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2.
J Korean Med Sci ; 35(10): e67, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32174065

RESUMO

BACKGROUND: Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia. METHODS: All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching. RESULTS: A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups. CONCLUSION: In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.


Assuntos
Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Cânula , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Hipercapnia , Unidades de Terapia Intensiva , Ventilação não Invasiva/instrumentação , Pontuação de Propensão , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(12): e19525, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195955

RESUMO

BACKGROUND: To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS: This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION: This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION: This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).


Assuntos
Anestesia Geral/tendências , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Cabeça/cirurgia , Oxigenação Hiperbárica/tendências , Pescoço/cirurgia , Gasometria , Cânula/normas , Cânula/estatística & dados numéricos , Humanos , Intubação Intratraqueal/métodos , Máscaras/normas , Máscaras/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Oxigênio/sangue , Estudos Prospectivos , Artéria Radial/cirurgia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Dispositivos de Acesso Vascular/normas
4.
JAMA ; 323(5): 455-465, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016309

RESUMO

Importance: The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. Objective: To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia. Data Sources: Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019. Study Selection: Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included. Data Extraction and Synthesis: Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies. Main Outcomes and Measures: Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up. Results: A total of 21 RCTs and 12 observational studies evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], -5.53% [95% CI, -10.29% to -0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P = .003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, -35.26% [95% CI, -49.39% to -21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P < .001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, -8.02% [95% CI, -14.77% to -1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P = .02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P = .47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, -0.06 to 0.39]; P = .15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P < .001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, -11.99% [95% CI, -24.77% to 0.79%]; OR, 0.56 [95% CI, 0.29-1.08]; P = .49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P = .84; 6 studies; 414 patients). Conclusions and Relevance: In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.


Assuntos
Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/métodos , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Hipercapnia/etiologia , Ventilação não Invasiva/instrumentação , Respiração com Pressão Positiva/instrumentação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Respiração Artificial/instrumentação , Resultado do Tratamento
5.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 28-34, ene. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186463

RESUMO

Background: The objective of this study was to evaluate the effects of three single-limb heated wired circuits (SLHWC) for NIV, on ventilatory parameters and humidification performance in a simulation lung model. Methods: Three SLHWC compatible with the MR-850 Heated Humidifier (HH) (Fisher & Paykel, Auckland, New Zealand) were tested: RT-319 (FP) (Fisher & Paykel, Auckland, New Zealand), Respironics 1045770 (RP) (DEAS, Castel Bolognese, Italy) and Intersurgical B/SYS 5809001 (IT) (Intersurgical, Wokingham, UK). A Bipap Vision ventilator (Philips Respironics, Murrysville, PA, USA) in pressure control ventilation (PCV) connected to a test lung was used for simulation. Each SHWC performance was evaluated in four ventilatory conditions: IPAP of 15 cm H2O with FiO2 0.3 and 1, respectively; and, IPAP of 25 cm H2O with FiO2 0.3 and 1, respectively. EPAP was set at 5 cm H2O. Hygrometric and ventilatory measurements including: relative humidity (RH), temperature (T), Pplat, PIP, PEEP, peak inspiratory flow (PIF), and tidal volume (Vt) were measured. Results: In each FiO2 group absolute humidity (AH) was similar with FP regardless of the IPAP level employed compared to IT and RP (P<.001). Except for RP at FiO2 0.3, AH increased significantly in IT and RP groups as IPAP increased (P < .001). PIP, Pplat, PEEP, PIF, and Vt values were significantly higher with FP and RP in each FiO2 group compared to IT (P < .001). Conclusions: Humidification performance varied significantly among the three circuits, being FP the only one able to maintain stable AH values during the study with no influence on ventilatory parameters


Introducción: El objetivo de este estudio fue evaluar los efectos de 3 circuitos de ramal único (SLHWC) para la ventilación mecánica no invasiva (VNI) en los parámetros de ventilación y la humidificación en un modelo de simulación pulmonar. Métodos: Se evaluaron 3 SLHWC compatibles con el humidificador calefactado MR-850 (HH) (Fisher & Paykel, Auckland, Nueva Zelanda): RT-319 (FP) (Fisher & Paykel, Auckland, Nueva Zelanda), Respironics 1045770 (RP) (DEAS, Castel Bolognese, Italia) y Intersurgical B/SYS 5809001 (IT) (Intersurgical, Wokingham, Reino Unido). Para la simulación se empleó un ventilador Bipap Vision (Philips Respironics, Murrysville, PA, EE. UU.) con ventilación controlada por presión (PCV) conectado a un simulador pulmonar. El rendimiento de cada SHWC se evaluó en 4 condiciones ventilatorias: IPAP de 15 cm H2O con FiO2 igual a 0,3 o igual a 1; IPAP de 25 cm H2O con FiO2 igual a 0,3 o igual a 1. La EPAP se estableció en 5 cm H2O. Las medidas ventilatorias e higrométricas incluyeron: humedad relativa (HR) humedad absoluta (AH), temperature (T), Pplat, PIP, PEEP, pico de flujo inspiratorio (PIF) y volumen tidal (Vt). Resultados: Para cada grupo de FiO2 FP detectó valores similares de humedad absoluta (HA) en comparación con IT y RP (p<0,001), independientemente del nivel IPAP utilizado. Se registró un incremento significativo de la HA en todos los grupos medidos con IT y RP conforme aumentaron los valores de IPAP (p<0,001), excepto en el grupo de FiO2, igual a 0,3 medido con RP. Los valores de PIP, Pplat, PEEP, PIF y Vt resultaron significativamente más elevados con FP y RP en cada grupo FiO2 en comparación con IT (p < 0 ,001). Conclusiones: La evaluación de la humidificación varió significativamente entre los 3 circuitos, siendo FP el único capaz de mantener estables los valores de HA durante el estudio sin influencia alguna de los parámetros ventilatorios


Assuntos
Humanos , Umidificadores/normas , Mecânica Respiratória , Ventilação não Invasiva/instrumentação , Manuseio das Vias Aéreas/instrumentação , Pico do Fluxo Expiratório , Análise de Variância , Ventilação não Invasiva/métodos , Ventilação não Invasiva/tendências
6.
Niger J Clin Pract ; 23(1): 91-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929213

RESUMO

Background: Due to the prolonged use of face mask in noninvasive ventilation, pressure ulcer is a common complication. Pressure ulcer can occur within a few hours at the site where the mask contacts in 2-70% of cases. Aims: The aim of this study is to conduct a randomized controlled trial to investigate the effects of transparent film use on the duration of pressure ulcer formation in the nasal region in patients undergoing noninvasive ventilation. Methods: This study was a randomized controlled trial. 46 patients who met the sample selection criteria and agreed to participate in the study were included in the study at a university hospital in Izmir, Turkey. Of them, 25 were assigned to the intervention group and 21 to the control group. Data were collected using the Socio-demographic and Disease-related Characteristics Questionnaire, The Noninvasive Ventilation Parameters Monitoring Form, and The Pressure Ulcer Classification Form at 4-hour intervals. Results: The duration of pressure ulcer formation in intervention group was longer than that in control group, and the difference between them was statistically significant (P < 0.05). Conclusion: In this study, the use of nasal protective film (transparent film) prolonged the duration of pressure ulcer formation on the nasal bridge in patients who underwent noninvasive mechanical ventilation.


Assuntos
Máscaras/efeitos adversos , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/instrumentação , Lesão por Pressão/etiologia , Insuficiência Respiratória/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Fita Cirúrgica , Turquia
7.
Med. intensiva (Madr., Ed. impr.) ; 44: 1-30, 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186897

RESUMO

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente, que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente, la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrolla una enfermedad grave que requiere hospitalización y oxígeno, y el 5% puede requerir ingreso en una Unidad de Cuidados Intensivos (1). En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica delDolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos. Palabras clave: Ventilación mecánica no invasiva, terapia nasal de alto flujo, procedimientos generadores de aerosoles, control de infección. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos


Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus , that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit (1). In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials


Assuntos
Humanos , Adulto , Síndrome Respiratória Aguda Grave/terapia , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Betacoronavirus , Insuficiência Respiratória/etiologia , Síndrome Respiratória Aguda Grave/complicações , Doenças Transmissíveis Emergentes , Oxigenoterapia , Administração Intranasal , Ventilação não Invasiva/instrumentação , Pandemias , Sociedades Médicas/normas , Espanha
10.
Medicine (Baltimore) ; 98(27): e15998, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277092

RESUMO

RATIONALE: Rigid bronchoscopy under general anesthesia enables performing diagnostic and/or therapeutic procedures in the tracheobronchial tree. As most patients undergoing rigid bronchoscopy have moderate to severe respiratory disease or central airway obstruction, the operators often face the risk of hypoxemia when inserting the rigid bronchoscope into the patients' airway. Applying high flow nasal cannula (HFNC) oxygen therapy before the insertion of the bronchoscope allows to maintain high fractional inspired oxygen (FiO2) and thus leading to maximizing apnea time before desaturation. PATIENT CONCERNS AND DIAGNOSIS: Case 1: A 70-year-old female patient was diagnosed with lung cancer in the left lower lobe and a tracheal mass of about 2.6 cm * 0.8 cm in size.Case 2: A male patient, 77 years old, 55.7 kg and 157.3 cm in height, had been diagnosed with chronic obstructive pulmonary disease, and was scheduled for the bronchoscopic volume reduction surgery upon exacerbation of his symptoms of dyspnea and cough with sputum. INTERVENTIONS: Preoxygenation was performed with HFNC (Fisher&Paykel Optiflow Thrive, New Zealand) for 3 minutes before the administration of anesthetic medications. The oxygen flow was set at 50 L/min and the FiO2 at 1.0. SpO2 increased to 100%. OUTCOMES: The HFNC oxygen has shown its effectiveness in safely maintaining the patients' SpO2 during the prolonged apneic period of inserting bronchoscope. LESSONS: HFNC oxygen is an effective tool in oxygenating the patients during the induction of rigid bronchoscopy, and that it may be a superior alternative to the conventional method of preoxygenation.


Assuntos
Anestesia Geral/métodos , Broncoscopia/métodos , Neoplasias Pulmonares/cirurgia , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Idoso , Cânula , Feminino , Humanos , Hipóxia/prevenção & controle , Masculino , Ventilação não Invasiva/instrumentação
11.
Eur J Pediatr ; 178(8): 1237-1242, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187264

RESUMO

Heated, humidified, high-flow nasal cannula (HHHFNC) is increasingly being used, but there is a paucity of evidence as to the optimum flow rates in prematurely born infants. We have determined the impact of three flow rates on the work of breathing (WOB) assessed by transcutaneous diaphragm electromyography (EMG) amplitude in infants with respiratory distress or bronchopulmonary dysplasia (BPD). Flow rates of 4, 6 and 8 L/min were delivered in random order. The mean amplitude of the EMG trace and mean area under the EMG curve (AEMGC) were calculated and the occurrence of bradycardias and desaturations recorded. Eighteen infants were studied with a median gestational age of 27.8 (range 23.9-33.5) weeks and postnatal age of 54 (range 3-122) days. The median flow rate prior to the study was 5 (range 3-8) L/min and the fraction of inspired oxygen (FiO2) was 0.29 (range 0.21-0.50). There were no significant differences between the mean amplitude of the diaphragm EMG and the AEGMC and the number of bradycardias or desaturations between the three flow rates.Conclusions: In infants with respiratory distress or BPD, there was no advantage of using high (8 L/min) compared with lower flow rates (4 or 6 L/min) during support by HHHFNC. What is known: • Humidified high flow nasal cannulae (HHHFNC) is increasingly being used as a non-invasive form of respiratory support for prematurely born infants. • There is a paucity of evidence regarding the optimum flow rate with 1 to 8 L/min being used. What is new: • We have assessed the work of breathing using the amplitude of the electromyogram of the diaphragm at three HHHFNC flow rates in infants with respiratory distress or BPD. • No significant differences were found in the EMG amplitude results or the numbers of bradycardias or desaturations at 4, 6 and 8 L/min.


Assuntos
Displasia Broncopulmonar/terapia , Diafragma/fisiologia , Eletromiografia , Ventilação não Invasiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Trabalho Respiratório/fisiologia , Displasia Broncopulmonar/fisiopatologia , Cânula , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Ventilação não Invasiva/instrumentação , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Resultado do Tratamento
12.
Crit Care ; 23(1): 180, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101127

RESUMO

BACKGROUND: The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes. METHOD: We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs) and crossover studies were included. The main outcome was postextubation respiratory failure. RESULTS: Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen therapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce postextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized mean differences (SMD), - 0.70; 95% CI, - 1.16, - 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay, comfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group. CONCLUSIONS: Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.


Assuntos
Cânula/normas , Oxigenoterapia/instrumentação , Oxigênio/administração & dosagem , Extubação/métodos , Humanos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Ventilação não Invasiva/normas , Oxigênio/uso terapêutico , Oxigenoterapia/métodos , Recidiva , Desmame do Respirador/métodos
15.
Curr Opin Anaesthesiol ; 32(2): 150-155, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817387

RESUMO

PURPOSE OF REVIEW: High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS: Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. SUMMARY: Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment.


Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Cuidados Críticos/métodos , Ventilação não Invasiva/efeitos adversos , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/fisiopatologia , Cânula , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Nariz , Oxigenoterapia/efeitos adversos , Oxigenoterapia/instrumentação , Seleção de Pacientes , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Resultado do Tratamento
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(1): 118-121, 2019 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-30707882

RESUMO

OBJECTIVE: To apply the concept of evidence-based nursing to the practice of non-invasive ventilation, and to introduce the method of using self-made pressure-resistant cap cotton cover and its application effect. METHODS: Fifty patients on non-invasive ventilation admitted to intensive care unit (ICU) of Harrison International Peace Hospital Affiliated to Hebei Medical University from September 2017 to April 2018 were enrolled as observation group. By retrieved the relevant literature at home and abroad to look for clinical evidence, the concept of evidence-based nursing care program was formulated and implemented, and self-made pressure-resistant cap cotton cover was used to prevent facial pressure sores in patients on non-invasive ventilation. Forty non-invasive ventilation patients admitted from January to August in 2017 were enrolled as the historical control group, and conventional nursing was conducted by using traditional hydrocolloid dressings to prevent pressure ulcers. The incidence of facial pressure ulcers, ocular complications, dressing replacement time and cost were compared between the two groups. RESULTS: All patients were enrolled in the final analysis. The incidence of pressure ulcers in the observation group was significantly lower than that in the control group [4.0% (2/50) vs. 22.5% (9/40), P < 0.05], and the incidences of ocular complications such as eyelid swelling [2.0% (1/50) vs. 5.0% (2/40)], conjunctival congestion [2.0% (1/50) vs. 5.0% (2/40)] and irritant keratitis [0% (0/50) vs. 7.5% (3/40)] were also significantly lower than those in the control group (P < 0.05). Because the pressure-resistant cap cotton cover made by ourselves was easy to be replaced at any time, the interval time of dressing change in the observation group was significantly shorter than that in the control group (minutes: 1.5±0.5 vs. 2.0±0.5, P < 0.05). In addition it could be cleaned, used alternately, and the cost was low, so the dressing cost in the observation group was significantly lower than that in the control group (Yuan: 30±10 vs. 123±20, P < 0.01). CONCLUSIONS: The application of self-made pressure-resistant cap cotton cover could obviously reduce the occurrence of complications such as facial pressure sores in patients on non-invasive ventilation.


Assuntos
Ventilação não Invasiva/instrumentação , Lesão por Pressão/prevenção & controle , Prática Clínica Baseada em Evidências , Face , Humanos , Unidades de Terapia Intensiva , Pressão/efeitos adversos , Lesão por Pressão/epidemiologia
17.
Crit Care ; 23(1): 2, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616669

RESUMO

BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients. METHODS: We performed a prospective, sequential, non-randomized and single-centre study. Two recording periods of 60 min of airway pressure, flow, and electrical activity of the diaphragm during PSV and NAVA were recorded in a random assignment and eight periods of 1 min were analysed for each mode. We searched for macro-asynchronies (ineffective, double, and auto-triggering) and micro-asynchronies (inspiratory trigger delay, premature, and late cycling). The number and type of asynchrony events per minute and asynchrony index (AI) were determined. The two respiratory phases were compared using the non-parametric Wilcoxon test after testing the equality of the two variances (F-Test). RESULTS: Among the 61 patients analysed, the total AI was lower in NAVA than in PSV mode: 2.1% vs 14% (p < 0.0001). This was mainly due to a decrease in the micro-asynchronies index: 0.35% vs 9.8% (p < 0.0001). The occurrence of macro-asynchronies was similar in both ventilator modes except for double triggering, which increased in NAVA. The tidal volume (ml/kg) was lower in NAVA than in PSV (5.8 vs 6.2, p < 0.001), and the respiratory rate was higher in NAVA than in PSV (28 vs 26, p < 0.05). CONCLUSION: NAVA appears to be a promising ventilator mode in tracheotomised patients, especially for those requiring prolonged weaning due to the decrease in asynchronies.


Assuntos
Suporte Ventilatório Interativo/métodos , Vias Neurais/fisiologia , Respiração Artificial/normas , Traqueostomia/métodos , Idoso , Feminino , França , Humanos , Suporte Ventilatório Interativo/instrumentação , Suporte Ventilatório Interativo/normas , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Respiração com Pressão Positiva/métodos , Estudos Prospectivos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Índice de Gravidade de Doença , Escala Psicológica Aguda Simplificada , Traqueostomia/normas , Desmame do Respirador/instrumentação , Desmame do Respirador/métodos
19.
J Clin Anesth ; 54: 19-24, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30391445

RESUMO

STUDY OBJECTIVE: Morbid obesity is associated with adverse airway events including desaturation during deep sedation. Prior works have suggested that proprietary high-flow nasal cannula devices generate positive pressure to all airway structures and may be superior to standard (low-flow) nasal cannula for prevention of desaturation. We hypothesized that, at a similar fraction of inspired oxygen (FiO2), use of a High-Flow Nasal Cannula (HFNC) at maximum flow rate would result in a lower incidence of intra-procedural desaturation episodes in morbidly obese patients compared to standard nasal cannula (SNC) during deep sedation with propofol. DESIGN: This is a pragmatic, prospective, randomized clinical trial at one hospital (NCT03148262, UTSW#112016-058). Morbidly obese patients were randomized to HFNC during propofol sedation for colonoscopy. HFNC was performed using maximum flow rates of 60 liters per minute (LPM) and FiO2 of 0.36-0.40, whereas SNC was performed at 4LPM. The primary endpoint was incidence of arterial oxygen desaturation <90% measured by pulse oximetry. At midpoint enrollment the Data Monitoring Committee (DMC) performed a pre-planned O'Brien and Fleming futility test. MAIN RESULTS: Patients were randomized to HFNC (n = 28) or SNC (n = 31). Interim analysis of the primary endpoint showed that the desaturation rates in the HFNC group (39.3%) and the SNC group (45.2%) were not significantly different (p = 0.79). The DMC halted the trial at that point due to futility. CONCLUSION: At similar FiO2, HFNC was not significantly different from SNC for prevention of arterial oxygen desaturation in morbidly obese patients undergoing propofol sedation for colonoscopy.


Assuntos
Colonoscopia/efeitos adversos , Sedação Profunda/efeitos adversos , Hipóxia/prevenção & controle , Ventilação não Invasiva/instrumentação , Obesidade Mórbida/complicações , Idoso , Cânula , Feminino , Humanos , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Dor Processual/prevenção & controle , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento
20.
J Prosthet Dent ; 121(1): 179-182, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30006225

RESUMO

The facial masks commercially available for noninvasive positive pressure ventilation therapy for children with clinical conditions of hypoventilation are limited by size and hardness. The present report describes a straightforward method of developing a nasal mask from a room-temperature vulcanizing silicone elastomer for daily contact with the nasal mucosa of babies during noninvasive positive pressure ventilation. The fabrication of the silicone mask with nasal tubes is based on maxillofacial prosthesis techniques, with retention with steel prongs and elastics.


Assuntos
Máscaras , Prótese Maxilofacial , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Elastômeros de Silicone , Prótese Dentária , Elasticidade , Desenho de Equipamento , Face , Humanos , Lactente , Mucosa Nasal
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