2: 71.9 (13.5) mmHg versus 80.0 (15.2) mmHg, p<0.0001; PaO2/FiO2: 212 (66) versus 184 (150-221), p<0.0001). NIV succeeded in avoiding intubation in 169/207 patients (81.6%) with hospital mortality of 15.5%. NIV failure was independently predicted by Activity of Daily Living score, pneumonia as cause of AHRF and Acute Physiology and Chronic Health Evaluation III score. Conclusions: In clinical practice NIV is feasible, effective in improving ABG and useful in avoiding intubation in most AHRF episodes that do not respond to the standard therapy managed in an RW adequately trained in NIV.

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