scholarly journals Comment on “Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study”

2019 ◽  
Vol 2019 ◽  
pp. 1-2 ◽  
Author(s):  
Habib Md. Reazaul Karim ◽  
Antonio M. Esquinas
Keyword(s):  
Respiratory Failure ◽  
Observational Study ◽  
Noninvasive Ventilation ◽  
Real Life ◽  
Copd Exacerbation ◽  
Hypercapnic Respiratory Failure ◽  
Ventilation Weaning ◽  
Acute Hypercapnic Respiratory Failure

scholarly journals Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Paola Faverio ◽  
Anna Stainer ◽  
Federica De Giacomi ◽  
Grazia Messinesi ◽  
Valentina Paolini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Real Life ◽  
Chronic Obstructive ◽  
British Thoracic Society ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Hypercapnic Respiratory Failure ◽  
Ventilation Weaning ◽  
Acute Hypercapnic Respiratory Failure

The most recent British Thoracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering. However, a limited number of studies evaluated the phase of NIV weaning. The aim of this study is to describe the NIV weaning protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients’ characteristics, clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group). Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described, our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients.

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

2020 ◽  
Vol 41 (06) ◽  
pp. 786-797
Author(s):  
Miquel Ferrer ◽  
Antoni Torres
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Noninvasive Ventilation ◽  
Work Of Breathing ◽  
High Flow ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hypercapnic Respiratory Failure ◽  
Acute Hypercapnic Respiratory Failure

AbstractNoninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory efficiency and reducing the work of breathing in patients with severe chronic obstructive pulmonary disease. Early studies indicate that some patients with acute hypercapnic respiratory failure can be managed with high-flow nasal therapy, but more information is needed before specific recommendations for this therapy can be made. Therefore, high-flow nasal therapy use should be individualized in each particular situation and institution, taking into account resources, and local and personal experience with all respiratory support therapies.

Efficacy of Helmet as Interface for Noninvasive Ventilation (NIV) in Acute Hypercapnic Respiratory Failure (AHRF)

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 946A ◽  
Author(s):  
Luca Fasano ◽  
Chiara Mega ◽  
Lara Pisani ◽  
Paolo Navalesi ◽  
Andrea Bellone ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Hypercapnic Respiratory Failure ◽  
Acute Hypercapnic Respiratory Failure
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