Early use of noninvasive positive pressure ventilation for acute lung injury

Zhan, Qingyuan; Sun, Bing; Liang, Lirong; Yan, Xixin; Zhang, Lutao; Yang, Jing; Wang, Ling; Ma, Zhuang; Shi, Liang; Wei, Luqing; Li, Guoqiang; Yang, Lan; Shi, Zhihong; Chen, Yuqing; Xu, Qixia; Li, Wei; Zhu, Xi; Wang, Zongyu; Sun, Yongchang; Zhuo, Jie; Liu, Yang; Li, Xuesong; Wang, Chen

doi:10.1097/ccm.0b013e318232d75e

Cited by 131 publications

(50 citation statements)

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“…We identified 1,066 citations; 40 studies were retrieved for detailed evaluation; and 11 RCTs (7–10, 19–25) met inclusion criteria (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The mean age of patients ranged from 46.5 to 65.5. Of the 11 included trials, two were single-center trials (22, 25), and all were conducted in Europe except one, which was conducted in Asia (19). …”

Section: Resultsmentioning

confidence: 99%

“…The results suggest that mild AHRF patients could benefit from NIV with helmet in reducing the hospital mortality. Similarly, among six RCTs reporting hospital mortality, there is only one research (19) applying BiPAP mode. Therefore, we did not show the results of subgroup analysis according to NIV modes.…”

Section: Resultsmentioning

confidence: 99%

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Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

Zhang

et al. 2017

Critical Care Medicine

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“…We identified 1,066 citations; 40 studies were retrieved for detailed evaluation; and 11 RCTs (7–10, 19–25) met inclusion criteria (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

Zhang

et al. 2017

Critical Care Medicine

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“…Interestingly, the rates of IPPV use (34.6%) in our study were much lower than historical cohorts (63–86%) (8, 12, 13, 50), which may suggest increased use of early proactive PICU admission and/or some success in halting critical illness progression such that IPPV was not needed. Noninvasive technologies such as NIPPV may assist in achieving this (25, 51, 52). In addition, our finding of 1.9% PICU mortality for those not using NIPPV, IPPV, RRT, or ECMO is quite low and suggests that there may be a practice trend to keep end-of-life do not resuscitate/do not intubate patients out of the PICU, particularly immediately prior to death (53).…”

Section: Discussionmentioning

confidence: 99%

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Zinter

Dvorak

Spicer

et al. 2015

Critical Care Medicine

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Objectives Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regarding outcomes for patients with different underlying hematopoietic stem cell transplantation indications, and the burden of infectious complications for these patients has not been evaluated. We aim to describe infections, critical care interventions, and mortality for pediatric hematopoietic stem cell transplantation patients requiring PICU admission. Design A retrospective multicenter cohort analysis. Setting One hundred twelve centers in the Virtual PICU Systems database, January 1, 2009, to June 30, 2012. Patients A total of 1,782 admissions for patients who are 21 years old or younger with prior hematopoietic stem cell transplantation. Interventions None. Measurements and Main Results Pediatric Index of Mortality-2, Pediatric Risk of Mortality-3, transplant indication, infections, interventions, and mortality were recorded from admission through PICU death or discharge. Pediatric hematopoietic stem cell transplantation patients comprised 0.7% of all PICU admissions (1,782/246,346), which resulted in 16.2% mortality compared with 2.4% mortality for non-hematopoietic stem cell transplantation admissions (odds ratio, 7.8; 95% CI, 6.8–8.8; p < 0.001). Mortality for admissions with underlying hematologic malignancy (22.7%) was similar to that of admissions with primary immunodeficiency (19.4%; p = 0.41) but significantly greater than admissions with underlying nonmalignant non-primary immunodeficiency hematologic disease (15.4%; p = 0.020), metabolic disorder (8.1%; p < 0.001), or solid malignancy (5.7%; p < 0.001). Infection was documented in 45.7% of admissions with 22.2% mortality; viral and fungal mortality were 28.5% and 33.7%, respectively. Invasive positive pressure ventilation and renal replacement therapy were used in only 34.6% and 11.9% of admissions, with mortality of 42.5% and 51.9%, respectively. Conclusions PICU mortality for pediatric hematopoietic stem cell transplantation patients may be as low as 16.2% but higher for those receiving intubation (42.5%) or replacement therapy (51.9%). Hematologic malignancy and primary immunodeficiency had greater risk for mortality than other transplant indications. Greater understanding of other risk factors affecting mortality and the need for critical care support is needed.

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“…The use of NIV in patients with ALI and acute respiratory distress syndrome (ARDS) remains controversial, with studies showing a high failure rate of NIV in this group [31]. However, when implemented early, the use of NIV for ALI has been shown to be safe and to improve clinical outcome [32]. …”

Section: Discussionmentioning

confidence: 99%

Lung protection during non-invasive synchronized assist versus volume control in rabbits

et al. 2014

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IntroductionExperimental work provides insight into potential lung protective strategies. The objective of this study was to evaluate markers of ventilator-induced lung injury after two different ventilation approaches: (1) a “conventional” lung-protective strategy (volume control (VC) with low tidal volume, positive end-expiratory pressure (PEEP) and paralysis), (2) a physiological approach with spontaneous breathing, permitting synchrony, variability and a liberated airway. For this, we used non-invasive Neurally Adjusted Ventilatory Assist (NIV-NAVA), with the hypothesis that liberation of upper airways and the ventilator’s integration with lung protective reflexes would be equally lung protective.MethodsIn this controlled and randomized in vivo laboratory study, 25 adult White New Zealand rabbits were studied, including five non-ventilated control animals. The twenty animals with aspiration-induced lung injury were randomized to ventilation with either VC (6 mL/kg, PEEP 5 cm H2O, and paralysis) or NIV-NAVA for six hours (PEEP = zero because of leaks). Markers of lung function, lung injury, vital signs and ventilator parameters were assessed.ResultsAt the end of six hours of ventilation (n = 20), there were no significant differences between VC and NIV-NAVA for vital signs, PaO2/FiO2 ratio, lung wet-to-dry ratio and broncho-alveolar Interleukin 8 (Il-8). Plasma IL-8 was higher in VC (P <0.05). Lung injury score was lower for NIV-NAVA (P = 0.03). Dynamic lung compliance recovered after six hours in NIV-NAVA but not in VC (P <0.05). During VC, peak pressures increased from 9.2 ± 2.4 cm H2O (hour 1) to 12.3 ± 12.3 cm H2O (hour 6) (P <0.05). During NIV-NAVA, the tracheal end-expiratory pressure was similar to the end-expiratory pressure during VC. Two animals regurgitated during NIV-NAVA, without clinical consequences, and survived the protocol.ConclusionsIn experimental acute lung injury, NIV-NAVA is as lung-protective as VC 6 ml/kg with PEEP.Electronic supplementary materialThe online version of this article (doi:10.1186/cc13706) contains supplementary material, which is available to authorized users.

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Early use of noninvasive positive pressure ventilation for acute lung injury

Abstract: Noninvasive positive pressure ventilation is safe for selected patients with acute lung injury. However, a larger randomized trial with need for intubation and mortality as the outcomes of interest is required.

Cited by 131 publications

References 3 publications

Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Lung protection during non-invasive synchronized assist versus volume control in rabbits

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