Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery

Erdoğan, Gülay; Okyay, Dilek; Yurtlu, Serhan; Hancı, Volkan; Ayoğlu, Hilal; Aydın, Bengü Gülhan; Turan, Iö

doi:10.1016/j.ijoa.2010.04.005

Cited by 16 publications

(8 citation statements)

References 12 publications

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“…2 -4 In patients with ARFor at high risk of ARF, the supine position required in most surgeries can worsen the respiratory function; moreover, neuraxial anaesthesia has the potential to interfere with the intercostal muscle function. 22 In the abovementioned conditions, NIV may improve ventilation reducing work of breathing, improving alveolar ventilation, reducing atelectasis, and reducing left ventricular afterload. 2 An improvement in diaphragmatic ventilatory excursion was observed by ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Cabrini

Nobile

Plumari

et al. 2014

British Journal of Anaesthesia

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Non-invasive ventilation (NIV) has been used to prevent or to treat perioperative acute respiratory failure (ARF). Intraoperative prophylactic and therapeutic use of NIV could be of interest to patients with anticipated difficulty in postoperative weaning from mechanical ventilation or to patients refusing tracheal intubation. Intraoperative NIV might also be useful when deep sedation is required, as this can cause respiratory depression. PubMed, Embase, Google Scholar, and Cochrane Library were searched for pertinent studies. Inclusion criteria were NIV use during surgery and adult patients; the exclusion criteria were NIV application only in the preoperative or postoperative periods, paediatric patients, NIV applied as negative pressure ventilation. Thirty papers including 618 patients were included for final analysis. Intraoperative therapeutic NIV to treat ARF was reported for 92 patients and in all those cases, including six Caesarean sections, surgery was completed uneventfully. Intraoperative prophylactic NIV to avoid ARF was described in 24 patients with severe respiratory limitation and in 502 healthy patients during deep sedation. Three patients could not be successfully ventilated due to upper airway obstruction, but no further complication was reported. Intraoperative NIV appears feasible, safe, and potentially useful, particularly when tracheal intubation is best avoided. However, high-quality, randomized studies are required.

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Section: Discussionmentioning

confidence: 99%

Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Cabrini

Nobile

Plumari

et al. 2014

British Journal of Anaesthesia

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“…A 22-year-old Hispanic woman with mitochondrial thymidine kinase 2 deficiency and chronic respiratory failure due to severe neuromuscular weakness requiring NIV since 12 years of age was also successfully managed by NIV without intubation during the cesarean section operation performed under NA [65]. Other cases of cesarean or tube ligation under NA+NIV are also reported in patients affected by cystic fibrosis, myasthenic syndrome and mitochondrial myopathy [66][67][68][69][70].…”

Section: Labor and Deliverymentioning

confidence: 99%

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

Corcione

Karim

Mina

et al. 2019

ait

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Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.

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“…Several case reports and small series have shown favourable outcomes with NIV use for respiratory failure in pregnancy (table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

“…Three reports have demonstrated perioperative use of NIV in combination with spinal anaesthesia for parturients with respiratory failure requiring emergency caesarean delivery [13][14][15]. A recent report also described the use of NIV with dexmedetomidine for sedation in a pregnant female with hypoxaemic respiratory failure from severe aspiration pneumonia [8].…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

“…Patient selection is paramount and indications and contraindications to its use must be considered carefully. To optimise the safety of NIV in this setting, staff should be [15] 2006 Case report 1 Non-cardiogenic pulmonary oedema AL-ANSARI [12] 2007 Case series 4 ARDS, acute chest syndrome PERBET [6] 2008 Case report 1 Non-cardiogenic pulmonary oedema associated with tocolytic agents BANGA [9] 2009 Case report 1 ARDS, community-acquired pneumonia BASSANI [10] 2009 Case report 1 ARDS/ATRA syndrome YUAN [5] 2009 Case report 1 Ventilatory failure, neuromuscular (mitochondrial myopathy) GUTERRES [14] 2010 Case report 1 Ventilatory failure, neuromuscular (high neuraxial blockade) DJIBRÉ [11] 2010 Case report 1 ARDS, H1N1 ERDOGAN [13] 2010 Case report 1 Non-cardiogenic pulmonary oedema, severe preeclampsia FRASSANITO [17] 2011 Case report 1 ARDS, sepsis ROJAS-SUAREZ [7] 2011 Case report 1 Non-cardiogenic pulmonary oedema, severe preeclampsia DUAN [8] 2012 Case report 1 Aspiration pneumonia DALAR [18] 2013 Case report 1 Community-acquired pneumonia DRAISCI [19] experienced in its use and patients should be in a protected environment, such as an ICU, in order to monitor changes in the clinical state of the mother and fetus.…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

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Successful use of noninvasive ventilation in pregnancy

Allred¹,

Esquinas²,

Caronia³

et al. 2014

Eur Respir Rev

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Acute respiratory failure (ARF) occurs in less than 0.1% of pregnancies; however, it is one of the most common reasons for obstetric admissions to the intensive care unit (ICU) and carries a high mortality for both mother and fetus. Pulmonary physiological and anatomic adaptations during pregnancy affect the overall management, as well as predispose patients to complications during respiratory illness. Pregnancyrelated upper airway mucosal oedema may obstruct visualisation of the airway during intubation and can make invasive airway management difficult. The pregnant female requiring endotracheal intubation has a four-fold higher risk of having a difficult airway and an eight-fold higher risk of a failed intubation [1].The application of noninvasive ventilation (NIV) in the treatment of ARF continues to expand as its benefits are increasingly recognised. NIV is often avoided in pregnancy due to the theoretical risk of aspiration. However, our current knowledge regarding the safety and efficacy of NIV for the management of respiratory failure in pregnancy is based on weak evidence. Only a few case reports and small case series have been published. Given the limited data, we review the current literature and report two cases of pregnant females who developed ARF from acute respiratory distress syndrome (ARDS) and were successfully and safely managed with NIV. Case 1A 30-year-old gravida 2 para 1 with an uncomplicated twin pregnancy presented with premature rupture of membranes at 30 weeks of gestation. She had also complained of a dry cough for 1 week prior to presentation and a low grade fever. Corticosteroids, antibiotics and tocolytic therapy were administered. On day 2 of admission, she developed acute shortness of breath and complained of severe chest pressure and worsening cough. Her oxygen saturation was 87% while breathing room air. On physical examination, she appeared to be in moderate respiratory distress, was alert and awake, and had reduced breath sounds bilaterally. Rhonchi were auscultated over her right lung field and she was subsequently transferred to the medical ICU.Arterial blood gas (ABG) results on 100% oxygen via a non-rebreather mask showed an oxygen tension (PO 2 ) of 58 mmHg, pH of 7.49 and a carbon dioxide tension (PCO 2 ) of 27 mmHg. Her breathing became more laboured and the decision was made to place her on NIV with an inspiratory pressure of 12 cmH 2 O and an expiratory pressure of 5 cmH 2 O. Inspiratory oxygen fraction (FIO 2 ) was set to 100%. Fetal monitoring was initiated. Her work of breathing and oxygenation rapidly improved. Repeat ABG analysis 1 h later revealed a PO 2 of 152 mmHg on the same settings. Clindamycin was added for suspected aspiration pneumonia. Computed tomography of the chest showed diffuse, bilateral airspace disease. An echocardiogram was unremarkable. Over the next 2 days she was weaned off NIV and her clinical condition continued to improve. She tolerated the mask well and no episodes of aspiration or other complications occurred. However, her contractions...

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Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery

Cited by 16 publications

References 12 publications

Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review

Successful use of noninvasive ventilation in pregnancy

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