scholarly journals Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
yirong zheng ◽  
wenpeng xie ◽  
jianfeng liu ◽  
ning xu ◽  
hua cao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Septal Defect ◽  
Positive Airway Pressure ◽  
Extubation Failure ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Failure Rates ◽  
Bilevel Positive Airway Pressure

Abstract Objective: To evaluate the effect of bilevel positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) in respiratory support after extubation in infants undergoing cardiac surgery. Methods: A total of 83 infants who underwent repair of atrial septal defect (ASD) or ventricular septal defect (VSD) after extubation were randomized to the BiPAP group (n= 42) or the NCPAP group (n= 41) between January 2020 and December 2020. The primary outcomes were the extubation failure rate and the level of PCO2 within 24 h after extubation. Results: The baseline characteristics between the two groups were similar. The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates compared to NCPAP (P>0.05). The PaCO2 level within 48 h was significantly lower in the BiPAP group (P<0.05). Additionally, the PaO2/FiO2 in the BiPAP group was significantly higher than that in the NCPAP group at 6h, 12h and 24h after treatment (P<0.05).There were no statistically significant differences in duaration on NIV, hospital length of stay, total hospital costs in $ and complications between the two groups (P>0.05). Conclusion: The introduction of BiPAP for post-extubation respiratory support did not reduce extubation failure rates versus NCPAP. However, BiPAP was shown to be superior to NCPAP in improving oxygenation and carbon dioxide clearance.

Acute Pulmonary Edema Complicating Tonsillectomy and Adenoidectomy

PEDIATRICS ◽  
1985 ◽  
Vol 75 (1) ◽  
pp. 112-114
Author(s):  
ARTHUR N. FEINBERG ◽  
CHARLES L. SHABINO
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Continuous Positive Airway Pressure ◽  
Pulmonary Edema ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Medical Personnel ◽  
Acute Onset ◽  
Respiratory Support ◽  
Acute Pulmonary Edema

In summary, we have presented two cases to illustrate the problem of postoperative pulmonary edema following tonsillectomy and adenoidectomy. Furthermore, we have discussed the difficulty in predicting those patients who will develop this complication. Because of the potential seriousness and unpredictability of acute pulmonary edema following tonsillectomy for chronic obstruction, it is important that medical personnel, including pediatricians caring for patients after tonsillectomy, be able to readily recognize this phenomenon of acute onset of congestive heart failure and treat it rapidly with diuretics, continuous positive airway pressure, and respiratory support as needed.

scholarly journals The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Allan Cameron ◽  
Sharif Fattah ◽  
Laura Knox ◽  
Pauline Grose
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Royal Infirmary ◽  
High Dependency ◽  
Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

scholarly journals FIRST-line support for assistance in breathing in children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high-flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038002 ◽  
Author(s):  
Alvin Richards-Belle ◽  
Peter Davis ◽  
Laura Drikite ◽  
Richard Feltbower ◽  
Richard Grieve ◽  
...  
Keyword(s):  
Critical Care ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
First Line ◽  
Non Invasive ◽  
Paediatric Critical Care

IntroductionEven though respiratory support is a common intervention in paediatric critical care, there is no randomised controlled trial (RCT) evidence regarding the effectiveness of two commonly used modes of non-invasive respiratory support (NRS), continuous positive airway pressure (CPAP) and high-flow nasal cannula therapy (HFNC). FIRST-line support for assistance in breathing in children is a master protocol of two pragmatic non-inferiority RCTs to evaluate the clinical and cost-effectiveness of HFNC (compared with CPAP) as the first-line mode of support in critically ill children.Methods and analysisWe will recruit participants over a 30-month period at 25 UK paediatric critical care units (paediatric intensive care units/high-dependency units). Patients are eligible if admitted/accepted for admission, aged >36 weeks corrected gestational age and <16 years, and assessed by the treating clinician to require NRS for an acute illness (step-up RCT) or within 72 hours of extubation following a period of invasive ventilation (step-down RCT). Due to the emergency nature of the treatment, written informed consent will be deferred to after randomisation. Randomisation will occur 1:1 to CPAP or HFNC, stratified by site and age (<12 vs ≥12 months). The primary outcome is time to liberation from respiratory support for a continuous period of 48 hours. A total sample size of 600 patients in each RCT will provide 90% power with a type I error rate of 2.5% (one sided) to exclude the prespecified non-inferiority margin of HR of 0.75. Primary analyses will be undertaken separately in each RCT in both the intention-to-treat and per-protocol populations.Ethics and disseminationThis master protocol received favourable ethical opinion from National Health Service East of England—Cambridge South Research Ethics Committee (reference: 19/EE/0185) and approval from the Health Research Authority (reference: 260536). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences.Trial registration numberISRCTN60048867

scholarly journals Successful Extubation Using Heliox BiPAP in Two Patients with Postextubation Stridor

2017 ◽  
Vol 2017 ◽  
pp. 1-2
Author(s):  
Pragya Punj ◽  
Premkumar Nattanmai ◽  
Pravin George ◽  
Christopher R. Newey
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Extubation Failure ◽  
Standard Medical Therapy ◽  
Bilevel Positive Airway Pressure ◽  
Postextubation Stridor ◽  
Nebulized Epinephrine ◽  
Intravenous Steroids ◽  
Successful Extubation

Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.e., combination of helium and oxygen) in managing patients with postextubation stridor has not been fully established. We report two cases of postextubation stridor successfully treated with heliox delivered with bilevel positive airway pressure (BiPAP) after failure of standard medical therapy.

Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants without the Need for Rescue with Nasal Continuous Positive Airway Pressure

Neonatology ◽  
2018 ◽  
Vol 115 (2) ◽  
pp. 175-181 ◽  
Author(s):  
Sanja Zivanovic ◽  
Alexandra Scrivens ◽  
Raffaella Panza ◽  
Peter Reynolds ◽  
Nicola Laforgia ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Respiratory Support ◽  
Nasal High Flow Therapy

scholarly journals Mask Continuous Positive Airway Pressure Therapy with Simultaneous Extrauterine Placental Transfusion for Resuscitation of Preterm Infants - A Preliminary Study

2018 ◽  
Vol 3 (2) ◽  
pp. 1-10 ◽  
Author(s):  
Benjamin Kuehne ◽  
Christoph Kirchgaessner ◽  
Ingrid Becker ◽  
Michelle Kuckelkorn ◽  
Markus Valter ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Retrospective Analysis ◽  
Preterm Infants ◽  
Respiratory Function ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Standard Group ◽  
Pressure Therapy ◽  
Heart Rates

Background: Delayed cord clamping or cord milking improves cardiovascular stability and outcome of preterm infants. However, both techniques may delay initiation of respiratory support. To allow lung aeration during cord blood transfusion, we implemented an extrauterine placental transfusion (EPT) approach. This study aimed to provide a detailed description of the EPT procedure and to evaluate its impact on the outcome of infants. Methods: A retrospective analysis was performed comprising 60 preterm infants (220/7 to 316/7 weeks of gestation). Of these, 40 were transferred to the resuscitation unit with the placenta still connected to the infant. In this EPT group, continuous positive airway pressure support was initiated while, simultaneously, placental blood was transfused by holding the placenta 40-50 cm above the infant's heart. The cords of another 20 infants were clamped before respiratory support was started (standard group). Data on the infants' outcome were compared retrospectively. In a subgroup of 22 infants (n = 14 EPT, n = 8 standard), respiratory function monitor recordings were performed and both heart rates and SpO2 levels in the first 10 min of life were compared between groups. Results: Although infants in the EPT group were lighter (EPT: 875 ± 355 g, standard: 1,117 ± 389 g; p = 0.02) and younger (266/7 weeks ± 19 days vs. 282/7 weeks ± 18 days; p = 0.045), there was no difference in neonatal outcome, including the incidence of intraventricular hemorrhage, bronchopulmonary disease, and red blood cell transfusions (all p > 0.1). Moreover, no differences in SpO2 levels and heart rates were observed in the infants whose resuscitations were recorded using a respiratory function monitor. Conclusions: In this retrospective analysis, EPT had no negative effects on the outcome of the infants, which warrants further evaluation in prospective randomized studies.

Sign in / Sign up

Export Citation Format

Share Document