Non-Invasive Ventilation in Patients with an Altered Level of Consciousness. A Clinical Review and Practical Insights

Gonçalves, Gil; Saeed, Haitham; Abdelrahim, Mohamed E. A.; Harb, Hadeer S.; Madney, Yasmin M.; Eng, Kevin; Karim, Habib Md Reazaul; El-Khatib, Mohamad; Mina, Bushra; Skoczyński, Szymon; Šarc, Irena; Caldeira, Vânia; Cabral, Sara M; Cabrita, Bruno; Guia, Miguel; Duan, Jun; Fiorentino, Giuseppe; Piervincenzi, Edoardo; Köksal, Güniz Meyancı; Sarin, Sibel O; Papadakos, Peter J.; Bayrakçı, Benan; Hadda, Vijay; Laier-Groeneveld, G; Burns, Karen E. A.; Scala, Raffaele; Carrillo-Alcaraz, Andrés; Esquinas, António M.

doi:10.5603/arm.2020.0110

Cited by 8 publications

(4 citation statements)

References 47 publications

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“…These considerations allowed us to successfully use NIV as first-line therapy in a hypercapnic, comatose, and severely acidotic AECOPD patient with multiple comorbidities and COVID-19 infection in whom ETI and IMV would have been performed otherwise. Recently, the use of NIV in altered consciousness is gaining acceptability [ 3 , 14 ], and our case supports the effectiveness of NIV, even in COVID-19-induced AECOPD.…”

Section: Discussionsupporting

confidence: 79%

Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report

et al. 2022

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Effective use of noninvasive ventilation in patients with chronic obstructive pulmonary disease is well-known. However, noninvasive ventilation in patients presenting with altered sensorium and severe acidosis (pH <7.1) has been rarely described. Invasive mechanical ventilation is associated with high mortality in coronavirus disease 2019 (COVID-19), and use of noninvasive ventilation over invasive ventilation is an area of investigation. We report a case of COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease in a 66-year-old male. His past medical history included obstructive sleep apnea, hypertension, cor-pulmonale, atrial fibrillation, and amiodarone-induced hypothyroidism. On presentation, he had acute hypercapnic respiratory failure, severe acidosis (partial pressure of carbon dioxide [PCO2], 147 mm Hg; pH, 7.06), and altered mentation. The patient was successfully managed with noninvasive ventilation, avoiding endotracheal intubation, invasive ventilation, and related complications. Although precarious, a trial of noninvasive ventilation can be considered in COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease with hypercapnic respiratory failure, severe acidosis, and altered mentation.

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Section: Discussionsupporting

confidence: 79%

Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report

et al. 2022

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“…Moreover, weak cough reflex, excessive secretions, hypercapnic encephalopathy (more specifically with 1 hour of NIV), Intolerance mask intolerance), Agitation, and Poor ABGs are also significantly associated with NIV failure in our study as well as in previous studies [21][22][23] . Research has shown that the outcome of NIV is favorable in acute hypercapnic encephalopathy as compared to other causes of encephalopathy [24][25][26] . However, in our study, NIV is more successful in cases with higher GCS regardless of hypercapnia.…”

Section: Discussionmentioning

confidence: 99%

“…Management with NIV needs little to no sedation, and have lesser chances of developing ventilator-acquired pneumonia as compared to IMV and it gives larger morbidity and mortality benefit by avoiding prolonged IMV, tracheostomy, and prolonged weaning procedures, and their complications. NIV improves the consciousness level of the patients by reducing the partial pressure of carbon dioxide (PaCO 2 ), which normalizes the arterial pH, and subsequently normalizes the cerebrospinal fluid pH [9][10] . NIV is effective for AECOPD, but some patients don't achieve the desired outcomes.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Non-Invasive Ventilation Failure in COPD Patients Presenting with Acute Exacerbation

2024

PJMD

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Background: Non-invasive ventilation (NIV) is the first-line management for acute exacerbation of COPD (AECOPD), but some patients don’t improve and need invasive ventilation, leading to high mortality. We conducted a study to determine risk factors associated with NIV outcomes in these patients. Identifying predictive parameters of NIV failure could help timely intervention and prevent mortality. Methods: A Quasi Single Arm study was conducted at a tertiary care Hospital, in Karachi, from July to December 2022. We studied 170 COPD patients admitted to Medicine Department and Medical ICU with acute respiratory failure, among those 170 patients 80 were male and 90 were female, aged above 40 and below 80 years. Results: Among 170 AECOPD patients studied, 38% experienced NIV failure, while 61% had NIV success. In the NIV failure group, 38.46% of patients died in hospital. Most factors like quadrant infiltrate, weak cough reflex, low consciousness level, more requirements of oxygen, low pH, more respiratory rate, and positive blood cultures (p-value <0.001) were significantly associated with NIV failure and mortality, while others with no significant association still contributed towards NIV failure, like co-morbidities. Out of the 66 patients with NIV failure, 56% experienced immediate failure, 33% had early NIV failure, and 11% had late NIV failure. Conclusion: Most identified risk factors significantly predicted NIV failure, suggesting they may serve as useful early indicators to guide intervention. Even non-significant factors still exhibited some association with NIV failure. Further research exploring additional predictors could optimize NIV outcomes and reduce mortality from AECOPD.

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“…They found similar outcomes between comatose patients and controls with respect to in-hospital mortality and 6-month survival. Gonçalves et al [23 ▪ ] reviewed 21 studies (including Lemyze et al 's) that used NIV in hypercapnic ventilatory failure. The systematic review demonstrates that worse initial mental status is associated to worse prognosis and risk of NIV failure; however, those who respond do so within the first hours of therapy and patient-centered outcomes are consistently improved.…”

Section: Contraindicationsmentioning

confidence: 99%

Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease

Nathani

Hatipoğlu

Mireles-Cabodevila

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewNoninvasive positive pressure ventilation (NIV) is standard of care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We review the most current evidence and highlight areas of uncertainty and ongoing research. We highlight key concepts for the clinician caring for patients with AECOPD which require NIV.Recent findingsImplementation of NIV in AECOPD is not uniform in spite of the evidence and guidelines. Initiation of NIV should be done early and following protocols. Low-intensity NIV remains the standard of care, although research and guidelines are evaluating higher intensity NIV. Scores to predict NIV failure continue to be refined to allow early identification and interventions. Several areas of uncertainty remain, among them are interventions to improve tolerance, length of support and titration and nutritional support during NIV.SummaryThe use of NIV in AECOPD is the standard of care as it has demonstrated benefits in several patient-centered outcomes. Current developments and research is related to the implementation and adjustment of NIV.

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Non-Invasive Ventilation in Patients with an Altered Level of Consciousness. A Clinical Review and Practical Insights

Cited by 8 publications

References 47 publications

Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report

Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report

Risk Factors of Non-Invasive Ventilation Failure in COPD Patients Presenting with Acute Exacerbation

Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease

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