British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Davidson, Craig; Banham, S. G.; Elliott, Mark; Kennedy, Daniel; Gelder, Colin; Glossop, Alastair J.; Church, Colin; Creagh-Brown, Ben; Dodd, James; Felton, Tim; Foëx, Bernard A; Mansfield, Leigh; McDonnell, Lynn; Parker, Robert; Patterson, Caroline; Sovani, Milind; Thomas, Lynn M.

doi:10.1136/bmjresp-2016-000133

Cited by 44 publications

(37 citation statements)

References 7 publications

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“…Thus, the staff should be guided by both the patient’s feedback and their own experience. According to recent British Thoracic Society (BTS) guidelines, the mask should be firm but not tight 41. Other approaches recommended to reduce the pressure of the interface on the facial skin include allowing 2 fingers’ distance between the harness and the facial skin and hanging the ventilator circuit to prevent movement of the interface 39.…”

Section: Risk Factors For Facial Pressure Ulcers Development and Theimentioning

confidence: 99%

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

Alqahtani¹,

AlAhmari²

2018

SMJ

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The last 2 decades have seen a growing trend towards the use of noninvasive ventilation (NIV) therapy in the management of many conditions that cause acute respiratory failure. However, there is a serious side effect that results in using these devices; the development of facial skin pressure damage, specifically pressure ulcers. This skin damage has a considerable effect on patients’ quality of life, treatment adherence and patients’ comfort in addition to the therapy challenges of wound care. The aim of this clinical review is to discuss the different characteristics of NIV interfaces and to provide evidence based recommendations to facilitate the selection and application of such interfaces to reduce NIV interfaces related pressure ulcers.

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Section: Risk Factors For Facial Pressure Ulcers Development and Theimentioning

confidence: 99%

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

Alqahtani¹,

AlAhmari²

2018

SMJ

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“…sory muscle use, and paradoxical abdominal motion. 1,11 Blood gas criteria for acute hypercapnic respiratory failure included at least a pH of Ͻ7.35 and P aCO 2 of Ͼ45 mm Hg. 1,11 The severity of hypercapnic coma was classified according to the scale of Kelly and Matthay 12 as follows: grade 1, alert, follows complex 3-step commands; grade 2, alert, follows simple commands; grade 3, lethargic but arousable and follows simple commands; grade 4, stuporous, only intermittently follows simple commands; grade 5, comatose with the brain stem intact; grade 6, comatose with brain stem dysfunction.…”

Section: What This Paper Contributes To Our Knowledge?mentioning

confidence: 99%

“…Despite the cumulative evidence that supports noninvasive ventilation (NIV) for acute hypercapnic respiratory failure, 1 NIV may be considered questionable for vulnerable patients with do-not-intubate orders, especially when hypercapnic coma occurs. However, NIV can relieve dys-pnea, improve comfort, and serve as a rescue therapy that can facilitate hospital discharge for some patients who are terminally ill and want to go home.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Frail Do-Not-Intubate Subjects With End-Stage Chronic Respiratory Failure and Their Opinion of Noninvasive Ventilation to Reverse Hypercapnic Coma

Lemyze

Palleja

Guiot³

et al. 2019

Respir Care

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BACKGROUND: The use of noninvasive ventilation (NIV) in the emergency setting to reverse hypercapnic coma in frail patients with end-stage chronic respiratory failure and do-not-intubate orders remains a questionable issue given the poor outcome of this vulnerable population. We aimed to answer this issue by assessing not only subjects' outcome with NIV but also subjects' point of view regarding NIV for this indication. METHODS: A prospective observational case-control study was conducted in 3 French tertiary care hospitals during a 2-y period. Forty-three individuals who were comatose (with pH < 7.25 and P aCO 2 > 100 mm Hg at admission) were compared with 43 subjects who were not comatose and who were treated with NIV for acute hypercapnic respiratory failure. NIV was applied by using the same protocol in both groups. They all had a do-notintubate order and were considered vulnerable individuals with end-stage chronic respiratory failure according to well-validated scores. RESULTS: NIV yielded similar outcomes in the 2 groups regarding in-hospital mortality (n ‫؍‬ 12 [28%] vs n ‫؍‬ 12 [28%] in the noncomatose controls, P > .99) and 6-month survival (n ‫؍‬ 28 [65%] vs n ‫؍‬ 22 [51%] in the noncomatose controls, P ‫؍‬ .31). Despite poor quality of life scores (21.5 ؎ 10 vs 31 ؎ 6 in the awakened controls, P ‫؍‬ .056) as assessed by using the VQ11 questionnaire 6 months to 1 y after hospital discharge, a large majority of the survivors (n ‫؍‬ 23 [85%]) would be willing to receive NIV again if a new episode of acute hypercapnic respiratory failure occurs. CONCLUSIONS: In the frailest subjects with supposed end-stage chronic respiratory failure that justifies treatment limitation decisions, it is worth trying NIV when acute hypercapnic respiratory failure occurs, even in the case of extreme respiratory acidosis with hypercapnic coma at admission.

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“…Noninvasive positive pressure ventilation (NPPV) has been shown to reduce mortality, the duration of hospitalization, and the intubation rate in patients with acute and chronic respiratory failure [1-3]. In acute settings, most patients on NPPV require aerosol inhalation therapy to moisturize the airways, as well as to deliver drugs such as bronchodilators, corticosteroids, mucolytics, and antibiotics [4].…”

Section: Introductionmentioning

confidence: 99%

Effect of Jet Nebulization on Noninvasive Positive-Pressure Ventilation Administered with Noninvasive or Intensive Care Unit Ventilators: A Bench Study

Dai

Peng

et al. 2018

Respiration

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Background: Most of the patients on noninvasive positive pressure ventilation require aerosol inhalation therapy to moisturize the airways or deliver drugs in acute settings. However, the effect of jet nebulization on noninvasive positive pressure ventilation (NPPV) has not been determined. Objectives: This study was designed to investigate the impact of jet nebulization on NPPV applied in ventilators. Methods: Aerosol therapy during NPPV was conducted in a simulated lung. The jet nebulizer was connected at both the distal and proximal end of the exhalation valve for the noninvasive ventilators, while it was placed both in front of the Y tube proximal to the patient and at 15 cm distance from the Y-tube inspiratory limb distal to the patient for the intensive care unit (ICU) ventilators. Driving flow was set at 4 and 8 L/min, respectively. Results: TP_min (time from the beginning of the lung simulator’s inspiratory effort to the lowest value of airway pressure needed to trigger the ventilator), T_trig (time to trigger), and P_trig (the magnitude of airway pressure drop needed to trigger) were not significantly altered by jet nebulization in the noninvasive ventilators, while they were significantly increased in the ICU ventilators. The greater the driving flow, the stronger the impact on TP_min, T_trig, and P_trig. The actual tidal volume and control performance were not significantly affected by jet nebulization in either noninvasive or ICU ventilators. The tidal volume monitored was significantly increased at 8 L/min driving flow. The greater the driving flow, the stronger the impact on the tidal volume monitored. Conclusion: The effect of jet nebulization on NPPV was different when compared to invasive ventilation. Jet nebulization only affected the tidal volume monitored in the noninvasive ventilator. Jet nebulization also affected the triggering performance and tidal volume monitored in the ICU ventilator.

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British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Cited by 44 publications

References 7 publications

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

Outcome of Frail Do-Not-Intubate Subjects With End-Stage Chronic Respiratory Failure and Their Opinion of Noninvasive Ventilation to Reverse Hypercapnic Coma

Effect of Jet Nebulization on Noninvasive Positive-Pressure Ventilation Administered with Noninvasive or Intensive Care Unit Ventilators: A Bench Study

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