Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Brochard, Laurent; Mancebo, Jordi; Wysocki, Marc; Lofaso, Frédéric; Conti, Giorgio; Rauss, Alain; Simonneau, G; Benito, S.; Gasparetto, A; Lemaire, F

doi:10.1056/nejm199509283331301

Cited by 1,738 publications

(1,156 citation statements)

References 29 publications

Supporting

Mentioning

994

Contrasting

Unclassified

Order By: Relevance

“…Finally, the number of included patients was small and as our group of patients included those admitted for acute respiratory failure and those at risk of developing respiratory failure after extubation, the group was heterogeneous. Nonetheless, despite this heterogeneity, all patients received NIV for well-validated indications [3,17,18]. It must also be pointed out that our study was a short-term evaluation and that the included patients were not in severe respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

View full text Add to dashboard Cite

Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Intensive care patients receiving NIV via an oronasal face mask for acute respiratory failure [17,18] or for being at risk of postextubation respiratory failure according to previously published criteria [3] were eligible for inclusion in the study. Exclusion criteria are outlined in the Electronic Supplementary Material.…”

Section: Patientsmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…Randomized controlled trials have shown that noninvasive ventilation (NIV) reduces the need for endotracheal intubation, reduces complications and increases short-term survival in patients with COPD-AE (4,5). Therefore, NIV is currently widely used as a first line treatment in patients with severe COPD-AE.…”

Section: Introductionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

View full text Add to dashboard Cite

Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

show abstract

“…In the study of BOTT et al [4], NIPSV was used for 6 days, as for patients in group I in the present study; however, respiratory acidosis was more significant for patients in the present study than in that of BOTT et al [4]. Some authors have previously proposed administering NIPSV discontinuously [1,4,5,20,23,24]. The sequential mode used on the present study is also a discontinuous mode, thus allowing comparison of the present results with those of other studies, with some specificity, i.e.…”

Section: Discussionmentioning

confidence: 51%

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

et al. 2000

View full text Add to dashboard Cite

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...

show abstract

Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract: In selected patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate.

Cited by 1,738 publications

References 29 publications

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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

Contact Info

Product

Resources

About