scholarly journals Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate–Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital

2021 ◽  
Vol 10 (23) ◽  
pp. 5608
Author(s):  
Nardi Tetaj ◽  
Gabriele Garotto ◽  
Fabrizio Albarello ◽  
Annelisa Mastrobattista ◽  
Micaela Maritti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Observational Study ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Respiratory Parameters ◽  
Significant Difference ◽  
Ventilation Strategies

(1) Background: COVID-19 is a novel cause of acute respiratory distress syndrome (ARDS). Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, there has also been an increase in the incidence of cases with pneumothorax (PNX) and pneumomediastinum (PNM). However, the incidence and the predictors of PNX/PMN in these patients are currently unclear and even conflicting. (2) Methods: The present observational study analyzed the incidence of barotrauma (PNX/PNM) in COVID-19 patients with moderate–severe ARDS hospitalized in a year of the pandemic, also focusing on the three waves occurring during the year, and treated with positive-pressure ventilation (PPV). We collected demographic and clinical data. (3) Results: During this period, 40 patients developed PNX/PNM. The overall incidence of barotrauma in all COVID-19 patients hospitalized in a year was 1.6%, and in those with moderate–severe ARDS in PPV was 7.2% and 3.8 events per 1000 positive-pressure ventilator days. The incidence of barotrauma in moderate–severe ARDS COVID-19 patients during the three waves was 7.8%, 7.4%, and 8.7%, respectively. Treatment with noninvasive respiratory support alone was associated with an incidence of barotrauma of 9.1% and 2.6 events per 1000 noninvasive ventilator days, of which 95% were admitted to the ICU after the event, due to a worsening of respiratory parameters. The incidence of barotrauma of ICU COVID-19 patients in invasive ventilation over a year was 5.8% and 2.7 events per 1000 invasive ventilator days. There was no significant difference in demographics and clinical features between the barotrauma and non-barotrauma group. The mortality was higher in the barotrauma group (17 patients died, 47.2%) than in the non-barotrauma group (170 patients died, 37%), although this difference was not statistically significant (p = 0.429). (4) Conclusions: The incidence of PNX/PNM in moderate–severe ARDS COVID-19 patients did not differ significantly between the three waves over a year, and does not appear to be very different from that in ARDS patients in the pre-COVID era. The barotrauma does not appear to significantly increase mortality in COVID-19 patients with moderate–severe ARDS if protective ventilation strategies are applied. Attention should be paid to the risk of barotrauma in COVID-19 patients in noninvasive ventilation because the event increases the probability of admission to the intensive care unit (ICU) and intubation.

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 A Rare Case of ARDS Caused by Bupropion Inhalation and Treated with Noninvasive Ventilation

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Yousif Al-Saiegh ◽  
Jenna Spears ◽  
Pieter S. De Klerk ◽  
Joshua Hitchings ◽  
Christopher Lee ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Noninvasive Ventilation ◽  
Complete Resolution ◽  
Rare Case ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation

Acute respiratory distress syndrome, characterized by the Berlin criteria, is associated with a high mortality rate. Its treatment includes addressing the underlying etiology, general supportive measures, and achievement of effective oxygenation. New key data indicates that in a subset of patients, noninvasive ventilation techniques can be a therapeutic and equivalent alternative to traditional invasive ventilation. We present a rare case of ARDS triggered by nasal bupropion inhalation and effectively treated with noninvasive positive pressure ventilation resulting in complete resolution.

scholarly journals Outcomes of Noninvasive Positive Pressure Ventilation in Acute Respiratory Distress Syndrome and Their Predictors: A National Cohort

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Ahmed Taha ◽  
Eneko Larumbe-Zabala ◽  
Ashraf Abugroun ◽  
Assad Mohammedzein ◽  
M. Tarek Naguib ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Liver Disease ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Rationale. Although noninvasive positive pressure ventilation (NIPPV) is increasingly used in acute respiratory distress syndrome (ARDS) to avoid invasive mechanical ventilation (IMV), the data supporting its benefit for this indication are lacking. Objectives. To analyze the all-cause in-hospital mortality rate and length of stay (LOS) for ARDS patients who received NIPPV in the United States (US) compared to those who were initially intubated. Our secondary outcome of interest was to determine the predicting factors for NIPPV failure. Methods. We used the 2016 National Inpatient Sample database to identify 4,277 adult records with ARDS who required positive pressure ventilation. We divided the cohort into initial treatment with IMV or NIPPV. Then, the NIPPV group was further subdivided into NIPPV failure or success. We defined NIPPV failure as same-patient use of NIPPV and IMV either on the same day or using IMV at a later date. We analyzed the in-hospital mortality, LOS, and NIPPV failure rate. Linear regression of log-transformed LOS and logistic regression of binary outcomes were used to test for associations. Results. The NIPPV success group had the lowest mortality rate (4.9% [3.8, 6.4]) and the shortest LOS (7 days [6.6, 7.5]). The NIPPV failure rate was 21%. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure (adjusted OR: 4.47, 2.65, and 2.23, respectively). There was no significant difference between NIPPV failure and IMV groups in-hospital mortality (26.9% [21.8, 32.8] vs. 25.1% [23.5, 26.9], p=0.885) or LOS (16 [14, 18] vs. 15.6 [15, 16.3], p=0.926). Conclusions. NIPPV success in ARDS exhibits significantly lower hospital mortality rates and shorter LOS compared with IMV, and NIPPV failure exhibits no significant difference in hospital mortality or LOS compared with patients who were initially intubated. Therefore, an initial trial of NIPPV may be considered in ARDS. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure; these factors should be used to stratify patients to the most suitable ventilation modality.

scholarly journals Short- and Intermediate-Term Outcomes of Preterm Infants Receiving Positive Pressure Ventilation in the Delivery Room

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Megan O'Reilly ◽  
Po-Yin Cheung ◽  
Khalid Aziz ◽  
Georg M. Schmölzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Positive Pressure Ventilation ◽  
Survival Rates ◽  
Delivery Room ◽  
Positive Pressure ◽  
Protective Strategy ◽  
Residual Capacity ◽  
Ventilation Strategies

Although recent advances in neonatal care have improved survival rates, rates of bronchopulmonary dysplasia remain unchanged. Although neonatologists are increasingly applying gentle ventilation strategies in the neonatal intensive care unit, the same emphasis has not been applied immediately after birth. A lung-protective strategy should start with the first breath to help in the establishment of functional residual capacity, facilitate gas exchange, and reduce volutrauma and atelectotrauma. This paper will discuss techniques and equipment during breathing assistance in the delivery room.

scholarly journals Application Effect and Nursing of Non-Invasive Ventilation in Acute Exacerbation of Chronic Obstruction Pulmonary Disease Patients

2015 ◽  
Vol 4 (4) ◽  
pp. 8
Author(s):  
Zongying Li
Keyword(s):  
Acute Exacerbation ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Control Group ◽  
Blood Gas ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Significant Difference ◽  
Experimental Group

<p><strong>Objective:</strong> To study the application methods, summarize the nursing experience and discuss the clinical effect of non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease (COPD). <strong>Methods:</strong> 152 cases of AECOPD patients, who received treatment in our hospital from January 2011 to December 2013, were selected and divided into the experimental group and control group randomly. Patients in control group received conventional treatment, whereas besides conventional treatment, experimental group received non-invasive positive pressure ventilation and relevant nursing management. The changes in arterial blood gas and clinical indicators before and after treatment for both groups were observed. <strong>Results:</strong> After 7 days treatment, all the results of blood gas analysis were significantly improved (<em>p</em> &lt; 0.05). For the respiratory status (based on Borg scale), two groups were significantly improved after treatment, however, experimental group shown better than control group (<em>p</em> &lt; 0.05). The two groups had statistically significant difference (<em>p</em> &lt; 0.05) in the aspects of prognosis, endotracheal intubation and hospitalization time. As for the death index, there was no significant difference between two groups. No special treatment was needed for adverse reactions, they would be relieved slowly. <strong>Conclusion:</strong> Non-invasive positive pressure ventilation able to improve the recovery rate and quality of life of patients with acute exacerbation of COPD.</p>

scholarly journals Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

2021 ◽  
Vol 15 ◽  
pp. 175346662110042
Author(s):  
Xiaoke Shang ◽  
Yanggan Wang
Keyword(s):  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Abdominal Distension ◽  
Apache Ii ◽  
Positive Pressure ◽  
Apache Ii Score ◽  
Subgroup Ii ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits

2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.

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