Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

Ambrosino, Nicolino; Foglio, K.; Rubini, F; Clini, Enrico; Nava, Stefano; Vitacca, Michele

doi:10.1136/thx.50.7.755

Cited by 324 publications

(244 citation statements)

References 11 publications

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“…However, these results are only achieved if NIV is set properly and the patient9s acceptance and tolerance of the procedure are optimal. Several clinical studies have reported that lack of compliance to ventilation is one of the major causes of failure in both acute hypercapnic and pure hypoxic respiratory failure [26][27][28].…”

Section: Tolerance To Ventilation and Air Leaksmentioning

confidence: 99%

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

et al. 2004

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The aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients9 breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage.A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate.No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients9 tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate.In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance.

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Section: Tolerance To Ventilation and Air Leaksmentioning

confidence: 99%

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

et al. 2004

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“…Thus it would appear that only a minority of failures of NIPSV could be related to major difficulties in the application of the technique. It is likely that failures of the method are more often due to the severity of the acute respiratory failure as demonstrated by AMBROSINO et al [25], and especially to the lack of rapid improvement in blood pH [4,6,21,24,25,26].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

et al. 2000

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Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit.During the first 24 h after enrolment, NIPSV was used for 6.7 3.2 h (mean SD) in group I and 5.6 3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47 12 and 11 7 min in group I, and 46 12 and 11 6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7 3.2 h . day -1 in group I and 4.9 3.5 h . day -1 in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44 10 and 7 4 min in group I, and 47 14 and 7 3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients.In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency. Methods of noninvasive pressure support ventilation (NIPSV) are being proposed more and more for patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure [1±6]. NIPSV can avoid the need for endotracheal intubation and its increasingly documented complications [7]. Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2, 4, 9, 10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].Three articles have demonstrated that the institution of noninvasive mechanical ventilation is not significantly more time-consuming for personnel than traditional medical therapy [4,12] or invasive mechanical ventilation [13]. However, two of these studies [12,13] were performed in respiratory intensive care units (ICUs) with a specialized activity, and where patient/staff ratios are generally lower than in general ICUs [13]. The authors consider that the problem lies not in comparing the workload linked to utilization of NIPSV with that linked to standard treatment or invasive mechanical ventilation, since it is advisable to use NIPSV to avoid intubation. It is more a question of know...

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“…However, pneumonia in patients treated with NIV is persistently associated with poor outcome in the literature, compared with other causes of ARF, both in patients with COPD exacerbations (29) and in hypoxemic ARF (28). More recent studies have confirmed high failure rates in patients with pneumonia and severe ARF (27,(30)(31)(32).…”

Section: Severe Community-acquired Pneumoniamentioning

confidence: 97%

The art and science of non-invasive ventilation

Ferrer¹

2014

sob

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SummaryNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). NIV is considered a standard of care for the management of hypercapnic ARF in patients with acute exacerbation of chronic obstructive pulmonary disease. With an appropriate selection of patients, NIV can reduce the need for invasive mechanical ventilation, mortality and length of stay. Patients with severe hypoxemic ARF have in general a lower likelihood to need tracheal intubation when NIV as a support for ARF is added to the standard medical treatment. However, the effects of NIV on mortality are less evident, and the heterogeneity of the different published studies suggests that the efficacy may be different among different populations. The optimal time for intubation after NIV failure remains a challenging issue due to increasing evidences on the relationship between delayed intubation and excess mortality in these populations. In intubated patients with preexisting lung disease, the use of NIV in order to advance extubation during difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates and improved survival. Moreover, NIV immediately after extubation is effective in avoiding respiratory failure after extubation and improving survival in patients at risk for this complication, particularly those with chronic respiratory disorders, cardiac co-morbidity, and hypercapnic respiratory failure.KEY WORDS: non-invasive ventilation, acute respiratory failure, weaning, hypoxemic respiratory failure, hypercapnic respiratory failure. IntroductionNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). Non-invasive ventilation is ventilatory support through the upper airways of patients with an interface, usually a mask; therefore, tracheal intubation or a tracheostomy is not needed. The benefits of NIV appear to be the consequence of avoiding tracheal intubation and the associated morbidity and mortality (1, 2). There are several potential advantages for the use of NIV. Some patients can be managed out of an intensive care unit (ICU), a particularly stressful environment, with additional benefits in reducing the occupation of ICU beds and related costs. Ventilatory support can be intermittent and therefore withdrawal of NIV can be gradual. These patients can cooperate in respiratory therapy; they can receive nebulised therapy, expectorate and communicate with staff and their relatives. However, there are limitations for NIV. Unnecessary delay in intubation of those patients who fail with NIV treatment is associated with worse outcome (3). Some patients do not tolerate the mask due to claustrophobia or other causes, and nasal bridge skin breakdown can occur and difficult the use of NIV. Non-invasive ventilation is now considered as a firstline intervention in selected patients with severe exacerbation of chronic obstructive...

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Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

Cited by 324 publications

References 11 publications

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

Effect of varying the pressurisation rate during noninvasive pressure support ventilation

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

The art and science of non-invasive ventilation

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