scholarly journals Non-Invasive Mechanical Ventilation in Children with Previous Unsuccessful Weaning from Respiratory Therapy

2020 ◽  
Vol 27 (3) ◽  
pp. E2020311
Author(s):  
Olha Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive ◽  
Group I ◽  
Significant Difference ◽  
Successful Weaning ◽  
Secondary Outcomes ◽  
Group Ii ◽  
Protective Mechanical Ventilation ◽  
Lung Protective Mechanical Ventilation

The objective of the research was to establish the impact of diaphragm-protective mechanical ventilation on the rate of successful weaning from invasive and non-invasive mechanical ventilation in children with acute respiratory failure. Materials and Methods. We conducted a prospective, observational cohort study. Seventy-eight patients were randomly divided into 2 groups: patients of Group I received lung-protective mechanical ventilation; patients of Group II received diaphragm-protective + lung-protective mechanical ventilation. For age-specific data analysis, patients were divided into age subgroups: the 1st subgroup included children being 1 to 12 months old; the 2nd age subgroup comprised children being 12 to 36 months old. We started respiratory support in both groups with invasive mechanical ventilation and when patients met the criteria, we weaned them. We confirmed successful weaning, when patients had no need to be mechanically ventilated within next 48 hours, otherwise, they were intubated again. Before the second trial to wean, patients in Group I were simply extubated, while patients in Group II received non-invasive mechanical ventilation. The primary endpoint was the rate of successful weaning from mechanical ventilation in the first trial. The secondary outcomes were complications, namely reintubation rate, tracheostomy rate and death. Results. We found a significant difference in the primary outcome for the 1st age subgroup: there were 72.4% in Group I vs. 52.6% in Group II successfully weaned patients (p=0.04). No significant difference in the primary outcome was observed in the 2nd age subgroup: there were 80% in Group I vs. 82.3% in Group II successfully weaned patients (p=0.78). There were significant differences in the secondary outcomes between groups in the 1st age subgroup, namely reintubation rate was seen in 9.1% patients of Group I vs. 36.8% patients of Group II (p=0.05); death happened in 18.2% cases in Group I vs. no cases in Group II (p=0.01). There were no differences in tracheostomy rate in the 1st age subgroup and there were no differences in the  secondary outcomes between groups in 2nd age subgroup. Conclusions. Diaphragm-protective mechanical ventilation significantly reduced the incidence of successful weaning from invasive mechanical ventilation; however, it increased the incidence of successful weaning from non-invasive mechanical ventilation, and, significantly decreased the mortality rate in the 1st age subgroup, while in the 2nd age subgroup, it had no impact on the incidence of successful weaning from invasive mechanical ventilation and mortality rate.

scholarly journals Inhalation surfactant therapy in the integrated treatment of severe COVID-19 pneumonia

2020 ◽  
Vol 98 (9) ◽  
pp. 6-12
Author(s):  
A. E. Bautin ◽  
S. N. Avdeev ◽  
A. A. Seyliev ◽  
M. V. Shvechkova ◽  
Z. M. Merzhoeva ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Integrated Treatment ◽  
Surfactant Therapy ◽  
Inhalation Therapy ◽  
Non Invasive ◽  
Oxygen Inhalation ◽  
Group I ◽  
High Flow Oxygen ◽  
Group Ii

The objective: to evaluate the effectiveness of inhaled surfactant therapy in the integrated treatment of severe COVID-19 pneumonia in a multicenter prospective clinical trial of surfactant-BL.Subjects and methods. 122 patients with severe COVID-19-associated pneumonia treated in two treatment centers were enrolled in the study. All of them received antiviral, anticoagulant and anti-inflammatory therapy. 56 patients also received inhalation therapy with surfactant-BL (OOO Biosurf, St. Petersburg, Russia) at a dose of 1 mg/kg 2-3 times a day. The remaining 66 patients received no surfactant-BL inhalation. When included into the study, all patients were divided into two groups based on severity of the condition at the time of inclusion: 62 people (Group I) needed oxygen inhalation through a face mask with the flow of 6-8 L/min for hypoxemia correction (27 received surfactant therapy and 35 did not); other 60 patients (Group II) required non-invasive respiratory support (constant positive airway pressure, non-invasive mechanical ventilation, high-flow oxygen therapy), of them 29 received surfactant therapy, while 31 patients did not.Results. In Group I, switching to invasive mechanical ventilation was required for 3/27 (11.1%) patients who received surfactant therapy, and 10/35 (28.6%) who received no surfactant therapy (p = 0.085); lethality made 3/27 (11.1%) and 9/35 (25.7%) (p = 0.131), respectively. In Group II, among those who received surfactant therapy, 5/29 (17.2%) were switched to invasive mechanical ventilation and 18/31 (58.1%) among those who did not receive it (p = 0.001); lethality made 5/29 (17.2%) and 18/31 (58.1%) (p = 0.001), respectively. In the pooled group of 122 patients with severe COVID-19-associated pneumonia, 8 (14.3%) of 56 patients who received surfactant died, and 27 (40.9%) of 66 died among those who did not receive it, (p = 0.001).Conclusion: Inhalation surfactant therapy can reduce the frequency of switching patients to mechanical ventilation and statistically significantly reduce lethality caused by severe pneumonia associated with SARS-CoV-2. 

scholarly journals Drainage of transudative pleural effusion: how does it affect weaning from mechanical ventilation?

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Heba Said Gharraf ◽  
Alaa El Din AbdAllah
Keyword(s):  
Mechanical Ventilation ◽  
Pleural Effusion ◽  
Total Duration ◽  
Specific Procedure ◽  
Group I ◽  
Significant Difference ◽  
Prolonged Duration ◽  
Successful Weaning ◽  
Group Ii ◽  
Physiological Benefits

Abstract Background Pleural collections of the transudative type occur frequently in patients who need mechanical ventilation (MV). Treatment of the etiology of the effusion takes a prolonged duration of time. The study intended to assess the effect of transudative effusion drainage through chest tube on the process of weaning from MV. Results No statistically significant difference was found between the two studied groups regarding age, sex, and comorbidities. Total duration of MV was significantly shorter in patients of group I compared with patients of group II (P = 0.002). Successful weaning from MV within 2 days after the start of the study was statistically significantly more achieved in patients of group I (56.7%) compared with patients of group II (23.3%) (P = 0.017). One and 3 days after beginning of the study, patients in group I showed a significant improvement in oxygenation as demonstrated by a statistically significantly higher value of PaO2/FiO2 ratio compared with patients of group II (P = 0.003 and 0.008, respectively). Conclusion More work is needed to determine the physiological benefits of transudate pleural effusion drainage and the effect of the specific procedure on the clinical parameters. Further studies are needed to study different modalities or tools of drainage of transudate effusion and the effect of each on the different clinical outcomes in comparison with each other to reach the optimum way of drainage of transudate effusion with the best results and least complications.

scholarly journals Non-invasive mechanical ventilation after the successful weaning: a comparision with the venturi mask

2018 ◽  
Vol 68 (2) ◽  
pp. 213
Author(s):  
Adıyeke Esra ◽  
Ozgultekin Asu ◽  
Turan Guldem ◽  
Iskender Altay ◽  
Canpolat Gamze ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive ◽  
Venturi Mask ◽  
Successful Weaning

scholarly journals Cost-Minimization Analysis of Non-Invasive and Invasive Mechanical Ventilation for De Novo Acute Hypoxemic Respiratory Failure in an Eastern European Setting

2019 ◽  
Vol 46 (1) ◽  
pp. 17-20
Author(s):  
V. Ilieva ◽  
T. Mihalova ◽  
Yo. Yamakova ◽  
R. Petkov ◽  
B. Velev
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Cost Minimization ◽  
Invasive Mechanical Ventilation ◽  
Medical Costs ◽  
Non Invasive ◽  
Saps Ii ◽  
Direct Medical Costs ◽  
Saps Ii Score ◽  
Significant Difference

Abstract Introduction: In the light of constant pressure for minimizing healthcare costs we made a cost-minimization analysis comparing invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) as treatment for hypoxemic acute respiratory failure (ARF). Aim: The primary objective was to estimate the direct medical costs generated by a patient on IMV and NIV. A secondary objective was to identify which aspect of the treatment was most expensive. Material and Methods: This is a single center retrospective study including 36 patients on mechanical ventilation due to hypoxemic ARF, separated in two groups – NIV (n = 18) and IMV (n = 18). We calculated all direct medical costs in Euro and compared them statistically. Results: On admission the PaO2/FiO2 and SAPS II score were comparable in both groups. We observed a significant difference in the costs per patient for drug treatment (NIV: 616.07; IQR: 236.68, IMV:1456.18; IQR:1741.95, p = 0.005), consumables (NIV: 16.47; IQR: 21.44, IMV: 98.79; IQR: 81.52, p < 0.001) and diagnostic tests (NIV: 351; IQR: 183.88, IMV: 765.69; IQR: 851.43, p < 0.001). We also computed the costs per patient per day and there was a significant difference in the costs in all above listed categories. In both groups the highest costs were for drug treatment – around 61%. Conclusions: In the setting of hypoxemic ARF NIV reduces significantly the direct medical costs of treatment in comparison to IMV. The decreased costs in NIV are not associated with severity of disease according to the respiratory quotient and SAPS II score.

scholarly journals Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma

2021 ◽  
pp. 8-15
Author(s):  
Mai Mohammed Mahran ◽  
Rehab Said El-Kalla ◽  
Ayman Abd El Khalek Sallam ◽  
Mohamed Ahmed El Heniedy ◽  
Hala Mohey El- deen EL- Gendy
Keyword(s):  
Mechanical Ventilation ◽  
Chest Trauma ◽  
Chest Injury ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Arterial Blood ◽  
Group I ◽  
Non Invasive Ventilation ◽  
Group Ii ◽  
Duration Of Ventilation

Background: Chest injury was found to cause death in 20%–25% of multiple trauma patients. Thoracic trauma is, therefore, important in the overall management of multiple injury patients and may require a longer stay in the Intensive Care Unit (ICU) and use of mechanical ventilation. Methods: This prospective randomized clinical study was in Emergency Intensive Care, Tanta University Hospitals. For, 88 adult patients with blunt chest injury. Patients were enrolled in this study aged ≥18 years old classified into two equal groups: Group I (Non-Invasive Mechanical Ventilation group) = 44 patient: Patients in this group received BIPAP. Group II (Control group=44 patient: Patients in this group have received high flow O2 by mask O2 without use of non-invasive mechanical ventilation. Data of collection were: the demographic data, Frequent arterial blood gas analysis of all patients every 6 hrs. Respiratory rate, Arterial blood pressure, Heart rate were recorded: every 6 h. All Patients receive analgesia. Evaluate outcome: a-Primary outcome. Tracheal intubation, duration of ventilation. b-Secondary outcome. Mortality, ICU length stay. And Chest Trauma Scoring System. Results: Ten patients (22%) were intubated and mechanically ventilated in group I (BiPAP). with mean value of duration of ventilation 34.4 hrs. But at group II 16   patients (36%) were intubated and mechanically ventilated with mean value of duration of ventilation 34.12 hrs. ICU stay at group I (BiPAP) was statistically decrease of number of days when compared to group II (control). 6 days at group I and 12 days at group II. In this study no case of mortality was recorded with non-invasive ventilation, although three mortality cases were recorded with the control group. Conclusion: This study recommends the pre-emptive use of Non-Invasive Ventilation in the treatment for blunt chest injury in patients at risk for respiratory failure. Success of Non-Invasive Ventilation depends on improvement of hypercarbia and hypoxemia in patients impending respiratory failure due to reversible cause as blunt chest trauma with the expectation of a good outcome and avoidance of intubation.

scholarly journals Outcomes and characteristics of COVID-19 patients treated with CPAP/ HFNO outside of the intensive care setting

2021 ◽  
pp. 00318-2021
Author(s):  
Dominic L Sykes ◽  
Michael G Crooks ◽  
Khaing Thu Thu ◽  
Oliver I Brown ◽  
Theodore J p Tyrer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Care Setting ◽  
Treatment Options ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Intensive Care Setting ◽  
Non Invasive ◽  
Significant Difference

BackgroundContinuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to COVID-19 pneumonia. Limited data are available for patients treated with non-invasive respiratory support outside of the intensive care setting.MethodsIn this single-centre observational study we observed the characteristics, physiological observations, laboratory tests, and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with non-invasive respiratory support outside of the intensive care setting.ResultsWe report the outcomes of 140 patients (Mean Age=71.2 [sd=11.1], 65% Male [n=91]) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.ConclusionsCPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.

scholarly journals Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

2016 ◽  
Vol 66 (6) ◽  
pp. 572-576
Author(s):  
Esra Adıyeke ◽  
Asu Ozgultekin ◽  
Guldem Turan ◽  
Altay Iskender ◽  
Gamze Canpolat ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive ◽  
Venturi Mask ◽  
Successful Weaning

scholarly journals Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation

2017 ◽  
Vol 21 (1) ◽  
pp. 5-10
Author(s):  
Akila Prashant ◽  
Prashant Vishwanath ◽  
Nalini Kotekar ◽  
Suma M Nataraj ◽  
Caroline Kuruvilla ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Venous Blood ◽  
Serum Levels ◽  
Cytokine Response ◽  
Group I ◽  
Tnf Α ◽  
Significant Difference ◽  
Group Ii ◽  
Factor Α ◽  
Sandwich Enzyme Immunoassay

ABSTRACT Purpose Despite the lifesaving potential, mechanical ventilation (MV) imposes a considerable amount of mechanical stress on the lung. Pulmonary and systemic cytokine release due to inflammatory process triggered by MV may give valuable information on patient outcome. Materials and methods Thirty patients aged >18 years with acute respiratory distress who required MV were enrolled for the study. Three milliliters of the venous blood was collected immediately after the initiation of MV and at 24 hours. Serum levels of interleukin (IL)-6, IL-8 and, tumor necrosis factor-α (TNF-α) were estimated using quantitative immunometric sandwich enzyme immunoassay technique. Based on their outcome from MV, they were divided into two groups: Survivors (group I) and nonsurvivors (group II). Results Serum levels of IL-6 and IL-8 significantly increased in group II (n=13) when compared with group I (n = 17) (p < 0.0001 and p < 0.001 respectively) at 24 hours of MV. However, TNF-α did not show any significant difference between the two groups. The IL-6 >111.9 pg/mL at 24 hours of MV increases the probability of mortality by factor 2.40. An increase of IL-6 by 1 pg/mL significantly increases the relative probability of mortality by a factor of 1.004 (95% CI, 1.0003–1.0078, p = 0.0001). Conclusion Estimating the levels of IL-6 and IL-8 at 24 hours of connecting the patient to MV will help in predicting the outcome of the patient. How to cite this article Prashant A, Vishwanath P, Kotekar N, Nataraj SM, Kuruvilla C, Nagalakshmi CS, Doddamani P. Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation. Indian J Med Biochem 2017;21(1):5-10.

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