scholarly journals Non-invasive ventilation in acute respiratory failure in children

2012 ◽  
Vol 4 (2) ◽  
pp. 16 ◽  
Author(s):  
Clara Abadesso ◽  
Pedro Nunes ◽  
Catarina Silvestre ◽  
Ester Matias ◽  
Helena Loureiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Odds Ratio ◽  
Prospective Clinical Study ◽  
Invasive Ventilation ◽  
Failure Group ◽  
Non Invasive ◽  
Non Invasive Ventilation

The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/ fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42-71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33-111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.

scholarly journals Outcome of Non-Invasive Ventilation in Patients of Acute Respiratory Failure.

2021 ◽  
Vol 4 (1) ◽  
pp. 21-26
Author(s):  
Anusmriti Pal ◽  
Manoj Kumar Yadav ◽  
Chiranjeevi Pant
Keyword(s):  
Intensive Care Unit ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Face Mask ◽  
Invasive Ventilation ◽  
Failure Group ◽  
Non Invasive ◽  
Arterial Blood ◽  
Copd Patients ◽  
Non Invasive Ventilation

Introduction: Non-invasive ventilation (NIV) is a method of ventilator support or delivery of positive pressure into the lungs usually through a face mask, mostly initiated before severe acidosis occurs. NIV failure requiring invasive mechanical ventilation in decompensated chronic obstructive pulmonary disease (COPD) patients is low, but, in critical patients, it is as high as 60%. Acute respiratory failure (ARF) is the common reason for admission to the intensive care unit. This study assesses the outcome of NIV among patients with acute respiratory failure, the duration of use, stay in ICU, and failure rate of NIV. Such type of study result is scarce in our country. Methods:  Arterial blood gases were assessed prior, after, and at discontinuation of NIV. NIV was delivered by ventilator via face mask. All patients above age 15 years who presented to the hospital, diagnosed to have ARF by ABG were included and admitted to Medical Intensive Care Unit (MICU). . Appropriate statistical tests (Chi-square) were performed and the statistical significance of the results was assessed. Results: 35 patients with the median age of 73 years (range: 39- 89 years), of 60.0 % females among which 74.3 % were current smokers. Arterial blood pH prior to admission ranged from 7.11-7.39 and 7.06-7.41 among NIV success and failure, respectively. Similarly, PCo2 ranged from 54.0-127.5 and 29.5-105.9 among them, respectively. Two hours after ventilation pH ranged from 7.12-7.43 and 7.05-7.30 respectively in the success and failure group. The most common disease condition requiring NIV was 77.1% COPD.  Out of NIV failure group (n=19) ,57.8 % were intubated and 42.1% patients left the intervention.  Conclusions: Usage of NIV among ARF patients was associated with lower intubation and ICU mortality rate. COPD patients showed the most benefit with NIV, whereas patients suffering from interstitial lung disease, lung cancer had less benefit.

scholarly journals Risk Factors for Non-invasive Ventilation Failure in Influenza Infection with Acute Respiratory Failure in Emergency Department

2020 ◽  
Author(s):  
Karn Suttapanit ◽  
Jeeranun Boriboon ◽  
Pitsucha Sanguanwit
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Sofa Score ◽  
Chest Radiography ◽  
Influenza Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract BackgroundNon-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in emergency department (ED). However, the benefit of NIV in decreasing intubation rate remains controversial. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aims to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED.MethodWe perform a retrospective cohort observational study. Enrolled patients older than 18 years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical and laboratory outcome, chest imaging, NIV setting and parameter were recorded. We follow the outcome success or failure of the NIV used.Results162 patients were enrolled, 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included sequential organ failure assessment (SOFA) score (P = 0.001), PaO2/FiO2 (PF) ratio (P = 0.001) and quadrant infiltrations in chest x-rays (CXR) (P = 0.001). SOFA score, PF ratio and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (0.839 - 0.948), 0.828 (0.764 - 0.892) and 0.792 (0.721 – 0.863), respectively and no significant difference in the ability to predict NIV failure between three parameters. Use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated higher predictive ability for NIV failure in influenza infection with ARF.ConclusionsSOFA score, PF ratio and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

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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