scholarly journals Respiratory Care Year in Review 2010: Part 2. Invasive Mechanical Ventilation, Noninvasive Ventilation, Pediatric Mechanical Ventilation, Aerosol Therapy

2011 ◽  
Vol 56 (5) ◽  
pp. 667-680 ◽  
Author(s):  
N. R. MacIntyre ◽  
S. Nava ◽  
R. M. DiBlasi ◽  
R. D. Restrepo ◽  
D. R. Hess
Keyword(s):  
Mechanical Ventilation ◽  
Noninvasive Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Care ◽  
Aerosol Therapy

scholarly journals Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Rosanna Vaschetto ◽  
Alessandro Pecere ◽  
Gavin D. Perkins ◽  
Dipesh Mistry ◽  
Gianmaria Cammarota ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Noninvasive Ventilation ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Patient Data ◽  
Controlled Trials ◽  
Early Extubation ◽  
Randomized Controlled

Abstract Background Usefulness of noninvasive ventilation (NIV) in weaning patients with non-hypercapnic hypoxemic acute respiratory failure (hARF) is unclear. The study aims to assess in patients with non-hypercapnic hARF, the efficacy of NIV after early extubation, compared to standard weaning. Methods In this individual patient data meta-analysis, we searched EMBASE, Medline and Cochrane Central Register of Controlled Trials to identify potentially eligible randomized controlled trials published from database inception to October 2020. To be eligible, studies had to include patients treated with NIV after early extubation and compared to conventional weaning in adult non-hypercapnic hARF patients. Anonymized individual patient data from eligible studies were provided by study investigators. Using one-step and two-step meta-analysis models we tested the difference in total days spent on invasive ventilation. Results We screened 1605 records. Six studies were included in quantitative synthesis. Overall, 459 participants (mean [SD] age, 62 [15] years; 269 [59%] males) recovering from hARF were included in the analysis (233 in the intervention group and 226 controls). Participants receiving NIV had a shorter duration of invasive mechanical ventilation compared to control group (mean difference, − 3.43; 95% CI − 5.17 to − 1.69 days, p < 0.001), a shorter duration of total days spent on mechanical ventilation (mean difference, − 2.04; 95% CI − 3.82 to − 0.27 days, p = 0.024), a reduced risk of ventilatory associated pneumonia (odds ratio, 0.24; 95% CI 0.08 to 0.71, p = 0.014), a reduction of time spent in ICU (time ratio, 0.81; 95% CI 0.68 to 0.96, p = 0.015) and in-hospital (time ratio, 0.81; 95% CI 0.69 to 0.95, p = 0.010), with no difference in ICU mortality. Conclusions Although primary studies are limited, using an individual patient data metanalysis approach, NIV after early extubation appears useful in reducing total days spent on invasive mechanical ventilation. Trial registration The protocol was registered to PROSPERO database on 12/06/2019 and available at PROSPERO website inserting the study code i.e., CRD42019133837.

scholarly journals Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Satoshi Ikeda ◽  
Toshihiro Misumi ◽  
Shinyu Izumi ◽  
Keita Sakamoto ◽  
Naoki Nishimura ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Critically Ill ◽  
Noninvasive Ventilation ◽  
Clinical Status ◽  
Invasive Mechanical Ventilation ◽  
Hospitalized Patients ◽  
Radiological Findings ◽  
Corticosteroid Administration ◽  
Matched Study

AbstractCorticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score–matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January–April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388–0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323–2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841–2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347–5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).

scholarly journals Noninvasive ventilation during the weaning process in chronically critically ill patients

2016 ◽  
Vol 2 (4) ◽  
pp. 00061-2016 ◽  
Author(s):  
Jesus Sancho ◽  
Emilio Servera ◽  
Luis Jara-Palomares ◽  
Emilia Barrot ◽  
Raquel Sanchez-Oro-Gómez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Noninvasive Ventilation ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Spontaneous Breathing ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Care ◽  
Spontaneous Breathing Trials ◽  
Chronically Critically Ill

Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process.We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h.231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97).NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

scholarly journals EXPERIENCE WITH THE USE OF NONINVASIVE VENTILATION IN CANCER PATIENTS AFTER LOBECTOMY

2018 ◽  
pp. 98-103
Author(s):  
N. V. Krasnoselskyi ◽  
E. N. Krutko ◽  
O. N. Yurchenko ◽  
О. А. Halushko
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Cancer Patients ◽  
Noninvasive Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Blood Gases ◽  
Lung Ventilation ◽  
Early Postoperative Period ◽  
Surgical Operations ◽  
Local Protocol

With the appearance of the modern devices for noninvasive ventilation (NIAVL) in our country, the interest to this issue has increased even more, because the use of a simple, atraumatic method of ventilation allows to avoid intubation and of invasive mechanical ventilation through an endotracheal tube with their complications for some patients. The purpose of the study was to investigate the effectiveness and indications for the use of noninvasive ventilation in cancer patients which underwent surgical operations on the thoracic organs. Since 2013, 34 patients who underwent surgical treatment on the thoracic organs have been examined. Patients were divided into two groups. The first group included patients (n = 24), which received noninvasive lung ventilation (NIAVL) in the early postoperative period. The second group consisted of patients (n = 10) that were treated according to the local protocol. The use of NIAVL in patients that were operated on the chest organs proved to be effective as it improved hemodynamics and blood gases balance and it can prevent the development of respiratory failure.

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