The right interface for the right patient in noninvasive ventilation: a systematic review

Pierucci, Paola; Portacci, Andrea; Carpagnano, Giovanna Elisiana; Banfi, Paolo; Crimi, Claudia; Misseri, Giovanni; Gregoretti, Cesare

doi:10.1080/17476348.2022.2121706

Cited by 22 publications

(15 citation statements)

References 139 publications

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“…Interestingly, there was a long time-frame between the NIV initiation and the tracheotomy ( Table 2 ) which confirms the important value of NIV even for prolonged time during the day (more than 14 h); but also enhances the importance of a correct follow up (in person or in telemedicine) specifically in these patients [ 40 , 41 ]. The NIV success is related to the right choice of interface which may vary over the years of use and the strict follow up allow the right timing for transitioning to tracheotomy instead of an emergency procedure [ 42 ]. Indeed, the experience of the tracheotomy for a significant part of patients included in this study, almost 25%, was rushed and linked to an emergency procedure without much explanation of details.…”

Section: Discussionmentioning

confidence: 99%

Caregivers of Neuromuscular Patients Living with Tracheostomy during COVID-19 Pandemic: Their Experience

Pierucci

Volpato

Grosso

et al. 2023

JCM

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Background: During a pandemic, tracheostomy management in neuromuscular disease (NMD) patients can be complex. Methods: Using a multicentre, multiple case study approach, we sought perspectives through semi-structured interviews via hybrid quali-quantitative analysis. The qualitative analysis involved a semi-structured interview and the quantitative analysis the completion of a battery of questionnaires. Aim: To investigate the caregivers’ experiences, burden and beliefs regarding tracheostomy during the Italian COVID-19 pandemic. The following instruments were administered: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS); Zarit Burden Interview (ZBI). Results: Fifty-three caregivers (62.3% female, mean age 52.2 (SD = 18.2)) participated in the study. The more resilient the carers, the more they were psychologically flexible (r = 0.380, p = 0.014) and able to cope adaptively with the emergency (r = 0.378, p < 0.006). Similarly, perceived control was higher the more resilient they were (r = 0.897, p < 0.001). The main emotions emerging were isolation and loneliness (15; 34.88%). The perception of tracheostomy meant that it could be seen as a lifesaver or as a condemnation. Similarly, the relationship with health professionals moves from satisfaction to a feeling of abandonment over the course of the pandemic. Conclusions: These findings offer a unique opportunity to understand the point of view of caregivers of NMD patients living with tracheotomy during the COVID-19 pandemic, when going to the hospital may have been hampered.

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Section: Discussionmentioning

confidence: 99%

Caregivers of Neuromuscular Patients Living with Tracheostomy during COVID-19 Pandemic: Their Experience

Pierucci

Volpato

Grosso

et al. 2023

JCM

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“…In neuromuscular and/or kyphoscoliotic patients, NVS improves gas exchange and reduces the rate of intubation in cases of acute respiratory failure [ 21 , 22 ]. In our opinion, however, in neuromuscular patients on ventilation for more than 16 h per day, different types of interfaces need to be offered to avoid adverse events as much as possible, which is why we adopted the IAPV [ 23 , 24 ]. In our study of 28 patients, 13 had nasal decubitus; 1 patient had a nuchal decubitus; 2 began to have claustrophobia problems at the oronasal interface; 3 were engaged in smart working and did not want to be seen on video with the nasal interface; 2 preferred IAPV to mouth-piece ventilation; and 7 used IAPV during ambulation in preference to the nasal interface.…”

Section: Discussionmentioning

confidence: 99%

Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study

Volpi

Volpato

Compalati

et al. 2023

JCM

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Non-invasive ventilatory support (NVS) is a technique used to reduce respiratory work in neuromuscular diseases, preventing the progression of respiratory failure. NVS is usually administered via a nasal or an oronasal mask, causing discomfort, especially in patients ventilated for more than 16 h/day. Intermittent abdominal pressure ventilation (IAPV) differs completely from conventional NVS and consists of a portable ventilator and a corset with Velcro closures as the interface. In our study, the practicability and efficacy of IAPV were studied in three Italian centers monitoring 28 neuromuscular patients using IAPV who were then retrospectively analyzed. The primary outcomes were an improvement in hypoxemia and the normalization of hypercapnia, and the secondary outcome was an improvement in quality of life. Data were collected at baseline (T0) and after two hours of ventilation (T1), with follow-ups at three months (T2) and six months (T3). Statistical significance was found for PaCO2 over time (F (2.42) = 7.63, p = 0.001) and PaO2 (W = 0.539, p = 0.033). The time of NVS usage also significantly affected the quality of life (F (2.14) = 6.90, p = 0.010), as seen when comparing T0 and T3. As an alternative ventilation method, IAPV is still relevant today and could become a key part of daytime support, especially for patients who do not tolerate standard daytime NVS with an oral interface.

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“…Unintentional leakage is the main adverse effect encountered in the setting of long-term ventilation [ 9 , 11 , 12 , 25 ]. Several strategies can be proposed to reduce leakage such as mask size change, a careful choice of the type of interface, switching from a nasal to an oronasal mask when mouth leaks are suspected [ 26 , 27 ], or carefully reducing the pressure [ 26 , 28 ]. Unfortunately, such interventions are not always sufficient to tackle recalcitrant unintentional leakage since several determinants of unintentional leak exist and may be involved [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Responses of Bilevel Ventilators to Unintentional Leak: A Bench Study

Lebret

Fresnel²,

Prouvez

et al. 2022

Healthcare

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Background: The impact of leaks has mainly been assessed in bench models using continuous leak patterns which did not reflect real-life leakage. We aimed to assess the impact of the pattern and intensity of unintentional leakage (UL) using several respiratory models. Methods: An active artificial lung (ASL 5000) was connected to three bilevel-ventilators set in pressure mode; the experiments were carried out with three lung mechanics (COPD, OHS and NMD) with and without upper airway obstruction. Triggering delay, work of breathing, pressure rise time, inspiratory pressure, tidal volume, cycling delay and the asynchrony index were measured at 0, 6, 24 and 36 L/min of UL. We generated continuous and inspiratory UL. Results: Compared to 0 L/min of UL, triggering delays were significantly higher with 36 L/min of UL (+27 ms) and pressure rise times were longer (+71 ms). Cycling delays increased from −4 [−250–169] ms to 150 [−173–207] ms at, respectively 0 L/min and 36 L/min of UL and work of breathing increased from 0.15 [0.12–0.29] J/L to 0.19 [0.16–0.36] J/L. Inspiratory leakage pattern significantly increased triggering delays (+35 ms) and cycling delays (+263 ms) but decreased delivered pressure (−0.94 cmH2O) compared to continuous leakage pattern. Simulated upper airway obstruction significantly increased triggering delay (+199 ms), cycling delays (+371 ms), and decreased tidal volume (−407 mL) and pressure rise times (−56 ms). Conclusions: The pattern of leakage impacted more the device performances than the magnitude of the leakage per se. Flow limitation negatively reduced all ventilator performances.

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The right interface for the right patient in noninvasive ventilation: a systematic review

Cited by 22 publications

References 139 publications

Caregivers of Neuromuscular Patients Living with Tracheostomy during COVID-19 Pandemic: Their Experience

Caregivers of Neuromuscular Patients Living with Tracheostomy during COVID-19 Pandemic: Their Experience

Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study

Responses of Bilevel Ventilators to Unintentional Leak: A Bench Study

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