Faculty Opinions recommendation of Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation.

2013 ◽  
Author(s):  
Stefano Nava ◽  
Raffaele Scala
Keyword(s):  
Work Of Breathing ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Short-term effects of synchronized vs. non-synchronized NIPPV in preterm infants: study protocol for an unmasked randomized crossover trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Francesco Cresi ◽  
Federica Chiale ◽  
Elena Maggiora ◽  
Silvia Maria Borgione ◽  
Mattia Ferroglio ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Work Of Breathing ◽  
Respiratory Rhythm ◽  
Assisted Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Short Term Effects

Abstract Background Non-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management has not yet been established. Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant’s breathing efforts. The aim of the study is to evaluate the short-term effects of SNIPPV vs. NIPPV on the cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support. Methods An unmasked randomized crossover study with three treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frames of 4 h each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining continuous assisted ventilation without patient discomfort. During the whole duration of the study, the patient’s cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer. The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are the number of the cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index, and thoracoabdominal asynchrony. The calculated sample size was of 30 patients. Discussion It is known that NIPPV produces a percentage of ineffective acts due to asynchronies between the ventilator and the infant’s breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation. Trial registration ClinicalTrials.gov NCT03289936. Registered on September 21, 2017.

scholarly journals Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis

2019 ◽  
Vol 6 (1) ◽  
pp. e000399 ◽  
Author(s):  
Gemma Stanford ◽  
Helen Parrott ◽  
Diana Bilton ◽  
Penny Agent ◽  
Winston Banya ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Work Of Breathing ◽  
Evidence Base ◽  
Forced Expiratory Volume ◽  
Post Treatment ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Airway Clearance ◽  
Non Invasive Ventilation ◽  
Pre Treatment

IntroductionNon-invasive ventilation (NIV) is used in cystic fibrosis (CF) to support airway clearance techniques (ACTs) by augmenting tidal volumes and reducing patient effort. However, the evidence base for this is limited. We hypothesised that NIV, in addition to usual ACT, would increase sputum clearance. In addition, we investigated ease of sputum clearance (EoC), work of breathing (WoB) and NIV tolerability.MethodsAdults with CF (16+ years) at the end of hospitalisation for a pulmonary exacerbation were randomised to a cross-over trial of NIV-supported ACT or ACT alone in two consecutive days. No other changes to standard care were made. The primary outcome was the total 24-hour expectorated sputum wet weight after the intervention. Spirometry was completed pre-treatment and post-treatment. Oxygen saturations were measured pre-treatment, during treatment and post-treatment. EoC and WoB were assessed using Visual Analogue Scale.Results14 subjects completed the study (7 male, mean age 35 [SD 17] years, mean forced expiratory volume in 1 s [FEV1] 49 [20] % predicted). The difference between treatment regimens was −0.98 g sputum (95% CI −11.5 to 9.6, p=0.84) over 24 hours. During treatment oxygen saturations were significantly higher with NIV-supported ACT (mean difference 2.0, 95% CI 0.9 to 2.6, p=0.0004). No other significant differences were found in post-treatment FEV1, EoC, WoB, oxygen saturations or subject preference.ConclusionsThere was no difference in treatment effect between NIV-supported ACT and ACT alone, although the study was underpowered. Oxygen saturations were significantly higher during NIV-supported ACT, but with no effect on post-treatment saturations. NIV was well tolerated.Trial registration numberNCT01885650.

Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation

2012 ◽  
Vol 38 (5) ◽  
pp. 796-803 ◽  
Author(s):  
Emmanuel Vivier ◽  
Armand Mekontso Dessap ◽  
Saoussen Dimassi ◽  
Frederic Vargas ◽  
Aissam Lyazidi ◽  
...  
Keyword(s):  
Work Of Breathing ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Integrated oxygen therapy consisting of non invasive ventilation and nasal cannulae in respiratory failure secondary to COVID-19 pneumonia: Case series

2021 ◽  
Vol 8 (4) ◽  
pp. 45-48
Author(s):  
Anshul Singh ◽  
Suman Choudhary ◽  
Ashok Kumar Saxena
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Work Of Breathing ◽  
Case Series ◽  
Invasive Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Nasal Cannulae ◽  
Non Invasive Ventilation ◽  
Early Intubation

Patients with moderate to severe COVID-19 disease develop hypoxemic respiratory failure demonstrating profound degrees of hypoxia with little or no distress. This has put the conventional management consisting of an early intubation in question. In this case series, we attempted an integrated oxygen strategy utilizing non invasive ventilation with standard oxygen therapy (SO) via nasal cannula. We managed both the patients with successful outcomes, without the need of intubation. Hence, integrated oxygen therapy was successfully utilized for the ventilatory management of moderate to severe COVID-19 patients by improving oxygenation, making patients more comfortable and reducing the work of breathing. By complete avoidance of intubation, this technique might help in preservation of much-needed critical care ventilators and help improve patient outcomes in the areas hit hard by the pandemic.

scholarly journals Short term effects of synchronized vs. non-synchronized NIPPV in preterm infants: study protocol for an unmasked randomized crossover trial.

2021 ◽  
Author(s):  
Francesco Cresi ◽  
Federica Chiale ◽  
Elena Maggiora ◽  
Silvia Maria Borgione ◽  
Mattia Ferroglio ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Work Of Breathing ◽  
Respiratory Rhythm ◽  
Assisted Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Short Term Effects

Abstract Background: Non-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management is not yet established. Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant’s breathing efforts. The aim of the study is to evaluate short-term effects of SNIPPV vs NIPPV on cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support. Methods: An unmasked randomized crossover study with two treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frame of 4 hours each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining a continuous assisted ventilation without patient’s discomfort. During the whole study duration, patient cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer. The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are number of cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index and thoracoabdominal asynchrony. The sample size was calculated at 30 patients. Discussion: It is known that NIPPV produces a percentage of ineffective acts due to asynchronies between ventilator and infant’s breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation. Trial registration: ClinicalTrials.gov, NCT03289936. Registered on 09/21/2017. Keywords: Non-invasive ventilation, NIPPV, SNIPPV, Synchronization, Cardiorespiratory events, Preterm infants, RDS

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