Noninvasive Positive Pressure Ventilation in Status Asthmaticus

Meduri, G. Umberto; Cook, Timothy R.; Turner, R. Eugene; Cohen, Mark; Leeper, Kenneth V.

doi:10.1378/chest.110.3.767

Cited by 283 publications

(140 citation statements)

References 39 publications

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“…9,14 In the present study, breathing frequency and V E decreased in the group using nebulized ␤ agonists coupled with NIV. These findings corroborate previous studies reporting a reduction in breathing frequency and respiratory muscle recruitment, as well as improved gas exchange in patients with asthma treated with NIV in emergency rooms or hospitals.…”

Section: Discussionsupporting

confidence: 51%

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

et al. 2013

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BACKGROUND: Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling ␤-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance. METHODS: In this controlled trial, 21 adults with moderate to severe asthma attack were randomized to a control group (n ‫؍‬ 11) or experimental group (NIV ؉ nebulizer group, n ‫؍‬ 10). All subjects inhaled bronchodilators for 9 minutes, and after particles were counted with a gamma camera to analyze regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min. RESULTS: Breathing frequency (P ‫؍‬ < .001) and minute ventilation (P ‫؍‬ .01) were reduced, and tidal volume was increased (P ‫؍‬ .01) in the NIV ؉ nebulizer group, compared with the control group. The NIV ؉ nebulizer group had improvement from baseline values, compared to the control group in the following parameters: FEV 1 46.7 ؎ 0.5% of predicted vs 29.8 ؎ 8.9% of predicted, P ‫؍‬ .02), FVC (41.2 ؎ 1.5% of predicted vs 23.2 ؎ 7.1% of predicted, P ‫؍‬ .02), peak expiratory flow (67.3 ؎ 38.3% of predicted vs 26.9 ؎ 12.1% of predicted, P ‫؍‬ .01), and inspiratory capacity (54.9 ؎ 28.8% of predicted vs 31.2 ؎ 9.1% of predicted, P ‫؍‬ .01). No differences were observed between groups regarding radio-aerosol deposition index or pulmonary clearance. Negative correlations were found between FEV 1 , forced expiratory flow during the middle half of the FVC maneuver (FEF 25-75% ), inspiratory capacity, and radio-aerosol penetration index. CONCLUSIONS: Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050)

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Section: Discussionsupporting

confidence: 51%

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

et al. 2013

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“…The literature also demonstrates that this technique diminishes the occurrence of pulmonary dysfunction in the postoperative period and that its use after extubation, for a period of between 30 minutes and four hours, is associated with an increase in the PaO 2 and a reduction in PaCO 2 , when compared to the period of spontaneous ventilation with or without an oxygen supplement [5,14,15]. Hence, similar to this study utilizing non-invasive ventilation for 30 minutes immediately after extubation, there was a statistically significant improvement in the PaO 2 and a slight reduction in the PaCO 2 .…”

Section: Discussionmentioning

confidence: 98%

“…Even so, it is possible to increment gas exchange utilizing different levels of positive end-expiratory pressure [5].…”

Section: Introductionmentioning

confidence: 99%

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Lopes¹,

Brandão²,

Nozawa³

et al. 2008

Rev Bras Cir Cardiovasc

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Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíacaBenefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Abstract Objective: to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery.Methods: A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O 2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation.Results: The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO 2 . On comparing the groups, the PaO 2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO 2 (p = 0.557).Conclusion: The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery. Descriptors 345LOPES, CR ET AL -Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Bras Cir Cardiovasc 2008; 23(3): 344-350 Rev

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“…9 However, in another study of 27 patients managed with NIV, 2 of the 5 patients requiring intubation died. 10 In 12 In our series, NIV was used in 10 patients, 4 of whom were subsequently intubated. The average time on NIV before intubation was 2 hours, and there were no deaths in this group.…”

Section: Discussionmentioning

confidence: 89%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

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Noninvasive Positive Pressure Ventilation in Status Asthmaticus

Cited by 283 publications

References 39 publications

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Increasing severity of status asthmaticus in an urban medical intensive care unit

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