Ventilação não-invasiva com pressão positiva em pacientes com insuficiência respiratória aguda: fatores associados à falha ou ao sucesso

Holanda, Marcelo Alcântara; Oliveira, Carlos Henrique de; Rocha, E.; Bandeira, Rita Moara; Aguiar, Isabel Veras; Leal, Waltéria; Cunha, Ana Karina Monte; Silva, Alexandre Medeiros

doi:10.1590/s0102-35862001000600003

Cited by 12 publications

(12 citation statements)

References 21 publications

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“…(17)(18)(19) The EI reasons noted by this research include the ARF and the decreased level of consciousness. Similar results were also found by Yamauchi et al (13) and Holland et al (10) , which emphasized these same points as the main causes of failure of NIV. Identification of predictive success or failure of NIV can both avoid unnecessary EI as to avoid a late EI and its complications.…”

Section: Discussionsupporting

confidence: 88%

“…Thus, they should present at least two of the following criteria: a) respiratory rate > 25 breaths per minute; b) use of accessory muscles or paradoxical breathing; c) PaO 2 < 60 mmHg or SaO 2 < 90% on room air or oxygen; d) PaCO 2 > 45 mmHg with pH < 7.35. (10) In turn, individuals with tracheostomy or with insufficient information for the evaluation form fill, and those who had no indication for EI did not participate in the study.…”

Section: Methodsmentioning

confidence: 99%

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Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

Melo¹,

Nogueira²,

Felismino³

et al. 2015

mtprehabjournal

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Introduction:The noinvasive ventilation (NIV) has been an important resource for the management of acute respiratory failure (ARF) in intensive care unit (ICU). Several factors related to the patient, the healthcare team and the equipment used can influence in the success or failure of this therapy. Therefore, it is beneficial to analyze the use and effectiveness of NIV in everyday practice, which may lead to shorter hospital staying, reduce costs, and decrease mortality rate. Objective: To observe the use of NIV in patients with ARF in ICU. Methods: Prospective and observational study, assessing 37 patients aged over 18 years, who undergone NIV in ICU for ARF. The volunteers were assessed for clinical characteristics, physiological parameters, and outcome. The sample was divided into success group -SG (nonintubated patients after NIV use) and failure group -FG (intubated patients after NIV use). Results: The NIV was successful in 18 (48.6%) subjects and failed in 19 (51.4%) of them. Acute pulmonary edema was the main reason (62.4%) of ARF found. The FG compared to SG showed longer duration of NIV use (p = 0.05), lower arterial pH (p = 0.00), higher PaCO 2 (p = 0.02) greater accumulated water balance within 24 hours (p = 0.03) and 72 hours (p = 0.05) prior to the last use of NIV. It was also observed that the FG patients had higher hospital mortality rate, as follows: 73.8% versus 16.7% of FG SG (p = 0.00). Conclusion: The FG had a longer ICU staying and higher mortality rate. Moreover, the consciousness levels, the pH level, PaCO 2 and cumulative fluid balance appear to contribute to the success or the failure of NIV.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

Melo¹,

Nogueira²,

Felismino³

et al. 2015

mtprehabjournal

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“…(1)(2)(3) Nevertheless, NIV fails in up to 40 to 60% of cases. (2,(4)(5)(6)(7)(8)(9) Interface-related problems are the most common adverse effects, accounting for 50-100% of all complications associated with NIV. (10,11) In addition, 25-33% of appropriately selected patients adapt poorly to NIV, principally due to problems related to the mask.…”

Section: Introductionmentioning

confidence: 99%

Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Holanda

Reis²,

Winkeler³

et al. 2009

J. bras. pneumol.

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Objective: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. Methods: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO 2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. Results: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO 2 entering the ventilator circuit was zero for the TFM. Conclusions: The shortterm adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO 2 from the circuit is less likely to occur when a TFM is used.Keywords: Intermittent positive-pressure ventilation; Masks/adverse effects; Respiratory insufficiency; Equipment failure analysis. ResumoObjetivo: Falhas da ventilação não-invasiva (VNI) têm sido relacionadas a efeitos adversos agudos do uso de máscaras. O objetivo deste estudo foi comparar a incidência, tipo e intensidade de eventos adversos e conforto das máscaras facial total (MFT), facial (MF) e nasal (MN). Métodos: Estudo randomizado, tipo cruzado, em 24 voluntá-rios sadios submetidos a seis períodos de VNI, modo bilevel positive airway pressure em ajustes de baixa e moderada a alta pressão. Foi aplicado um questionário de avaliação de onze eventos adversos especificamente relacionados ao uso das máscaras. O conforto foi avaliado por escala visual analógica. O CO 2 exalado no circuito foi medido entre a conexão da máscara e o orifício de exalação. Resultados: A MFT teve desempenho similar a MF e MN quanto a escores de conforto. A aplicação de pressões mais altas reduziu o conforto e aumentou a incidência e a intensidade dos eventos adversos, independentemente do tipo de máscara. A MFT teve melhor desempenho quanto a vazamentos e dor no nariz e pior resultado quanto ao ressecamento oronasal e claustrofobia. A MF teve o pior resultado quanto a vazamentos. A pressão parcial do CO 2 exalado no circuito permaneceu em zero com a MFT. Conclusões: Os eventos adversos agudos causados pelas interfaces de VNI são relacionados ao tipo de máscara e aos parâmetros de press...

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“…O uso da ventilação não invasiva (VNI), sempre que indicado, não só pode evitar a intubação, sobretudo em pacientes com exacerbação da DPOC, edema agudo de pulmão cardiogênico e pacientes imunossuprimidos com infiltrados pulmonares, como pode facilitar uma extubação mais precoce, quando aplicada em pacientes com DPOC na fase de desmame da VM. (117,118,119) A reintubação constitui-se em fator de risco para PAVM e aumenta a mortalidade. O impacto benéfico do uso de VNI na falência respiratória pós extubação, prevenindo a reintubação, permanece incerto.…”

Section: Particularidades Relacionadas Com a Ventilação Mecânica Prevunclassified

Diretrizes brasileiras para tratamento das pneumonias adquiridas no hospital e das associadas à ventilação mecânica - 2007

2007

J. bras. pneumol.

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Ventilação não-invasiva com pressão positiva em pacientes com insuficiência respiratória aguda: fatores associados à falha ou ao sucesso

Cited by 12 publications

References 21 publications

Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Diretrizes brasileiras para tratamento das pneumonias adquiridas no hospital e das associadas à ventilação mecânica - 2007

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