The Japanese Respiratory Society Noninvasive Positive Pressure Ventilation (NPPV) Guidelines (second revised edition)

Akashiba, Tsuneto; Ishikawa, Yoshihiro; Ishihara, Hideki; Imanaka, Hideaki; Ohi, Motoharu; Ochiai, Ryoichi; Kasai, Takatoshi; Kimura, Kentaro; Kondoh, Yasuhiro; Sakurai, Shigeru; Shime, Nobuaki; Suzukawa, Masayuki; Takegami, Misa; Takeda, Satoru; Tasaka, Sadatomo; Taniguchi, Hiroyuki; Chohnabayashi, Naohiko; Chin, Kazuo; Tsuboi, Taijū; Tomii, Keisuke; Narui, Koji; Hasegawa, Naoyuki; Hasegawa, Ryuichi; Ujike, Yoshihito; Kubo, Keishi; Hasegawa, Yoshinori; Momomura, Shin‐ichi; Yamada, Yosuke; Yoshida, Masahiro; Takekawa, Yukie; Tachikawa, Ryo; Hamada, Shin; Murase, Kimihiko

doi:10.1016/j.resinv.2015.11.007

Cited by 32 publications

(29 citation statements)

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“…The Japanese Respiratory Society published the ‘Guidelines for Noninvasive Positive Pressure Ventilation (NPPV), 2nd Edition’ in 2015 [33]. In the guidelines, “(1) NPPV should be used with caution in patients with ARDS, (2) the use of NPPV is recommended in patients with mild ARDS with fewer other organs failing,” and there is no conflict between that statement and our recommendation [33].…”

Section: Resultsmentioning

confidence: 99%

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The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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BackgroundThe Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU.MethodThe guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan).ResultsThe recommendations for adult patients with ARDS include: we suggest against early tracheostomy (GRADE 2C), we suggest using NPPV for early respiratory management (GRADE 2C), we recommend the use of low tidal volumes at 6-8 mL/kg (GRADE 1B), we suggest setting the plateau pressure at 30cmH20 or less (GRADE2B), we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH2O, without compromising hemodynamics (Grade 2B), and using higher PEEP levels in patients with moderate to severe ARDS (Grade 2B), we suggest using protocolized methods for liberation from mechanical ventilation (Grade 2D), we suggest prone positioning especially in patients with moderate to severe respiratory dysfunction (GRADE 2C), we suggest against the use of high frequency oscillation (GRADE 2C), we suggest the use of neuromuscular blocking agents in patients requiring mechanical ventilation under certain circumstances (GRADE 2B), we suggest fluid restriction in the management of ARDS (GRADE 2A), we do not suggest the use of neutrophil elastase inhibitors (GRADE 2D), we suggest the administration of steroids, equivalent to methylprednisolone 1-2mg/kg/ day (GRADE 2A), and we do not recommend other medications for the treatment of adult patients with ARDS (GRADE1B; inhaled/intravenous β2 stimulants, prostaglandin E1, activated protein C, ketoconazole, and lisofylline, GRADE 1C; inhaled nitric oxide, GRADE 1D; surfactant, GRADE 2B; granulocyte macrophage colony-stimulating factor, N-acetylcysteine, GRADE 2C; Statin.)ConclusionsThis article was translated from the Japanese version originally published as the ARDS clinical practice guidelines 2016 by the committee of ARDS clinical practice guideline (Tokyo, 2016, 293p, available from http://www.jsicm.org/ARDSGL/ARDSGL2016.pdf). The original article, written for Japanese healthcare providers, provides points of view that are different from those in other countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-017-0222-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…In the guidelines, “(1) NPPV should be used with caution in patients with ARDS, (2) the use of NPPV is recommended in patients with mild ARDS with fewer other organs failing,” and there is no conflict between that statement and our recommendation [33]. …”

Section: Resultsmentioning

confidence: 99%

The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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“…9,11,12 As cons of this treatment, NPPV has risks in patients with disturbed consciousness, and those with an uncontrolled pneumothorax. 9,13 Therefore, careful investigation before application of NPPV is mandatory and close observation of the patient is essential.…”

Section: Discussionmentioning

confidence: 99%

Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

Kono

Koda

Abe

et al. 2019

J Orthop Surg (Hong Kong)

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Background: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Methods: Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel®) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. Results: We used the application of NPPV for 2 weeks in the first patient and 1 week in the second patient. In both of them, subarachnoid-pleural fistula was attenuated without apparent adverse events. Conclusion: NPPV is noninvasive and potentially useful therapy to attenuate subarachnoid-pleural fistula after thoracic spinal surgery.

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“…These episodic oxygen desaturation criteria were in line with Fletcher’s episodic desaturation criteria (the patient’s SaO 2 falls below a baseline of 90% for ≥5 minutes) and Japanese Respiratory Society (JRS)’s NPPV guidelines. 6 , 10 …”

Section: Methodsmentioning

confidence: 99%

Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD

Kitajima¹,

Marumo²,

Shima³

et al. 2018

COPD

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PurposeEpisodic nocturnal hypercapnia (eNH) caused by rapid eye movement (REM) sleep-related hypoventilation is often noted in patients with advanced COPD. The purpose of this study was to clarify the clinical significance of eNH and the effectiveness of eNH-targeted noninvasive positive pressure ventilation (NPPV).Patients and methodsWe enrolled patients with stable, severe, or very severe COPD with daytime arterial partial oxygen pressure PaO2 ≥55 mmHg and daytime arterial partial carbon dioxide pressure PaCO2 <55 mmHg, who underwent overnight transcutaneous carbon dioxide pressure (PtcCO2) monitoring from April 2013 to April 2016. We retrospectively compared clinical characteristics, daytime blood gas analysis, frequency of exacerbation, serum albumin levels, and ratio of pulmonary artery to aorta diameter (PA:A ratio), between patients with COPD with and without eNH. For those with eNH, we applied NPPV and compared these clinical characteristics before and after NPPV.ResultsTwenty-one patients were finally included in this study. Ten patients (47.6%) were evaluated to have eNH. These patients had lower albumin levels (p=0.027), larger PA:A ratio (p=0.019), and higher frequency of exacerbations during the last year (p=0.036). NPPV for the patients with eNH improved daytime PaCO2 compared with that 12 months after NPPV (p=0.011). The frequency of exacerbations 1 year before NPPV decreased 1 year after NPPV (p=0.030). Serum albumin levels improved 1 year after NPPV (p=0.001).ConclusionIn patients with stable severe or very severe COPD, eNH may be a risk factor of exacerbations, hypoalbuminemia, and pulmonary hypertension. NPPV may be effective against hypoalbuminemia and acute exacerbations. However, further study is necessary to validate these findings.

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The Japanese Respiratory Society Noninvasive Positive Pressure Ventilation (NPPV) Guidelines (second revised edition)

Cited by 32 publications

References 0 publications

The clinical practice guideline for the management of ARDS in Japan

The clinical practice guideline for the management of ARDS in Japan

Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD

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