Utilização da ventilação não invasiva em edema agudo de pulmão e exacerbação da doença pulmonar obstrutiva crônica na emergência: preditores de insucesso

Abstract

Use of non-invasive ventilation in acute pulmonary ABSTRACTObjective: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service.Methods: This study was a prospective, descriptive and analytical study. We included patients of both genders aged ≥18 years who used noninvasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH 2 O and inspiratory pressures between 10 and 12 cmH 2 O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation.Results: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 -32 hours) for chronic obstructive

Facial pressure ulcers in inpatients undergoing non-invasive ventilation in intermediate care units

“…This will increase air leaks and, consequently, the need for greater pressure to adjust the mask and avoid these leaks. To prevent the occurrence of ulceration of the nasal dorsum, the authors suggest the use of special masks and that the mask contact surface should be inflated using water instead of air (Passarini et al, 2012). In our study, we found that 60.0% of the participants had undergone NIV for 18 hours, being that 26.7% of these patients had developed facial PUs.…”

“…They concluded that hypertension was a statistically significant variable for PU development parameters should be taken into account when choosing the type of mask: age, severity of clinical status, level of surveillance, facial morphology, patient adherence and tolerance, Maruccia et al (2015) reported that participants only used oronasal masks. As mentioned by Passarini et al (2012), in most situations, the choice of equipment depends on its availability at the time of patient admission and the severity of the patient's condition, , which does not always allow using the most adequate mask. Mask use, and cleaning and sterilization procedures cause its clear deterioration.…”

“…However, despite the broad spectrum of indications, contraindications should be taken into account, namely cardiac arrests and/or respiratory disorders, severe encephalopathy with Glasgow Coma Scale (GCS) <10 with risk of aspiration, severe upper gastrointestinal bleeding, hemodynamic or electrocardiographic instability, facial deformity or trauma, upper airway obstruction, inability to protect the airways, inability to remove secretions, severe hypoxemia, untreated pneumothorax, need for sedation, increased risk of aspiration, multiple organ failure, and acute myocardial infarction (Marcelino, 2009;Cruz & Zamora, 2013). The primary benefit of using such a ventilation method is the prevention of complications from invasive ventilation, such as the aspiration of gastric contents, oropharynx trauma, ventilator-associated pneumonia, tracheal stenosis, and pneumothorax (Passarini, Zambon, Morcillo, Kosour, & Saad, 2012). NIV also maintains the ability to speak and cough, reduces the need for sedation, the risk of hemodynamic instability, and delirium, preserves the activity of respiratory muscles, and leads to less time on mechanical ventilation, ICU stay, and increased survival (Marcelino, 2009;Cruz & Zamora, 2013).…”

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

“…Passarini et al (15) observing patients with COPD and APE, found that higher scores on the GCS were predictive of success of NIV. Similarly, Confalonieri et al (16) found that patients with GCS below 11, pH ≥ 7.25, respiratory rate ≥ 30 breaths per minute, and high level predictive of mortality on admission had risk > 70% of failure of NIV.…”

Noninvasive ventilation and exercise tolerance in heart failure: A systematic review and meta-analysis

“…Continuous positive airway pressure (CPAP and bi-level positive airway pressure (commercially known as BiPAP ) , characterized by promoting constant pressure during inspiration and expiration 14 , 15 or positive inspiratory and positive pressure 16 , 17 , respectively, are known as NIV therapies.…”