Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

Hidalgo, Viviane; Giugliano-Jaramillo, C; Pérez, Rodrigo; Cerpa, F; Budini, H; Cáceres, D; Gutierrez, Tatiana; Molina, Jorge; Keymer, Juan E.; Romero-Dapueto, C

doi:10.2174/1874306401509010120

Cited by 9 publications

(4 citation statements)

References 41 publications

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“…We speculate that unmeasured hospital factors may also play a role in NIV failure rates, such as site of NIV use (ward, intermediate care, ICU); nurse (12), respiratory therapist (13), and physician (14) staffing ratios; and intensity of surveillance of patients (e.g., frequency of blood gas monitoring) or use of multidisciplinary NIV teams (56).…”

Section: Original Researchmentioning

confidence: 99%

“…However, NIV use in acute respiratory failure involves processes of care that require careful patient selection, monitoring, and titration by a multidisciplinary team of nurses (12), respiratory therapists (13), and physicians (14), often across multiple hospital care settings. Hospitals that care for a greater number of patients may develop local expertise ("practice makes perfect") that results in better patient outcomes, as has been demonstrated across other critical care conditions and procedures (15), including IMV (16)(17)(18), sepsis (19), and surgery (20,21).…”

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confidence: 99%

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Hospital Non-Invasive Ventilation Case-Volume and Outcomes for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Mehta¹,

Douglas

Walkey

2016

Annals ATS

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Rationale: Higher hospital case volume may produce local expertise ("practice makes perfect"), resulting in better patient outcomes. Associations between hospital noninvasive ventilation (NIV) case volume and outcomes for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are unclear.Objectives: To determine associations between total hospital NIV case volume for all indications and NIV failure and hospital mortality among patients with acute exacerbations of COPD.Methods: Using the 2011 California State Inpatient Database and multivariable hierarchical logistic regression, we calculated hospitallevel risk-adjusted rates for NIV failure (progression from NIV to invasive mechanical ventilation) and hospital mortality among patients with acute exacerbations of COPD. Measurements and Main Results:We identified 37,516 hospitalizations for acute exacerbations of COPD in 252 California hospitals in 2011. Total hospital NIV use for all indications ranged from 2 to 565 cases (median, 64; interquartile range, 96). Hospital NIV failure rates for acute exacerbations of COPD ranged from 3.7 to 31.3% (median, 8.5%; interquartile range, 4.2). At the hospital level, higher total hospital NIV case volume was weakly associated with higher hospital NIV failure rates for acute exacerbations of COPD (r = 0.13; P = 0.03). Higher hospital NIV failure rates were weakly associated with higher hospital mortality rates for acute exacerbations of COPD (r = 0.15; P = 0.02), but higher total hospital NIV case volume was not associated with hospital mortality for exacerbations of COPD (r = 20.11; P = 0.08). At the patient level, patients admitted to high-NIV versus low-NIV case-volume hospitals had greater odds of NIV failure (quartile 4 vs. quartile 1 adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.12-3.40). Compared with initial treatment with invasive mechanical ventilation, NIV failure was associated with higher odds of death (aOR, 1.81; 95% CI, 1.35-2.44). However, admission to high-NIV versus low-NIV case-volume hospitals was not significantly associated with patient in-hospital mortality (quartile 4 vs. quartile 1 aOR, 0.76; 95% CI, 0.57-1.02).Conclusions: Despite strong evidence for use of NIV in the management of acute exacerbations of COPD, we observed no significant mortality benefit and higher rates of NIV failure in high-NIV case-volume hospitals. Further investigation of patient selection and hospital factors associated with NIV failure is needed to maximize favorable patient outcomes associated with use of NIV for acute exacerbations of COPD.

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Section: Original Researchmentioning

confidence: 99%

mentioning

confidence: 99%

Hospital Non-Invasive Ventilation Case-Volume and Outcomes for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Mehta¹,

Douglas

Walkey

2016

Annals ATS

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“…Our group on 2015, in a review [13] describe that in COPD, NIV must be the first line treatment, giving a chance to avoid intubation, NIV have evidence 1A on hypercapnic failure, immunodepressed patients and pulmonary edema. Almost NIV have good evidence in IMV weaning of patients with COPD diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Physiotherapy Management of Copd Exacerbations

Keymer¹,

Leon²,

Molina³

et al. 2020

Act Scie Medic

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Physiotherapy remains an important tool in the treatment of cronic obstructive pulmonary disease (COPD) and especially when this disease presents exacerbations that lead to hospitalize our patients. In this article we will analyze how the physiotherapist can help these patients through respiratory therapy using, non-invasive ventilation (NIV), positioning, aerosol therapy, humidification and assistance in fibroboncoscopy.Airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases [1]. The global initiative for chronic obstructive lung disease is a global entity that published in 2001 a consensus and global strategy reports for the diagnosis and prevention of cronic obstructive pulmonary disease (COPD). The reports published in 2013, 2014, 2015 and 2017 were based on the scientific literature published since 2011, but maintain the same paradigm of treatment. Only in 2015 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and The Global Initiative for Asthma (GINA) approved the agreements prepared by a scientific committee for the management of Asthma and COPD overlap syndrome. Now we can see that COPD defintion until 2017 has been change progressively in the limitation of the air flow and that is associated to an unexpected inflammatory answer of lungs caused by gases or noxious particles.COPD is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is caused by airway and/or alveolar abnormalities usually caused by signicant exposure to noxious particles or gases2.Since the definition of GOLD 2017, they acknowledge that it is an abnormal inflammatory response and define it as a frequent, prevenible and treatable disease. It is also characterized by persistent respiratory symptoms and by limitation of air flow, kept from the previous definition. Also defines that this limitation must result in anomalies in the respiratory and alveolar airways caused by exposure to particles and harmful agents. This definition is roughly similar but should clarify that COPD is associated with an inflammatory response, that is a thing of the past.

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“…Hastanın kliniğinin düzelmesi için IMV bir sonraki adım olarak planlanabilir. 19,20,28,29 KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞINDA NONİNVAZİV MEKANİK VENTİLASYONA İLİŞKİN SORUNLAR VE HEMŞİRELİK YÖNETİMİ Hemşire, NIMV uygulanan KOAH tanılı hastanın bakımında karşılaşabileceği sorunların ve hasta gereksinimlerinin farkında olarak eleştirel bir bakış açısıyla yönetim algoritmasını oluşturmalıdır. NIMV uygulanan hastalarda gelişebilecek sorunlara ilişkin hemşirelik tanıları ve girişimler Tablo 4'te görülmektedir.…”

Section: -11unclassified

Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease and Nursing Management: Review

Kirca¹,

Kutlutürkan²

2017

Turkiye Klinikleri J Nurs Sci

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Ö ÖZ ZE ET T Kronik obstrüktif akciğer hastalığı ile ilişkili akut solunum yetmezliği gelişen hastalarda, noninvaziv mekanik ventilasyon (NIMV) güvenle uygulanabilen bir destek tedavisidir. NIMV, hastaya endotrakeal tüp olmaksızın pozitif basınçla solunum desteğinin verilmesidir. KOAH NIMV'nın kullanım amacı; solunum iş yükünü azaltmak, oksijenasyonu iyileştirmek, entübasyonu engellemek, fonksiyonel durumu ve yaşam kalitesini iyileştirmektir. Noninvaziv mekanik ventilasyonun en önemli avantajları; acil servis, genel servisler, özellikle ev ortamında uygulanması, sedasyon gerektirmemesi, hastanın çevresiyle iletişim kurabilmesi, yan etkiler açısından ventilatör ilişkili pnömoni gibi majör sorunların daha az oranda yaşanması ve maliyetinin uygun olmasıdır. Noninvaziv mekanik ventilasyon, akut KOAH ataklarında sıklıkla kullanımı tercih edilen bir tedavi yöntemidir. Bu tedavi yönteminde hava kaçaklarının önlenmesi açısından maske yüz uyumunun sağlanması ve hastanın solunumsal parametrelerindeki değişimler gözlenerek doğru zamanda başlanması gerekmektedir. KOAH'ta, NIMV uygulanacak hastanın belirlenmesi ve zamanlamanın doğru planlanması entübasyon ihtiyacını azaltmaktadır. KOAH'ta, NIMV tam ve donanımlı disipliner arası bir ekip yaklaşımıyla uygulanmalı ve hasta izlenmelidir. NIMV uygulaması sırasında hastada, nazal ülserasyon, eritem, klostrofobi, maske-yüz uyumsuzluğu, rahatsızlık hissi, hava kaçaklarıyla ilişkili gaz değişiminde bozulma ve anksiyete gibi çeşitli komplikasyonlar gözlenmektedir. Bu komplikasyonların yönetiminde öncelikli olarak sorun tam kapsamlı değerlendirilmeli, kanıta dayalı araştırmalar doğrultusunda planlama ve uygulamalar ile semptom kontrolü sağlanmalıdır. Bu çalışmanın, hemşirelerin NIMV uygulanan hastaların bakım ve izleminde karşılaşılan sorunlar ve yönetimine ilişkin güncel yaklaşımlar konusunda bilgi gereksinimlerinin karşılanmasına ve hastalara sunulan bakım kalitesinin artmasında katkı sağlayacağı düşü-nülmektedir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Pulmoner hastalık, kronik obstrüktif; pozitif basınçlı solunum; hemşirelik bakımı A AB BS S T TR RA AC CT T Noninvasive mechanical ventilation (NIMV) is a supportive treatment that can be safely app lied in patients in whom acute respiration deficiency develops related with chronic obstructive pulmonary disease (COPD). NIMV is providing respiration support to the patient without endotracheal tube. The purpose of NIMV usage in COPD, is to decrease work load on respiration, heal oxygenation, prevent intubation and meliorate functional status and life quality. Most important advantages of NIMV are as follows: there is no need for sedation during application in emergency service, general services and home, patient can establish communication with his surrounding, ventilator related pneumonia is not common (side effect related advantage) and cost-effective. Noninvasive mechanical ventilation is a treatment method widely used during acute attacks of COPD. In this treatment method in order to prevent air leakage mask should b...

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Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

Cited by 9 publications

References 41 publications

Hospital Non-Invasive Ventilation Case-Volume and Outcomes for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Hospital Non-Invasive Ventilation Case-Volume and Outcomes for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Physiotherapy Management of Copd Exacerbations

Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease and Nursing Management: Review

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