Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

Esteban, Andrés; Frutos‐Vivar, Fernando; Ferguson, Niall D.; Arabi, Yaseen M.; Apezteguía, Carlos; González, Marco; Epstein, Scott K.; Hill, Nicholas S.; Nava, Stefano; Soares, Marco Antonio; D’Empaire, Gabriel; Alía, Inmaculada; Anzueto, Antonio

doi:10.1056/nejmoa032736

Cited by 768 publications

(534 citation statements)

References 30 publications

Supporting

Mentioning

437

Contrasting

Unclassified

Order By: Relevance

“…However few studies have demonstrated the efficacy of non-invasive ventilation after weaning from invasive ventilation for acute respiratory failure [9,10].…”

Section: Discussionmentioning

confidence: 99%

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Lopes¹,

Brandão²,

Nozawa³

et al. 2008

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíacaBenefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Abstract Objective: to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery.Methods: A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O 2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation.Results: The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO 2 . On comparing the groups, the PaO 2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO 2 (p = 0.557).Conclusion: The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery. Descriptors 345LOPES, CR ET AL -Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery Bras Cir Cardiovasc 2008; 23(3): 344-350 Rev

show abstract

“…However few studies have demonstrated the efficacy of non-invasive ventilation after weaning from invasive ventilation for acute respiratory failure [9,10].…”

Section: Discussionmentioning

confidence: 99%

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Lopes¹,

Brandão²,

Nozawa³

et al. 2008

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…There is considerable variation amongst studies reporting the outcome of BiPAP in the setting of acute respiratory failure. [82][83][84] In theory, BiPAP should minimize the decline in lung volume after surgery and may reduce pulmonary com-plications, but this possibility has not been studied. It has been shown that the use of CPAP may decrease the incidence of tracheal reintubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery.…”

Section: Non-invasive Ventilationmentioning

confidence: 99%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

View full text Add to dashboard Cite

Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.Source: A MEDLINE-based English-language literature search was undertaken for the period 1966-2006, and an EMBASE search covered the overlapping period 1988-2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings:Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion:Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif

show abstract

“…However, 15.2% of respondents were uncertain as to whether a written directive existed to guide sedation administration in their ICUs. Three sedation scale scores [Ramsay 17 (27 RT respiratory therapist; SBT spontaneous breathing trial the verbal component of the GCS (24.7%), assigning a verbal score of 1 (15.5%), or prioritizing verbal scores of 1, 3, and 5 (14.4%) in computing the GCS. Twenty-nine percent of respondents confirmed that they do not calculate the GCS.…”

Section: Other Aspects Of Weaningmentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

show abstract

Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

Abstract: Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have respiratory failure after extubation.

Cited by 768 publications

References 30 publications

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

Review article: Age related alterations in respiratory function — anesthetic considerations

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Contact Info

Product

Resources

About