New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

Longhini, Federico; Pan, Chun; Xie, Jianfeng; Cammarota, Gianmaria; Bruni, Andrea; Garofalo, Eugenio; Yang, Yi; Navalesi, Paolo; Qiu, Haibo

doi:10.1186/s13054-017-1761-7

Cited by 42 publications

(58 citation statements)

References 39 publications

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“…The tracings with rates of AI ≥10% is consistent with the results of previous investigations [ 7 – 10 , 15 , 28 , 29 ], while our average AI (18.1%) is slightly lower than previously reported by V ignaux et al [ 7 ] (26%, interquartile range 15–54%). It should be noted, however, that in that study, the asynchronies were related to the extent of air leaks and all but six patients received NIV through ventilators not equipped with software for compensation of leaks [ 7 ].…”

Section: Discussionsupporting

confidence: 93%

“…Flow, airway pressure ( P aw ) and diaphragm electrical activity (EA di ) tracings had been obtained from 40 patients enrolled in previous studies [ 6 , 8 , 15 ], who had received NIV, 20 through facial masks and 20 through a helmet, for treatment of acute respiratory failure (ARF) of various aetiologies. Patient's characteristics at enrolment and ventilator settings are reported in table S1.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of ventilator waveform observation for detection of patient–ventilator asynchrony during NIV: a multicentre study

Longhini

Colombo²,

Pisani

et al. 2017

ERJ Open Res

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The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies.35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow–time and airway pressure–time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity. We determined: 1) sensitivity, specificity, and positive and negative predictive values; 2) the correlation between the double true index (DTI) of each report (i.e., the ratio between the sum of true positives and true negatives, and the overall breath count) and the corresponding asynchrony index (AI); and 3) the influence of breathing pattern and respiratory drive on both AI and sensitivity.Sensitivities to detect asynchronies were low either according to experience (0.20 (95% CI 0.14–0.29) for expert versus 0.21 (95% CI 0.12–0.30) for nonexpert, p=0.837) or interface (0.28 (95% CI 0.17–0.37) for mask versus 0.10 (95% CI 0.05–0.16) for helmet, p<0.0001). DTI inversely correlated with the AI (r2=0.67, p<0.0001). Breathing pattern and respiratory drive did not affect prevalence of asynchronies and sensitivity.Patient–ventilator asynchrony during NIV is difficult to recognise solely by visual inspection of ventilator waveforms.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Efficacy of ventilator waveform observation for detection of patient–ventilator asynchrony during NIV: a multicentre study

Longhini

Colombo²,

Pisani

et al. 2017

ERJ Open Res

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“…In this study, we measured patient comfort during various HFNC settings, as comfort could represent a balanced synthesis of various physiologic mechanisms, potentially being a patient-level outcome per se [ 9 , 10 ]. Previous physiologic studies in patients undergoing non-invasive respiratory support assessed comfort by the same method as used in this study (i.e., VNS) [ 24 , 25 ]. Comfort during non-invasive support could be particularly relevant for improving tolerance.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, a recent post hoc analysis of the FLORALI study identified poor comfort as the only predictor of intubation in patients on HFNC within 1 h from the start, thus suggesting a link between comfort and improved hard clinical outcomes [ 27 ]. Interestingly, in all of these studies [ 1 , 24 , 25 , 27 ] dyspnea was independently assessed by the Borg scale as we did. Relief of dyspnea is only one component of improved comfort, and discomfort can still be present at relatively low dyspnea scores, its determinants being wider and more holistic (e.g., including also physiologic and sensorial factors).…”

Section: Discussionmentioning

confidence: 99%

Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula

et al. 2018

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BackgroundThe high-flow nasal cannula (HFNC) delivers up to 60 l/min of humidified air/oxygen blend at a temperature close to that of the human body. In this study, we tested whether higher temperature and flow decrease patient comfort. In more severe patients, instead, we hypothesized that higher flow might be associated with improved comfort.MethodsA prospective, randomized, cross-over study was performed on 40 acute hypoxemic respiratory failure (AHRF) patients (PaO2/FiO2 ≤ 300 + pulmonary infiltrates + exclusion of cardiogenic edema) supported by HFNC. The primary outcome was the assessment of patient comfort during HFNC delivery at increasing flow and temperature. Two flows (30 and 60 l/min), each combined with two temperatures (31 and 37 °C), were randomly applied for 20 min (four steps per patient), leaving clinical FiO2 unchanged. Toward the end of each step, the following were recorded: comfort by Visual Numerical Scale ranging between 1 (extreme discomfort) and 5 (very comfortable), together with respiratory parameters. A subgroup of more severe patients was defined by clinical FiO2 ≥ 45%.ResultsPatient comfort was reported as significantly higher during steps at the lower temperature (31 °C) in comparison to 37 °C, with the HFNC set at both 30 and 60 l/min (p < 0.0001). Higher flow, however, was not associated with poorer comfort.In the subgroup of patients with clinical FiO2 ≥ 45%, both lower temperature (31 °C) and higher HFNC flow (60 l/min) led to higher comfort (p < 0.01).ConclusionsHFNC temperature seems to significantly impact the comfort of AHRF patients: for equal flow, lower temperature could be more comfortable. Higher flow does not decrease patient comfort; at variance, it improves comfort in the more severely hypoxemic patient.

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“…At day 8 of ICU admission, blood test and gas exchange significantly improved and the patient was extubated and weaned off from iMV through helmet noninvasive ventilation (NIV) [10] in a proportional mode to improve patient-ventilator interaction and to increase the rate of success [11][12][13][14]. After 48 h, weaning from NIV was performed with high-flow oxygen through nasal cannula, to unload respiratory muscles and provide heated and humidified air-oxygen admixture [15][16][17].…”

Section: Case Presentationmentioning

confidence: 99%

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

et al. 2020

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Background: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. Case presentation: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4)

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New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

Cited by 42 publications

References 39 publications

Efficacy of ventilator waveform observation for detection of patient–ventilator asynchrony during NIV: a multicentre study

Efficacy of ventilator waveform observation for detection of patient–ventilator asynchrony during NIV: a multicentre study

Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

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