scholarly journals Continuous positive airway pressure therapy in the management of hypercapnic cardiogenic pulmonary edema

2021 ◽  
Author(s):  
Alfonso Sforza ◽  
Mario Guarino ◽  
Claudia Sara Cimmino ◽  
Arturo Izzo ◽  
Giovanna Cristiano ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Tracheal Intubation ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Ultrasound Examination ◽  
Invasive Ventilation ◽  
Cpap Therapy ◽  
Non Invasive ◽  
Non Invasive Ventilation

Continuous positive airway pressure (CPAP) therapy or non-invasive ventilation (NIV) represent the first line therapy for acute cardiogenic pulmonary edema (CPE) together with medical therapy. CPAP benefits in acute CPE with normo-hypocapnia are known, but it is not clear whether the use of CPAP is safe in the hypercapnic patients. The aim of this study is to evaluate CPAP efficacy in the treatment of hypercapnic CPE. We enrolled 9 patients admitted to the emergency room with diagnosis of acute CPE based on history, clinical examination, arterial blood gas analysis (ABG) and lung-heart ultrasound examination. We selected patients with hypercapnia (pCO2 >50 mmHg) and bicarbonate levels <30 mEq/L. All patients received medical therapy with furosemide and nitrates and helmet CPAP therapy. All patients received a second and a third ABG, respectively at 30 and 60 min. Primary end-points of the study were respiratory distress resolution, pCO2 reduction, pH improvement, lactates normalization and the no need for non-invasive ventilation or endo-tracheal intubation. All patients showed resolution of respiratory distress with CPAP weaning and shift to Venturi mask with no need for NIV or endo-tracheal intubation. Serial ABG tests showed clear reduction in CO2 levels with improvement of pH and progressive lactate reduction. CPAP therapy can be effective in the treatment of hypercapnic CPE as long as the patients have no signs of chronic hypercapnia on ABG and as long as the diagnosis of heart failure is supported by bedside lung-heart ultrasound examination.   

scholarly journals Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arash Malakian ◽  
Mohammad Reza Aramesh ◽  
Mina Agahin ◽  
Masoud Dehdashtian
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

Bedeutung nicht-invasiver Verfahren in der Therapie des akuten hypoxämischen Versagens bei COVID-19

Pneumologie ◽  
2021 ◽  
Author(s):  
Wolfram Windisch ◽  
Bernd Schönhofer ◽  
Daniel Sebastian Majorski ◽  
Maximilian Wollsching-Strobel ◽  
Carl-Peter Criée ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Invasive Verfahren

ZusammenfassungIn der Corona-Pandemie werden zunehmend nicht-invasive Verfahren zur Behandlung des akuten hypoxämischen Versagens bei COVID-19 eingesetzt. Hier stehen mit der HFOT (high-flow oxygen therapy), CPAP (continuous positive airway pressure) und der NIV (non-invasive ventilation) unterschiedliche Verfahren zur Verfügung, die das Ziel einer Intubationsvermeidung verfolgen. Der aktuelle Übersichtsartikel fasst die heterogene Studienlage zusammen. Wesentlich ist die Erkenntnis, dass diese nicht-invasiven Verfahren durchaus auch bei einem schweren, akuten hypoxämischen Versagen erfolgreich sein können und damit die Intubation wie auch Tubus-assoziierte Komplikationen vermeiden können. Demgegenüber bleibt aber ebenso zu betonen, dass die prolongierte unterstützte Spontanatmung ebenfalls zu Komplikationen führt und dass demzufolge insbesondere ein spätes NIV-Versagen mit erheblich verschlechterter Prognose einhergeht, was vor dem Hintergrund weiterhin hoher NIV-Versagensraten in Deutschland bedeutsam ist. Der aktuelle Artikel verweist schließlich auch auf einen Parallelartikel in dieser Ausgabe, der die medial in der Öffentlichkeit in Deutschland geführte Debatte zu diesem Thema aufgreift und deren inhaltliche Fragwürdigkeit, aber auch die negativen Auswirkungen auf die Gesellschaft und die Fachwelt adressiert. Gleichzeitig wird die Bedeutung von regelmäßig zu überarbeitenden Leitlinien untermauert.

Non-invasive ventilation

2017 ◽  
Author(s):  
Josep Masip ◽  
Kenneth Planas ◽  
Arantxa Mas
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Pressure Support Ventilation ◽  
Airway Pressure ◽  
Pressure Support ◽  
Positive Airway Pressure ◽  
Fine Tuning ◽  
Invasive Ventilation ◽  
Support Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.

scholarly journals Avaliação do uso de ventilação não-invasiva no desmame da ventilação mecânica em pacientes adultos – revisão integrativa

2019 ◽  
Vol 9 (1) ◽  
pp. 139-149
Author(s):  
Ana Letícia Santos do Nascimento ◽  
Jefferson Carlos Araujo Silva ◽  
Luan Nascimento da Silva ◽  
Lara Patrícia Bastos Rocha ◽  
Ana Carolina Sá Mendonça ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Intervention Studies ◽  
Positive Airway Pressure ◽  
Extubation Failure ◽  
Ventilator Weaning ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

INTRODUÇÃO: pacientes com quadro de insuficiência respiratória aguda ou crônica necessitam de suporte através da Ventilação Mecânica Invasiva (VMI), após a correção do evento que levou o paciente a necessitar de VMI é iniciado o processo de desmame, definido como a transição da ventilação artificial para a espontânea. A Ventilação Não-Invasiva (VNI) tem-se mostrado eficiente no processo de desmame, otimizando o processo de transição e evitando a reintubação. OBJETIVO: avaliar o uso da VNI no processo de desmame da VMI em pacientes adultos. MÉTODOS: revisão integrativa, o levantamento de pesquisas indexadas se deu nos meses de março a maio de 2018, através do acesso as bases de dados: PubMed/MEDLINE, SciELO e LILACS, utilizando os descritores: weaning mechanical ventilation e ventilator weaning, non-invasive, non-invasive ventilation, continuous positive airway pressure, CPAP ventilation, bilevel continuous positive airway pressure, intervention studies e clinical trials, extubation, extubation failure, reintubation, reintubation failure e weaning. Os descritores foram utilizados de maneira individual e cruzada. RESULTADOS: Um total de 123 artigos foram encontrados com a busca nas bases de dados, 60 artigos foram excluídos após a leitura dos resumos por não se enquadrarem nos critérios de inclusão do estudo, 63 artigos foram lidos na íntegra, de onde 10 foram eleitos para integrar esta revisão integrativa. CONCLUSÃO: a VNI é uma terapêutica que se mostrou viável em alguns estudos para reduzir os riscos de reintubação em pacientes com diversidade diagnóstica que apresentaram insuficiência respiratória aguda após a extubação. Porém, esse resultado não foi unanimidade, o que dificulta sua recomendação.

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