scholarly journals Effectiveness and applicability of Non-Invasive Ventilation (NIV) in the Emergency Department in acute respiratory failure due to Sars-CoV-2 pneumonia

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Federico Lari ◽  
Fabrizio Giostra ◽  
Stefania Guerrini
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
De Novo ◽  
Correct Identification ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Radiological Features ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure

Treatment of de novo acute hypoxic respiratory failure is not recommended by current Non-Invasive Ventilation (NIV) guidelines as it does not seem to improve patients outcome. Many cases of acute hypoxic respiratory failure associated with Sars-Cov2 infection (SARI) have been observed during Sars-Cov2 pandemic. So far, data are missing regarding the use of NIV, but a correct identification of subgroups of patients based on different clinical, patho-physiological and radiological features, might be helpful for stratifying patients and choosing the correct respiratory support (invasive versus non-invasive). In case of NIV appliance, risk of environmental virus dispersion is particularly elevated; therefore, extreme attention by operators is required.

scholarly journals Non-Invasive Ventilation in the Elderly at Emergency Department: Epidemiological Data and Results

2020 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Elderly People ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Hospital Data ◽  
Non Invasive ◽  
Non Invasive Ventilation

Introduction: Non-invasive ventilation (NIV) could be a good alternative in elderly people with acute respiratory failure (ARF), to procure them a respiratory support while avoiding as much as possible the complications of invasive ventilation. Methods: This is an observational retrospective study conducted at the emergency department (ED) of a tertiary care, university-based teaching hospital. Data of elderly patients (≥ 65 years) admitted to ED between January 2017 and April 2018 for ARF and requiring NIV were collected and analyzed using SPSS 22 software. Results: Sixty six patients (≥ 65 years) requiring NIV for acute respiratory failure (ARF) were included. The mean age was 76 years (± 7), the median Charlson index was 5. Acute respiratory failure was related to acute heart failure in 68%, acute exacerbation of chronic obstructive pulmonary disease in 53% and pneumonia in 39% of cases. Forty eight percent had more than one etiologic diagnosis. Hypercapnic acute respiratory failure was observed in 61%. On initiation of NIV, the average pH was 7.31 (± 0.11) and PaCO2 56 mmHg (± 21), After NIV, the average pH was 7.38 (± 0.11) and PaCO2 53 mmHg (± 26). Improvement of pH was significant (p < 0.05). 61% of patients were discharged at home, 9% were admitted to intensive care unit. Invasive ventilation was performed in 4%, of which 23% died. Success of NIV was observed in 68% of patients. Conclusion: NIV can be of a great interest in elderly people. Our study showed that it can be used successfully in the studied settings.

scholarly journals Risk Factors for Non-invasive Ventilation Failure in Influenza Infection with Acute Respiratory Failure in Emergency Department

2020 ◽  
Author(s):  
Karn Suttapanit ◽  
Jeeranun Boriboon ◽  
Pitsucha Sanguanwit
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Sofa Score ◽  
Chest Radiography ◽  
Influenza Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract BackgroundNon-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in emergency department (ED). However, the benefit of NIV in decreasing intubation rate remains controversial. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aims to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED.MethodWe perform a retrospective cohort observational study. Enrolled patients older than 18 years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical and laboratory outcome, chest imaging, NIV setting and parameter were recorded. We follow the outcome success or failure of the NIV used.Results162 patients were enrolled, 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included sequential organ failure assessment (SOFA) score (P = 0.001), PaO2/FiO2 (PF) ratio (P = 0.001) and quadrant infiltrations in chest x-rays (CXR) (P = 0.001). SOFA score, PF ratio and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (0.839 - 0.948), 0.828 (0.764 - 0.892) and 0.792 (0.721 – 0.863), respectively and no significant difference in the ability to predict NIV failure between three parameters. Use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated higher predictive ability for NIV failure in influenza infection with ARF.ConclusionsSOFA score, PF ratio and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits

2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.

scholarly journals Effectiveness of non-invasive ventilation in acute respiratory failure of obese patients: a brief narrative review

2018 ◽  
Vol 12 (1) ◽  
pp. 5
Author(s):  
Maurizio Alessandro Cavalleri ◽  
Elena Barbagelata ◽  
Marco Scudeletti ◽  
Antonello Nicolini
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Obese Patients ◽  
Invasive Ventilation ◽  
Acute Setting ◽  
Non Invasive ◽  
High Severity ◽  
Non Invasive Ventilation ◽  
Hypoventilation Syndrome ◽  
High Severity Score

Non-invasive ventilation (NIV) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades compared to prior decades; nevertheless, NIV can have failure rates ranging from 5% to 50%. However, there are particular groups of patients that are more likely to benefit from NIV. One of these groups is patients with hypoventilation syndrome (OHS). The aim of this review is to seek evaluation of the effectiveness of NIV in acute setting. Only a few studies have investigated NIV success or failure in OHS patients. More than 30% of them were diagnosed when hospitalized for ARF. NIV rarely failed in reversing ARF. OHS patients who exhibited early NIV failure had a high severity score and a low HCO3 level at admission; more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS have a better prognosis and response to NIV than other hypercapnic patients. They require more aggressive NIV settings, a longer time to reduce PaCO2 levels, and more frequently a delayed but successful response to NIV.

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