CRITICALLY ILL CHILDREN WITH ASTHMA EXACERBATION IN A TERTIARY PAEDIATRIC HOSPITAL: FACTORS RELATED TO REQUIREMENT FOR NON-INVASIVE VENTILATION

In critically ill COVID-19 patients, proper management of sedation is an important issue. Therefore, for this purpose, several strategies and protocols have been proposed. In this paper, we illustrate an approach focused on lung damage, and both the pharmacokinetic and pharmacodynamic profiles of drugs used. In line with this, during high flow nasal (HFN), continuous positive airway pressure, or non-invasive ventilation, dexmedetomidine-based light sedation can be helpful for maintaining the respiratory driving and improving the patient comfort. A worsening in the respiratory clinical picture with mechanical ventilation may require deep sedation with the use of clonidine. The latter may reduce the hypnotic doses, allowing improved hemodynamic stability. When respiratory performance improves, dexmedetomidine can replace clonidine to reduce the time to extubation.

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Our insight about Mukhtar et al.’s outcome of non-invasive ventilation in COVID-19 critically ill patients

Anaesthesia Critical Care & Pain Medicine ◽

10.1016/j.accpm.2020.09.012 ◽

2020 ◽

pp. 100781

Author(s):

Habib Md Reazaul Karim ◽

Antonio M. Esquinas

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

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Respiratory System: Physiology of Mechanical Ventilation

10.2310/7ccsp.2416 ◽

2019 ◽

Author(s):

John Yerxa ◽

Cory J Vatsaas ◽

Suresh Agarwal

Keyword(s):

Mechanical Ventilation ◽

Airway Management ◽

Critically Ill ◽

Critically Ill Patient ◽

Positive Pressure ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Subsequent Chapter ◽

System Physiology

Airway and ventilatory management are mandatory skills for the critical care surgeon. Identifying and correctly managing a patient’s airway is the first step followed by correcting any oxygenation or ventilation deliver deficits. Mechanical ventilation with positive pressure has multiple physiologic effects that must be completely understood in a complex critically ill patient. Invasive and non-invasive modalities may be used to aid in achieving these goals. Further strategies such as using low tidal volume, adequate PEEP, and rescue strategies are important in patients with ARDS. Weaning from the ventilator as soon as able is an important consideration to improve outcomes, The subsequent chapter reviews airway management and the physiologic aspects of mechanical ventilation to aid in decision-making when caring for the critically ill patient with deficits in oxygenation or ventilation. This review 5 figures, 2 tables, and 41 references. Key Words: airway management, mechanical ventilation, invasive ventilation, non-invasive ventilation, tracheostomy, Acute Respiratory Distress Syndrome (ARDS), positive pressure ventilation, oxygenation

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Non-invasive ventilation versus invasive weaning in critically ill adults: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2021-216993 ◽

2021 ◽

pp. thoraxjnl-2021-216993

Author(s):

Karen E A Burns ◽

James Stevenson ◽

Matthew Laird ◽

Neill K J Adhikari ◽

Yuchong Li ◽

...

Keyword(s):

Critically Ill ◽

Total Duration ◽

Cochrane Central Register ◽

Invasive Ventilation ◽

High Quality ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Critically Ill Adults ◽

Ill Adults ◽

Duration Of Ventilation

BackgroundExtubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data.ResultsWe identified 28 trials, of moderate-to-good quality, involving 2066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Non-invasive weaning significantly reduced mortality (risk ratio (RR) 0.57, 95% CI 0.44 to 0.74; high quality), weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) (mean difference (MD) −4.62 days, 95% CI −5.91 to −3.34) and hospital stay (MD −6.29 days, 95% CI −8.90 to −3.68). Non-invasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD −0.57, 95% CI −1.08 to −0.07) and tracheostomy rate. Mortality, pneumonia, reintubation and ICU stay were significantly lower in trials enrolling COPD (vs mixed) populations.ConclusionNon-invasive weaning significantly reduced mortality, pneumonia and the duration of ventilation related to weaning, particularly in patients with COPD. Beneficial effects are less clear (or more careful patient selection is required) in non-COPD patients.PROSPERO registration numberCRD42020201402.

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