Practical approach to respiratory emergencies in neurological diseases

Racca, Fabrizio; Vianello, Andrea; Mongini, Tiziana; Ruggeri, Paolo; Versaci, A; Vita, Gian Luca; Vita, Giuseppe

doi:10.1007/s10072-019-04163-0

Cited by 45 publications

(37 citation statements)

References 90 publications

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“…Development of respiratory exacerbations may be a life-threatening event in patients with NMD, deriving from secretion accumulation and further weakening of respiratory muscles, and leading to acute respiratory failure ( 17 ). In clinical practice, the management includes early or prophylactic use of antibiotics for respiratory exacerbations, although no studies proving the benefits of this approach are available in literature ( 2 ).…”

Section: Clinical Management and Treatment Of Nmd Pediatric Patient With Respiratory Exacerbations And Pneumoniamentioning

confidence: 99%

All You Need Is Evidence: What We Know About Pneumonia in Children With Neuromuscular Diseases

et al. 2021

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Neuromuscular diseases may involve all major respiratory muscles groups including inspiratory, expiratory, and bulbar muscles. Respiratory complications are the major cause of morbidity and mortality. Pneumonia represents a frequent cause of morbidity in children with neuromuscular disease. The aim of this review is to collect knowledge about pneumonia in children with neuromuscular diseases. Pneumonia usually follows viral respiratory infections of the upper respiratory tract, due to the combination of an increased amount of nasal and oral secretions and an impairment of the cough efficiency and of the clearance of secretions due to the muscle weakness, further compromised by the infection itself. The accumulation of bronchial secretions leads to atelectasis and promote bacterial infection. Moreover, dysfunction of swallowing mechanism exposes these children to the risk of developing aspiration pneumonia. However, etiology of viral and bacterial respiratory infection in these patients is still poorly studied.

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Section: Clinical Management and Treatment Of Nmd Pediatric Patient With Respiratory Exacerbations And Pneumoniamentioning

confidence: 99%

All You Need Is Evidence: What We Know About Pneumonia in Children With Neuromuscular Diseases

et al. 2021

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“…4 Penyakit yang mempengaruhi sistem saraf pusat memiliki kemungkinan yang cukup besar untuk mengakibatkan hipoksia dan/atau hiperkapnea. 26 Kasus non trauma seperti tumor akan sangat mempengaruhi pusat pernapasan, terutama jika lokasinya terdapat pada bagian medulla oblongata, namun mekanisme terjadinya belum jelas. Sedangkan diagnosis lainnya seperti pada stroke, dapat menyebabkan kelemahan pada diafragma sehingga juga mengganggu pernapasan.…”

Section: Distribusi Kejadian Hap Dan Vap Berdasarkan Jenis Kelaminunclassified

Gambaran Kejadian Pneumonia pada Pasien Pasca Kraniotomi di Ruang Rawat Intensif RSUD Arifin Achmad Provinsi Riau Periode Januari 2015 sampai Desember 2019

Valentino

Endriani

Ameini

2021

JIK

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Operasi kraniotomi merupakan tindakan membuka sebagian tulang tengkorak hingga dapat memberikan akses langsung menuju otak. Komplikasi yang paling sering terjadi merupakan Ventilator Associated Pneumonia (VAP) dan Healthcare Associated Pneumonia (HAP). Penelitian ini dilakukan untuk melihat gambaran kejadian pneumonia pada pasien pasca kraniotomi di ICU RSUD Arifin Achmad Provinsi Riau periode Januari 2015 s/d Desember 2019. Data penelitian ini didapatkan dari rekam medik pasien pasca kraniotomi di ruang ICU RSUD Arifin Achmad Provinsi Riau, dengan total rekam medik yang ditemukan sebanyak 216 rekam medik. Hasil penelitian ini berupa, didapatkan kejadian pneumonia pada 56 pasien (26%), dengan kejadian HAP 3,7% dan VAP 22,7%. Kejadian HAP lebih banyak terjadi pada pasien perempuan (62,5%) dengan kelompok usia 56-65 tahun (50%), serta lama rawatan >5 hari (75%). Kejadian VAP memiliki distribusi yang sama antara laki-laki dan perempuan (50%) dengan kelompok usia 36-45 tahun (29,2%) dan lama rawatan >5 hari (45,8%), serta lama pemakaian ventilator mekanik <96 jam (66,7%). Kejadian pneumonia paling banyak terjadi pada pasien tanpa komorbid (71,4%) atau memiliki komorbid berupa hipertensi (21,4%) dengan diagnosis meningioma (28,6%), jumlah leukosit >11.000 (76,8%), lama pembedahan ≥2 jam (55,4%), dan patogen penyebab terbanyak berupa Acinetobacter baumanii (30,3%). Angka kematian pada penelitian ini sebesar 7,1%.

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“…The patient selection remains the most critical factor for the success of NIV in treating ARF. The contraindications to the NIV use include hemodynamic instability, severely decreased consciousness level, severe bulbar dysfunction (i.e., absence of gag reflex, or vocal cord paralysis), un-drained pneumothorax, facial deformity or injuries, recent surgery of facial, upper airway, or upper gastrointestinal tract, intolerance to NIV interface, multi-organ failure, life-threatening hypoxemia (PaO 2 < 60 mmHg with FiO 2 > 0.6), and lack of familiarity of health-care provider with NIV operation (6,14,62,69,70).…”

Section: Contraindications and Complications Of Niv And Mi-ementioning

confidence: 99%

Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With Neuromuscular Disorders

Chen

Hsu

2020

Front. Pediatr.

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Children with neuromuscular disorder (NMD) usually have pulmonary involvement characterized by weakened respiratory muscles, insufficient coughing, and inability to clear airway secretions. When suffering from community-acquired pneumonia, these patients are more likely to develop acute respiratory failure (ARF). Therefore, recurrent pneumonias leading to acute on chronic respiratory failure accounts for a common cause of mortality in children with NMD. For many years, noninvasive ventilation (NIV) has been regarded as a life-prolonging tool and has been used as the preferred intervention for treating chronic hypoventilation in patients with advanced NMD. However, an increasing number of studies have proposed the utility of NIV as first-line management for acute on chronic respiratory failure in NMD patients. The benefits of NIV support in acute settings include avoiding invasive mechanical ventilation, shorter intensive care unit or hospital stays, facilitation of extubation, and improved overall survival. As the difficulty in clearing respiratory secretions is considered a significant risk factor attributing to NIV failure, combined coughing assistance of mechanical insufflator-exsufflator (MI-E) with NIV has been recommended the treatment of acute neuromuscular respiratory failure. Several recent studies have demonstrated the feasibility and effectiveness of combined NIV and MI-E in treating ARF of children with NMD in acute care settings. However, to date, only one randomized controlled study has investigated the efficacy of NIV in childhood ARF, but subjects with underlying NMD were excluded. It reflects the need for more studies to elaborate evidence-based practice, especially the combined NIV and MI-E use in children with acute neuromuscular respiratory failure. In this article, we will review the feasibility, effectiveness, predictors of outcome, and perspectives of novel applications of combined NIV and MI-E in the treatment of ARF in NMD children.

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Practical approach to respiratory emergencies in neurological diseases

Cited by 45 publications

References 90 publications

All You Need Is Evidence: What We Know About Pneumonia in Children With Neuromuscular Diseases

All You Need Is Evidence: What We Know About Pneumonia in Children With Neuromuscular Diseases

Gambaran Kejadian Pneumonia pada Pasien Pasca Kraniotomi di Ruang Rawat Intensif RSUD Arifin Achmad Provinsi Riau Periode Januari 2015 sampai Desember 2019

Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With Neuromuscular Disorders

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