Noninvasive Mechanical Ventilation in Acute Ventilatory Failure

Esquinas, António M.; Benhamou, Maly Oron; Glossop, Alastair J.; Mina, Bushra

doi:10.1016/j.jsmc.2017.07.009

Cited by 16 publications

(4 citation statements)

References 67 publications

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“…Further, different types of mechanical ventilation have been proposed, from fully controlled to partially assisted and spontaneous breathing (5,6). Additionally, non-invasive mechanical ventilation has been also proposed in the early or later phases of respiratory support (7). However, mechanical ventilation may induce lung injury even when used for a limited period of time (1).…”

Section: Introductionmentioning

confidence: 99%

Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect

Pelosi

Ball

2018

Ann. Transl. Med

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Mechanical ventilation maintains adequate gas exchange in patients during general anaesthesia, as well as in critically ill patients without and with acute respiratory distress syndrome (ARDS). Optimization of mechanical ventilation is important to minimize ventilator induced lung injury and improve outcome. Tidal volume (V T), positive end-expiratory pressure (PEEP), respiratory rate (RR), plateau pressures as well as inspiratory oxygen are the main parameters to set mechanical ventilation. Recently, the driving pressure (∆P), i.e., the difference of the plateau pressure and end-expiratory pressure of the respiratory system or of the lung, has been proposed as a key role parameter to optimize mechanical ventilation parameters. The ∆P depends on the V T as well as on the relative balance between the amount of aerated and/or overinflated lung at end-expiration and end-inspiration at different levels of PEEP. During surgery, higher ∆P, mainly due to V T , was progressively associated with an increased risk to develop post-operative pulmonary complications; in two large randomized controlled trials the reduction in ∆P by PEEP did not result in better outcome. In non-ARDS patients, ∆P was not found even associated with morbidity and mortality. In ARDS patients, an association between ∆P (higher than 13-15 cmH 2 O) and mortality has been reported. In several randomized controlled trials, when ∆P was minimized by the use of higher PEEP with or without recruitment manoeuvres, this strategy resulted in equal or even higher mortality. No clear data are currently available about the interpretation and clinical use of ∆P during assisted ventilation. In conclusion, ∆P is an indicator of severity of the lung disease, is related to V T size and associated with complications and mortality. We advocate the use of ∆P to optimize individually V T but not PEEP in mechanically ventilated patients with and without ARDS.

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Section: Introductionmentioning

confidence: 99%

Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect

Pelosi

Ball

2018

Ann. Transl. Med

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“…The influenza virus can damage airway epithelial cells, which leads to structural and functional abnormalities in the airways. Advantages of NIV in the treatment of patients with ARDS include avoiding structural damage to the respiratory tract caused by invasive mechanical ventilation and complications, such as ventilator-associated pneumonia [ 34 , 35 ]. van de Veerdonk et al [ 36 ] reported a series of nine cases of invasive aspergillosis among 40 critically ill patients with influenza A (H1N1) infection (9/40; 23%) with very high mortality (61%).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Mechanical Ventilation in Patients with Viral Pneumonia-Associated Acute Respiratory Distress Syndrome: An Observational Retrospective Study

Chen

Weng

et al. 2023

International Journal of Clinical Practice

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Objectives. Appropriate mechanical ventilation may change the prognosis of patients with viral pneumonia-associated acute respiratory distress syndrome (ARDS). This study aimed to identify the factors associated with the success of noninvasive ventilation in the management of patients with ARDS secondary to respiratory viral infection. Methods. In this retrospective cohort study, all patients with viral pneumonia-associated ARDS were divided into the noninvasive mechanical ventilation (NIV) success group and the NIV failure group. The demographic and clinical data of all patients were collected. The factors associated with the success of noninvasive ventilation were identified by the logistic regression analysis. Results. Among this cohort, 24 patients with an average age of 57.9 ± 17.0 years received successful NIVs, and NIV failure occurred in 21 patients with an average age of 54.1 ± 14.0 years. The independent influencing factors for the success of the NIV were the acute physiology and chronic health evaluation (APACHE) II score (odds ratio (OR): 1.83, 95% confidence interval (CI): 1.10–3.03) and lactate dehydrogenase (LDH) (OR: 1.011, 95% CI: 1.00–1.02). When the oxygenation index (OI) is <95 mmHg, APACHE II > 19, and LDH > 498 U/L, the sensitivity and specificity of predicting a failed NIV were (66.6% (95% CI: 43.0%–85.4%) and 87.5% (95% CI: 67.6%–97.3%)); (85.7% (95% CI: 63.7%–97.0%) and 79.1% (95% CI: 57.8%–92.9%)); (90.4% (95% CI: 69.6%–98.8%) and 62.5% (95% CI: 40.6%–81.2%)), respectively. The areas under the receiver operating characteristic curve (AUC) of the OI, APACHE II scores, and LDH were 0.85, which was lower than the AUC of the OI combined with LDH and the APACHE II score (OLA) of 0.97 ( P = 0.0247 ). Conclusions. Overall, patients with viral pneumonia-associated ARDS receiving successful NIV have lower mortality rates than those for whom NIV failed. In patients with influenza A-associated ARDS, the OI may not be the only indicator of whether NIV can be used; a new indicator of NIV success may be the OLA.

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“…These effects could negate the potential benefits of avoiding intraoperative endotracheal intubation and mechanical ventilation [16]. Since NIV can (1) partially compensate for the affected respiratory function by unloading the respiratory muscles and reducing the work of breathing, (2) improve alveolar recruitment with preservation of lung volumes, resulting in better gas exchange, (3) reduce right ventricular preload and left ventricular afterload, and (4) avoid complications of invasive mechanical ventilation [35][36][37][38][39][40], the intraoperative use of NIV along with NA may be, at least in theory, justifiable in some patients with COPD or chest wall and NMDs (Figure 1).…”

Section: Non-invasive Ventilation To Support Lung Function During Neumentioning

confidence: 99%

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

Corcione

Karim

Mina

et al. 2019

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Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.

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Noninvasive Mechanical Ventilation in Acute Ventilatory Failure

Cited by 16 publications

References 67 publications

Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect

Should we titrate ventilation based on driving pressure? Maybe not in the way we would expect

Noninvasive Mechanical Ventilation in Patients with Viral Pneumonia-Associated Acute Respiratory Distress Syndrome: An Observational Retrospective Study

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

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