During CPAPLF helmets were more efficient than FM, while during CPAPHF the three interfaces were comparable. Using CPAPVENT and PSV, FM was more efficient than helmets
Non-invasive positive pressure ventilation is increasingly used as a first-line treatment for respiratory failure. Non-invasive positive pressure ventilation can reduce the complications of endotracheal intubation such as barotrauma, nosocomial infections and the need for sedation. Non-invasive positive pressure ventilation has been shown to reduce the rate of endotracheal intubation in acute cardiogenic pulmonary oedema (27%), in chronic obstructive pulmonary disease (21%), and in acute respiratory failure (17%). Non-invasive positive pressure ventilation can be successfully delivered in the emergency department or in the general ward. However, the criteria for interrupting non-invasive positive pressure ventilation must be stricter (i.e. failure to improve gas exchange within 30 min) than in the general ward. One of the main reasons for the failure of non-invasive positive pressure ventilation lies in the technical problems caused by the face mask. We recently developed a new interface, the 'helmet', to deliver non-invasive positive pressure ventilation. When using the helmet instead of a face mask an increase of 10 cm H(2)O of pressure support and a fast pressurization rate are recommended. In a lung model and in healthy individuals the helmet reduced inspiratory effort. In hypoxemic patients the helmet reduced the intubation rate and the incidence of face mask-related complications. We believe that the helmet can extend the application of non-invasive positive pressure ventilation in different categories of patients with respiratory failure.
Increased intra-abdominal pressure (IAP) may occur in critically ill patients. The easiest method to estimate IAP at the bedside is the bladder pressure measurement. A standard procedure (same volume infused, pressure transducers, and patient's position) should be used to obtain comparable and reproducible data among different patients and during different stages and time of the disease. The increase in IAP leads to two major pathological conditions: 1) the intraabdominal hypertension (IAP above 16 cmH2O) and 2) the abdominal compartment syndrome (IAP above 30 cmH2O). Increased IAP negatively affects pulmonary, cardiovascular, renal, gastrointestinal and central nervous system function. Most of critically ill patients have an intraabdominal hypertension, while few of them (less than 5%) present clinical characteristics of abdominal compartment syndrome. IAP is different among different categories of patients. The highest mean values during intensive care unit stay have been reported in respiratory and cardiologic patients among medical categories and in neurologic patients among surgical patients. IAP seems to be correlated with severity scores but its relation to mortality is uncertain. Routine measurements of IAP by means of bladder pressure are not associated with an increased rate of urinary tract infections. Future trials are warranted to better evaluate the role of routine IAP measurements on clinical management of critically ill patients
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