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1.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32236089

RESUMO

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Controle de Infecções/métodos , Ventilação não Invasiva/métodos , Modalidades de Fisioterapia , Pneumonia Viral/etiologia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Terapia Respiratória/métodos , Infecções por Coronavirus/reabilitação , Cuidados Críticos , Dispneia/etiologia , Humanos , Hipóxia/complicações , Hipóxia/etiologia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Itália , Ventilação não Invasiva/normas , Pandemias , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Pronação , Respiração Artificial/normas , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/reabilitação , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/reabilitação , Dispositivos de Proteção Respiratória , Terapia Respiratória/normas
2.
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
3.
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
4.
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
5.
Pneumologie ; 74(3): 137-148, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31918445

RESUMO

Nasal high-flow provides a stable oxygenation in acute hypoxemic respiratory failure, modifies breathing patterns, reduces work of breathing and can decrease hypercapnia. Thereby NHF provides more features than low-flow oxygen and acts as a ventilatory support device. Different studies show benefits of NHF compared to NIV. For these reasons we will discuss the capabilities of NHF and NIV in selected settings.


Assuntos
Pulmão/fisiopatologia , Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Oxigênio/administração & dosagem , Respiração com Pressão Positiva/métodos , Insuficiência Respiratória/terapia , Trabalho Respiratório/fisiologia , Humanos , Hipercapnia/prevenção & controle , Resultado do Tratamento
6.
Saudi Med J ; 40(10): 989-995, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31588476

RESUMO

OBJECTIVES: To compare the occurrence of gastric insufflation during anesthesia induction in patients undergoing laparoscopic cholecystectomy, using facemask ventilation with different ventilation volumes. METHODS: This is a prospective study of 54 patients undergoing laparoscopic cholecystectomy under general anesthesia between January 2018 and June 2018. Facemask ventilation with volume mode controlled at 6 ml/kg (group V6), 8 ml/kg (group V8) or 10 ml/kg (group V10) was applied for 120 seconds (sec) during anesthesia induction. Before facemask ventilation and at 120 sec of facemask ventilation, gastric insufflation was determined by ultrasonography. Gastric insufflation was also evaluated using direct vision of laparoscopy. Respiratory parameters were monitored. RESULTS: The incidence of gastric insufflation in group V10 (55.6%) was significantly higher than that in groups V6 (11.1%) and V8 (16.7%). However, it showed no significant difference between groups V6 and V8. During facemask ventilation for 120 sec, carbon dioxide accumulation trend occurred in group V6, and group V10 exhibited evidence of hyper-ventilation. Group V8 might be considered the best balance between low gastric insufflation and effective lung ventilation. CONCLUSION: Facemask ventilation with a ventilation volume of 8 ml/kg seems to have adequate preoxygenation and avoid excessive gastric insufflation during anesthesia induction in laparoscopic cholecystectomy.


Assuntos
Anestesia Geral/métodos , Colecistectomia Laparoscópica/métodos , Ventilação não Invasiva/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Feminino , Humanos , Insuflação , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Estudos Prospectivos , Estômago
7.
Zhonghua Er Ke Za Zhi ; 57(10): 792-796, 2019 Oct 02.
Artigo em Chinês | MEDLINE | ID: mdl-31594067

RESUMO

Objective: To study the short-term and long-term efficacy of the non-invasive ventilation treatment in children with spinal muscular atrophy (SMA) and sleep-disordered breathing. Methods: This was a prospective research to study the effect of night-time non-invasive ventilation in children with SMA and moderate to severe sleep-disordered breathing during March 2016 to January 2018, from the Pulmonary Department of Capital Institute of Pediatrics Affiliated Children's Hospital. Patients were divided into the treated group (with night-time non-invasive ventilation) and the control group (without ventilator). Sleep breathing pressure titration was suggested to the patients who were prepared to receive non-invasive ventilation. All cases were followed up for one year. Parameters'changes in polysomnography were assessed (paired t-test) in titration patients. Frequency of respiratory tract infection during the next year in the patients with and without ventilation was collected and compared (Mann-Whitney U-test). Results: Seventeen cases were recruited. The average age was (5.1±2.9) years, 10 cases were boys and 7 cases were girls. In the titration group (8 patients), after non-invasive ventilation, the average apnea hypopnea index was (3.8±2.5) times/h (t=4.086, P=0.005), hypopnea index was (2.4±1.2) times/h (t=2.779, P=0.027), average oxygen saturation during total sleep time was 0.966±0.007 (t=-5.292, P=0.001), and the minimum oxygen saturation was 0.906±0.023 (t=-3.938, P=0.006). All the above parameters were significantly improved after treatment. Than before, which was (16.6±9.7) times/h, (7.2±4.7) times/h, 0.946±0.015, 0.786±0.092 respectively. Ventilator mode for the 9 children with long time non-invasive ventilation at home was Bi-level positive airway pressure S/T. The positive airway pressure was set at 8-14 cmH(2)O (1 cmH(2)O=0.098 kPa) in inspiratory phase and 4-6 cmH(2)O in expiratory phase. In the treated group (9 patients), the average frequency of upper respiratory tract infection was 1.0 (0, 3.0) times/year (Z=-2.245, P=0.023), the lower respiratory tract infection was 0 (0, 0) times/year (Z=-3.189, P=0.001), hospitalization was 0 (0, 0) times/year (Z=-3.420, P<0.01), and admission to intensive care unit was 0 (0, 0) times/year (Z=-3.353, P=0.029). All the above indexes were significantly decreased compared with the control group (8 patients), which was 3.0 (2.3, 7.0) times/year, 2.0 (1.3, 4.5) times/year, 1.0 (1.0, 4.3) times/year, 0.5 (0, 1.0) times/year respectively. Conclusion: Non-invasive ventilation is efficient to SMA children with sleep-disordered breathing, and also can reduce the incidence of respiratory tract infections for children with SMA.


Assuntos
Ventilação não Invasiva/métodos , Síndromes da Apneia do Sono/terapia , Atrofias Musculares Espinais da Infância/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ventilação não Invasiva/efeitos adversos , Polissonografia , Estudos Prospectivos , Síndromes da Apneia do Sono/diagnóstico , Atrofias Musculares Espinais da Infância/diagnóstico , Resultado do Tratamento
8.
Ann Acad Med Singapore ; 48(7): 224-232, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31495868

RESUMO

INTRODUCTION: Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure. MATERIALS AND METHODS: This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared. RESULTS: There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4- 187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; P <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; P = 0.004). Overall mortality rate was 32.1% (17/53). CONCLUSION: The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Hipóxia/terapia , Ventilação não Invasiva/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Lactente , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal , Tempo de Internação , Masculino , Mortalidade , Escores de Disfunção Orgânica , Oxigênio/metabolismo , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Trabalho Respiratório
10.
Eur. respir. j ; 54(3)Sept. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026241

RESUMO

While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients. The European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients. The task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode. Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.


Assuntos
Humanos , Ventilação não Invasiva/enfermagem , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Hipercapnia/complicações
11.
J Pak Med Assoc ; 69(8): 1146-1149, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431769

RESUMO

OBJECTIVE: The aim was to access the effectiveness of Bilevel Positive Airway Pressure (BiPAP) in patients with type II respiratory failure secondary to Post Tuberculosis (TB) sequelae and determine the factors that can predict its success. PostTB pulmonary sequelae are complications after healing of TB and type II respiratory failure is frequently encountered in this group. . METHODS: This prospective study was carried out in the department of Chest Medicine, Jinnah Postgraduate Medical Center Karachi. (JPMC) Total 78 patients, between 20-80 years of age having hypercapnic respiratory failure, were included. Patients were given BiPAP along with standard treatment. RESULTS: Among 78 patients, 45 (56.3%) were males and 33 (43.7%) were females. Patients mean age was 50.6 } 15.76 years. The BiPAP success rate was 70.5% (55/78). There is significant difference in age (p=0.008), duration of disease (p=0.021), baseline pH (p=0.00), PaCO2 (p=0.004), Glasgow Coma Score (p=0.031), Chest X-ray (p<0.05) and systolic blood pressure (p=0.007) between responders and non-responders. Improvement in Abgs and vitals was observed among responders following 3 hours of therapy while pH drops significantly at 3 hours in non-responders. CONCLUSIONS: This study reveals that BiPAP is also efficacious method in patients with Type II respiratory failure post TB sequelae. Potential non responders can be identified relatively early in course of treatment and considered for ventilator.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Hipercapnia/terapia , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Tuberculose Pulmonar/complicações , Adulto , Fatores Etários , Idoso , Gasometria , Pressão Sanguínea , Feminino , Escala de Coma de Glasgow , Humanos , Concentração de Íons de Hidrogênio , Hipercapnia/etiologia , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Prognóstico , Radiografia Torácica , Insuficiência Respiratória/sangue , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Fatores de Tempo
12.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F655-F659, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31296694

RESUMO

Non-invasive ventilation and especially the application of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems. However, CPAP failure may occur due to respiratory distress syndrome, that is, surfactant deficiency. Less invasive surfactant administration (LISA) aims to provide an adequate dose of surfactant while the infant is breathing spontaneously, thus avoiding positive pressure ventilation support. Using a thin catheter for surfactant application allows infants to maintain function of the glottis and continue spontaneous breathing, whereas the INtubate-SURfactant-Extubate (INSURE) procedure is connected with sedation/analgesia, regular intubation and a (brief) period of positive pressure ventilation. Individual studies and meta-analyses summarised in this review point in the direction that LISA is more effective than standard treatment or INSURE both in terms of short-term (avoidance of mechanical ventilation) and long-term (intracerebral haemorrhage and bronchopulmonary dysplasia) outcomes. Open questions include exact treatment thresholds for different gestational ages, the usefulness of devices/catheters that have recently been purpose-built for the LISA technique and especially the question of analgesia/sedation during the procedure. The current technology still demands laryngoscopy with all its unpleasant effects for infants. Therefore, studies with pharyngeal surfactant deposition immediately after delivery, the use of laryngeal airways for surfactant administration and attempts to nebulise surfactant are under way. Finally, LISA is not simply an isolated technical procedure for surfactant delivery but rather part of a comprehensive non-invasive approach supporting the concept of a gentle transition to the extrauterine world enabling preterm infants to benefit from the advantages of spontaneous breathing.


Assuntos
Recém-Nascido Prematuro , Ventilação não Invasiva/métodos , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Idade Gestacional , Humanos , Recém-Nascido , Surfactantes Pulmonares/administração & dosagem
13.
BMC Pulm Med ; 19(1): 131, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319839

RESUMO

BACKGROUND: Noninvasive ventilation (NIV) reduces the rate of endotracheal intubation (ETI) and overall mortality in severe acute exacerbation of COPD (AECOPD) with acute respiratory failure and is increasingly applied in respiratory intermediate care units. However, inadequate patient selection and incorrect management of NIV increase mortality. We aimed to identify factors that predict the outcome of NIV in AECOPD. Also, we looked for factors that influence ventilator settings and duration. METHODS: A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2016 and 2017. Age, BMI, lung function, arterial pH and pCO2 at admission (t0), at 1-2 h (t1) and 4-6 h (t2) after admission, creatinine clearance, echocardiographic data (that defined left heart dysfunction), mean inspiratory pressure during the first 72 h (mIPAP-72 h) and hours of NIV during the first 72 h (dNIV-72 h) were recorded. Main outcome was NIV failure (i.e., ETI or in-hospital death). Secondary outcomes were in-hospital mortality, length of stay (LOS), duration of NIV (days), mIPAP-72 h, and dNIV-72 h. RESULTS: We included 89 patients (45 male, mean age 67.6 years) with AECOPD that required NIV. NIV failure was 12.4%, and in-hospital mortality was 11.2%. NIV failure was correlated with days of NIV, LOS, in-hospital mortality (p < 0.01), and kidney dysfunction (p < 0.05). In-hospital mortality was strongly associated with days of NIV (OR 1.27, 95%CI: 1.07-1.5, p < 0.01) and with FEV1 (p < 0.05). All other investigated parameters (including left heart dysfunction, dNIV-72 h, mIPAP-72 h, pH, etc.) did not influence NIV failure or mortality. dNIV-72 h and days of NIV were independent predictors of LOS (p < 0.01). Regarding the secondary outcomes, left heart dysfunction and pH at 1-2 h independently predicted NIV duration (dNIV-72 h, p < 0.01), while BMI and baseline pCO2 predicted NIV settings (mIPAP-72 h, p < 0.01). CONCLUSION: In-hospital mortality and NIV failure were not influenced by BMI, left heart dysfunction, age, nor by arterial blood gas values in the first 6 h of NIV. Patients with severe acidosis and left heart dysfunction required prolonged use of NIV. BMI and pCO2 levels influence the NIV settings in AECOPD regardless of lung function.


Assuntos
Mortalidade Hospitalar , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Gasometria , Progressão da Doença , Feminino , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Análise de Regressão , Unidades de Cuidados Respiratórios , Insuficiência Respiratória/mortalidade , Romênia/epidemiologia
14.
Prehosp Disaster Med ; 34(4): 454-455, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239002

RESUMO

Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/análise , Pressão Positiva Contínua nas Vias Aéreas/métodos , Doença Aguda , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Medição de Risco , Resultado do Tratamento
16.
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
18.
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
19.
BMC Neurol ; 19(1): 79, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043155

RESUMO

OBJECTIVE: Patients with severe brain injury is usual at high risk of extubation failure, despite of those with no/minor primary respiratory problem, majority of them still needs long term respiratory support and has severe pulmonary complications. This retrospective study aimed to compare the effect of noninvasive ventilation (NIV) and tracheotomy on the prognosis in critically ill mechanically ventilated neurosurgical patients. METHODS: This is a single center, retrospective observe cohort study. Postoperative patients with brain injury consecutively admitted to ICU from November 1st, 2015 through February 28th, 2017, who had received invasive mechanical ventilation more than 48 h were screened, those who received NIV or tracheotomy procedure, meanwhile with Glasgow Coma Scale (GCS) score between 8 and 13 points before using NIV or undergoing tracheotomy, were retrospectively included in this study. The demographic data and clinical main outcomes such as ICU and hospital mortality, time of mechanical ventilation, length of ICU and hospital were collected. The primary outcome was the incidence of postoperative pulmonary infection between two groups. RESULTS: 77 patients were included in this study. 33 patients received NIV, and 44 patients received tracheotomy through the ICU duration. The incidence of postoperative pulmonary infection in NIV group was significantly lower than that in tracheotomy group (54.5% VS 84.1%, P < 0.05), Application of NIV was associated with shorter duration of invasive mechanical ventilation ([median 123.0 h VS 195.0 h, P < 0.05). Moreover, GCS score at ICU discharge, as well as the difference of GCS score between at admission to ICU and ICU discharge were also better than the tracheotomy group (P < 0.001). CONCLUSION: Compared with tracheotomy, use of NIV after extubation in critically ill mechanically ventilated neurosurgical patients may be associated with lower incidence of postoperative pulmonary infection, shorter duration of invasive mechanical ventilation and better improvement in brain function. Further studies need to verify the effect of NIV in this kind of patients.


Assuntos
Ventilação não Invasiva/métodos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Traqueotomia/métodos , Adulto , Idoso , Extubação , Lesões Encefálicas/terapia , Estudos de Coortes , Estado Terminal , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Traqueotomia/efeitos adversos
20.
Paediatr Respir Rev ; 30: 16-24, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31076380

RESUMO

Bronchiolitis is a common viral disease that significantly affects infants less than 12 months of age. The purpose of this review is to present a review of the current knowledge of the uses of respiratory support in the management of infants with bronchiolitis presenting to hospital. We electronically searched MEDLINE, Cochrane, CINAHL and EMBASE (inception to 25th March 2018), to manually search for clinical trials that address the management strategies for respiratory support of infants with bronchiolitis. We identified 120 papers who met the inclusion criteria, of which 33 papers were relevant for this review with only nine randomized controlled trials. This review demonstrated that non-invasive respiratory support reduced the need for escalation of therapy, particularly the proportion of intubations required for infants with bronchiolitis. Additionally, clear economic benefits have been demonstrated when non-invasive ventilation has been used. The potential early use of non-invasive respiratory supports such as nasal high flow therapy and non-invasive ventilation may have an impact on health care costs and reduction in ICU admissions and intubation rates. High-grade evidence demonstrates safety and quality of high flow therapy in general ward settings.


Assuntos
Bronquiolite Viral/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/métodos , Oxigenoterapia/métodos , Respiração Artificial/métodos
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