Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease

Nava, Stefano; Ambrosino, Nicolino; Clini, Enrico; Prato, Maurizio; Orlando, Giacomo; Vitacca, Michele; Brigada, Paolo; Fracchia, Claudio; Rubini, F

doi:10.7326/0003-4819-128-9-199805010-00004

Cited by 591 publications

(340 citation statements)

References 28 publications

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“…They may continue invasive mechanical ventilation until patients can be extubated [5]. In selected cases, intensivists may extubate patients straight away and immediately institute noninvasive mechanical ventilation (NIV) [6,7]. In contrast, for patients recovering from hypoxemic respiratory failure intensivists have one choice: continue invasive mechanical ventilation until extubation [8].…”

mentioning

confidence: 99%

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

Laghi

Fernández

2012

Intensive Care Med

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mentioning

confidence: 99%

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

Laghi

Fernández

2012

Intensive Care Med

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“…There are two kinds of noninvasive assisted ventilation schemes: one is the use of noninvasive positive pressure ventilation immediately after the extubation (sequential invasive-noninvasive strategy); [21] the other is the use of noninvasive positive pressure ventilation when exacerbations of respiratory failure post extubation (noninvasive positive pressure ventilation as remedial strategy). [22] Many studies support the sequential invasive-noninvasive strategy, but researches on sequential invasive-noninvasive ventilation strategy mainly focused on the direct tracheal extubation of patients after their intubation.…”

Section: Discussionmentioning

confidence: 99%

Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy

Wang

Yan

et al. 2015

World Journal of Emergency Medicine

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BACKGROUND:Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain diffi culties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy. METHODS:Fifty patients including 24 patients with withdrawal of mechanical ventilation (conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy (sequential group) were analyzed retrospectively after appearance of pulmonary infection control (PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia (VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.

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“…A recent study showed that extubation and weaning with noninvasive (by facemask), as opposed to invasive (by tracheal tube), ventilation can reduce VAP (28% vs. 0%) and mortality in suitable patients with respiratory failure secondary to chronic obstructive airways disease [87]. Survival rates at 60 days were significantly higher in the noninvasive group (92% vs. 72%); the excess deaths related to the complications of conventional mechanical ventilation, in particular pneumonia.…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

Young¹,

Ridley²

1999

Anaesthesia

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SummaryVentilator-associated pneumonia is common, difficult to diagnose, affects the most vulnerable of patients and carries a high mortality. During prolonged mechanical ventilation the oropharynx, sinuses, dentition and stomach of critically ill patients become colonised with pathogenic bacteria. Colonised secretions pool in the oropharynx and subglottic space. These secretions repeatedly gain access to the lower airways by leakage past the tracheal tube cuff. If host defence mechanisms are overwhelmed, multiplication occurs in the lower respiratory tract producing an inflammatory response in the bronchioles and alveoli. The inflammatory response is characterised by capillary congestion, leucocyte and macrophage infiltration and fibrinous exudation into the alveolar spaces. If this inflammatory response occurs more than 48 h after intubation, it is called ventilatorassociated pneumonia. Prevention depends on reducing upper airway and gastrointestinal reservoirs of bacteria, reducing or abolishing aspiration of these bacteria past the tracheal tube cuff and enhancing bacterial clearance from the lower airways. Despite an increased understanding of the pathogenesis and diagnosis of ventilator-associated pneumonia (VAP), prevention has remained problematic. There is now good evidence for continuous leakage of infected secretions past the tracheal tube cuff being responsible for VAP. As a result, VAP strikes critically ill patients and increases their morbidity and mortality. The aim of this review is to discuss the diagnosis and pathogenesis of VAP, including a brief review of natural defence mechanisms. The review also covers the prevention of VAP with special reference to new developments aimed at reducing aspiration past the cuff. Definition

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Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease

Abstract: Noninvasive pressure support ventilation during weaning reduces weaning time, shortens the time in the intensive care unit, decreases the incidence of nosocomial pneumonia, and improves 60-day survival rates.

Cited by 591 publications

References 28 publications

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

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