Noninvasive and Invasive Ventilatory Support I

Key Words ◽

Noninvasive Ventilation ◽

Ventilatory Support ◽

Underlying Disease ◽

Iatrogenic Injury ◽

Pulmonary Mechanics

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken, as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allow the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This first chapter reviews pulmonary mechanics, machine settings, and current options for noninvasive and invasive support of respiratory failure. This review contains 7 figures, 3 tables and 44 references Key Words: hypoxemia, hypercapnia, mechanical ventilation, noninvasive ventilation, respiratory failure

Noninvasive and Invasive Ventilatory Support II

10.2310/7ccsp.8366 ◽

2018 ◽

Author(s):

Pauline K. Park ◽

Nicole L Werner ◽

Carl Haas

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Lung Injury ◽

Ventilatory Support ◽

Underlying Disease ◽

Protective Ventilation ◽

Pulmonary Mechanics ◽

Ventilator Induced Lung Injury

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allows the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This second chapter reviews indications for mechanical ventilation, routine management, troubleshooting, and liberation from mechanical ventilation This review contains 6 figures, 7 tables and 60 references Keywords: Mechanical ventilation, lung protective ventilation, sedation, ventilator-induced lung injury, liberation from mechanical ventilation

Noninvasive and Invasive Ventilatory Support II

10.2310/tywc.8366 ◽

2018 ◽

Author(s):

Pauline K. Park ◽

Nicole L Werner ◽

Carl Haas

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Lung Injury ◽

Ventilatory Support ◽

Underlying Disease ◽

Protective Ventilation ◽

Pulmonary Mechanics ◽

Ventilator Induced Lung Injury

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allows the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This second chapter reviews indications for mechanical ventilation, routine management, troubleshooting, and liberation from mechanical ventilation This review contains 6 figures, 7 tables and 60 references Keywords: Mechanical ventilation, lung protective ventilation, sedation, ventilator-induced lung injury, liberation from mechanical ventilation

Mechanical Ventilation: Approaches and Special Considerations

10.2310/7ccsp.2396 ◽

2018 ◽

Author(s):

Adrian A. Maung ◽

Lewis J Kaplan

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Key Words ◽

Spontaneous Breathing ◽

Functional Unit ◽

Spontaneous Breathing Trial

In this chapter, we complete the discussion of mechanical ventilation by examining approaches to mechanical ventilation for different patient populations and how to assess whether a patient is ready for liberation from mechanical ventilation. Each of the three chapters is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion. This review contains 1 Figure, 1 Table and 31 references Key Words: acute respiratory failure, ARDS, mechanical ventilation liberation, spontaneous breathing trial, tracheostomy

Interstitial Lung Disease Associated Acute Respiratory Failure Requiring Invasive Mechanical Ventilation: A Retrospective Analysis

10.21203/rs.2.23766/v1 ◽

2020 ◽

Author(s):

Cyrus Vahdatpour ◽

Alexander Pichler ◽

Harold I Palevsky ◽

Michael J Kallan ◽

Namrata B Patel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Positive Pressure ◽

High Dose ◽

One Year

Abstract Background Interstitial lung disease (ILD) patients requiring invasive mechanical ventilation (IMV) for acute respiratory failure (ARF) are known to have a poor prognosis. Few studies have investigated determinants of outcomes and the utility of trialing non-invasive positive pressure ventilation (NIPPV) prior to IMV to see if there are any effect(s) on mortality or morbidity. Methods We designed a retrospective study using patients at four different intensive care units within one health care system. Our primary objective was to determine if there are differences in outcomes for in-hospital and one-year mortality between patients who undergo NIPPV prior to IMV and those who receive only IMV. A secondary objective was to identify potential determinants of outcomes. Results Of 54 ILD patients with ARF treated with IMV, 20 (37.0%) survived to hospital discharge and 10 (18.5%) were alive at one-year. There was no significant mortality difference between patients trialed on NIPPV prior to IMV and those receiving only IMV. Several key determinants of outcomes were identified with higher mortality, including: higher ventilatory support, idiopathic pulmonary fibrosis (IPF) subtype, high dose steroids, use of vasopressors, supraventricular tachycardias (SVTs), and higher body mass index. Conclusions Considering that patients trialed on NIPPV prior to IMV was associated with no mortality disadvantage to patients treated with only IMV, trialing patients on NIPPV may identify responders and avoid complications associated with IMV. Increased ventilator support, need of vasopressors, SVTs, and high dose steroids reflect higher mortality and palliative care involvement should be considered as early as possible if lung transplant is not an option.

Approach to the Patient with Acute Respiratory Failure

10.2310/im.1198 ◽

2016 ◽

Author(s):

Eddy Fan ◽

Alice Vendramin

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Life Support ◽

Ventilatory Support ◽

Positive Pressure ◽

Hypoxemic Respiratory Failure ◽

Arterial Blood ◽

Common Causes

Acute respiratory failure (ARF) is a common reason for admission to the intensive care unit (ICU), and is associated with significant morbidity and mortality. Failure of one or more components of the respiratory system can lead to hypoxemia, hypercabia, or both. Initial evaluation of patients with ARF should include physical examination, chest imaging, and arterial blood gases (ABG) sampling. As ARF is often a life-threatening emergency, a patient’s oxygenation and ventilation will need to be supported at the same time that diagnostic and therapeutic interventions are planned. The priorities for early treatment are essentially those of basic life support: airway and breathing. The first step is to assess a patient’s airway and ascertain that it is patent. This is followed by efforts to support both oxygenation and ventilation. This can include non-invasive or invasive mechanical ventilatory support. As with all interventions, there are risks inherent in the use of mechanical ventilation, which may be minimized by the use of lung protective ventilation (i.e., with low tidal volumes and airway pressures). Finally, due to the potential complications associated with mechanical ventilation, it is important to regularly assess whether a patient continues to require the assistance of the ventilator, and to liberate patients from mechanical ventilation at the earliest opportunity when clinically safe and feasible to do so. Figures depict pressure-time curve. Tables list the clinical causes of hypoxemic respiratory failure, oxygen delivery devices, indications for noninvasive positive pressure support, common causes of abnormal respiratory mechanics, and common causes of acute respiratory distress syndrome (ARDS). This review contains 2 highly rendered figures, 5 tables, and 86 references.

Interstitial Lung Disease Associated Acute Respiratory Failure Requiring Invasive Mechanical Ventilation: A Retrospective Analysis

The Open Respiratory Medicine Journal ◽

10.2174/1874306402014010067 ◽

2020 ◽

Vol 14 (1) ◽

pp. 67-77

Author(s):

Cyrus A. Vahdatpour ◽

Alexander Pichler ◽

Harold I. Palevsky ◽

Michael J. Kallan ◽

Namrata B. Patel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Positive Pressure ◽

High Dose ◽

One Year

Background: Interstitial Lung Disease [ILD] patients requiring Invasive Mechanical Ventilation [IMV] for Acute Respiratory Failure [ARF] are known to have a poor prognosis. Few studies have investigated determinants of outcomes and the utility of trialing Non-Invasive Positive Pressure Ventilation [NIPPV] prior to IMV to see if there are any effect[s] on mortality or morbidity. Methods: A retrospective study was designed using patients at four different intensive care units within one health care system. The primary objective was to determine if there are differences in outcomes for in-hospital and one-year mortality between patients who undergo NIPPV prior to IMV and those who receive only IMV. A secondary objective was to identify potential determinants of outcomes. Results: Out of 54 ILD patients with ARF treated with IMV, 20 (37.0%) survived until hospital discharge and 10 (18.5%) were alive at one-year. There was no significant mortality difference between patients trialed on NIPPV prior to IMV and those receiving only IMV. Several key determinants of outcomes were identified with higher mortality, including higher ventilatory support, idiopathic pulmonary fibrosis (IPF) subtype, high dose steroids, use of vasopressors, supraventricular tachycardias (SVTs), and higher body mass index. Conclusion: Considering that patients trialed on NIPPV prior to IMV were associated with no mortality disadvantage to patients treated with only IMV, trialing patients on NIPPV may identify responders and avoid complications associated with IMV. Increased ventilator support, need of vasopressors, SVTs, and high dose steroids reflect higher mortality and palliative care involvement should be considered as early as possible if a lung transplant is not an option.

Validation of the Modified Integrative Weaning Index as a Predictor of Weaning from Mechanical Ventilation in Comparison to Conventional Weaning Indices in Adult Critically Ill Patients

QJM ◽

10.1093/qjmed/hcab086.042 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hythem Mohamed Mamdouh Abdelmeguid Barakat ◽

Galal Adel El-Kady ◽

Adel Mohammed El-Ansary ◽

Mohammed Abd El-Salam El-Gendy

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Good Predictor ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Underlying Disease ◽

Pulmonary Mechanics ◽

Weaning From Mechanical Ventilation ◽

Clinical Practices

Abstract Introduction Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Delays in both removing invasive ventilatory support and excessively early removal are correlated with complications that vary according to the severity of the underlying disease. Several weaning indices and predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. However, none of them have yet presented good results in discriminating the outcome of extubation, even those most used in clinical practices. Aim The aim of this study is to validate the modified integrative weaning index (mIWI) as a reliable weaning index in comparison to the conventional weaning indices in the weaning of critically ill patients from invasive mechanical ventilation. Patients Four hundred patients, above the age of 18 years, on mechanical ventilation for more than 48 hours through an endotracheal tube for any cause were randomly assigned to this study. Methods patients ready to be weaned were assessed using mIWI and conventional indices and monitored for 48 hours. The performance of the indices were assessed in both successful and unsuccessful groups. Results The performance of the mIWI was not significantly superior to the conventional weaning indices in predicting weaning success or failure than the traditional weaning indices. The cut-off value for the predicting successful weaning from mechanical ventilation for the mIWI was higher than suggested by the original study and yet in agreement with some other studies. The cut-off value for the mIWI is higher in patients above the age of 60 years. Conclusion The results of the study revealed that the mIWI is a good predictor of weaning from mechanical ventilation and assessment of pulmonary mechanics and is not significantly superior to the traditional weaning indices, yet is not a good predictor for extubation success.

Approach to the Patient with Acute Respiratory Failure

10.2310/tywc.1198 ◽

2018 ◽

Author(s):

Eddy Fan ◽

Alice Vendramin

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Life Support ◽

Ventilatory Support ◽

Positive Pressure ◽

Hypoxemic Respiratory Failure ◽

Arterial Blood ◽

Common Causes

Acute respiratory failure (ARF) is a common reason for admission to the intensive care unit (ICU), and is associated with significant morbidity and mortality. Failure of one or more components of the respiratory system can lead to hypoxemia, hypercabia, or both. Initial evaluation of patients with ARF should include physical examination, chest imaging, and arterial blood gases (ABG) sampling. As ARF is often a life-threatening emergency, a patient’s oxygenation and ventilation will need to be supported at the same time that diagnostic and therapeutic interventions are planned. The priorities for early treatment are essentially those of basic life support: airway and breathing. The first step is to assess a patient’s airway and ascertain that it is patent. This is followed by efforts to support both oxygenation and ventilation. This can include non-invasive or invasive mechanical ventilatory support. As with all interventions, there are risks inherent in the use of mechanical ventilation, which may be minimized by the use of lung protective ventilation (i.e., with low tidal volumes and airway pressures). Finally, due to the potential complications associated with mechanical ventilation, it is important to regularly assess whether a patient continues to require the assistance of the ventilator, and to liberate patients from mechanical ventilation at the earliest opportunity when clinically safe and feasible to do so. Figures depict pressure-time curve. Tables list the clinical causes of hypoxemic respiratory failure, oxygen delivery devices, indications for noninvasive positive pressure support, common causes of abnormal respiratory mechanics, and common causes of acute respiratory distress syndrome (ARDS). This review contains 2 highly rendered figures, 5 tables, and 86 references.