Noninvasive ventilation and the upper airway: should we pay more attention?

Oppersma, Eline; Doorduin, Jonne; Heijden, Erik H F M van der; Hoeven, Johannes G. van der; Heunks, Leo

doi:10.1186/cc13141

Cited by 19 publications

(9 citation statements)

References 43 publications

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“…The extradiaphragmatic inspiratory muscles support the diaphragm to maintain adequate ventilation, but each muscle has specific other tasks. For instance, the alae nasi and genioglossus maintain upper airway patency [20][21][22], the parasternal intercostals stabilize the chest wall and facilitate rotation of the trunk [23,24], while the scalene and sternocleidomastoid are involved in rotation of the head and flexion of the neck [25]. In previous studies, surface EMG has been used in ventilated ICU patients to evaluate activity of the extradiaphragmatic inspiratory muscles, including alae nasi, parasternal intercostals [26], scalene [26,27], sternocleidomastoid and genioglossus [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Roesthuis

Hoeven

Hees

et al. 2020

Ann. Intensive Care

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Background: Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. Methods: Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH 2 O every 5 min with steps of 3 cmH 2 O. The magnitude and timing of respiratory muscle activity were assessed. Results: We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r 2 = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. Conclusions: Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.

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Section: Introductionmentioning

confidence: 99%

Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Roesthuis

Hoeven

Hees

et al. 2020

Ann. Intensive Care

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“…Previous studies have shown that nasal ventilation can induce an inspiratory laryngeal narrowing in humans as well as in lambs [9,10,11,12]. The latter may promote patient-ventilator asynchrony and limit lung ventilation [13], as well as divert the insufflated gas into the esophagus, exposing the infant to gastric distension and further respiratory compromise [14]. Knowing whether nHFOV can induce active laryngeal narrowing is certainly of interest before contemplating a more widespread use in newborns.…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

et al. 2015

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Background: We have previously shown that nasal pressure support ventilation (nPSV) can lead to an active inspiratory laryngeal narrowing in lambs. This, in turn, can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. On the other hand, nasal high-frequency oscillatory ventilation (nHFOV) is particularly attractive in newborns, especially since, unlike nPSV, it does not require synchronization with the patient's inspiratory efforts. Objectives: The main aim of the present study was to test the hypothesis that glottal constrictor muscle activity (EMG) does not develop during nHFOV. A secondary objective was to study laryngeal EMG during nHFOV-induced central apneas. Methods: Polysomnographic recordings were performed in 7 nonsedated lambs which were ventilated with increasing levels of nPSV and nHFOV at both 4 and 8 Hz, in random order. States of alertness, diaphragm and glottal muscle EMG, SpO₂, and respiratory movements were continuously recorded. Results: While phasic inspiratory glottal constrictor EMG appeared with increasing nPSV levels in 6 out of 7 lambs, it was never observed with nHFOV. In addition, nHFOV at 4 Hz dramatically inhibited central respiratory drive in 4/7 lambs, with 64-100% of recording time spent in central apnea in 3 lambs. No glottal constrictor EMG was observed during these central apneas. Conclusion: nHFOV does not induce glottal constrictor muscle EMG in nonsedated newborn lambs, in contrast to nPSV. This may be an additional advantage of nHFOV relative to nPSV.

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“…The most important aim of NIMV is to avoid endotracheal intubation, and thus, to reduce complications related to IMV (9). NIMV has other long-term goals, such as prolonging the patient's life expectancy, improving the quality of life, improving sleep time/quality, and improving the patient's functional status (3).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Mechanical Ventilation Knowledge Level of the Nurses: A Questionnaire Survey in a Tertiary Care Training and Research Hospital

Tarhan¹,

Hançer²,

Polat³

et al. 2015

Eurasian J Pulmonol

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Objective: The correct use of necessary equipment is the key for a successful noninvasive mechanical ventilation (NIMV) practice. Trained health care personnel are important part of the practice. The current study was conducted to that end, with the aim of determining the level of knowledge about NIMV of nurses working in a training and research hospital as descriptive. Methods:The study was conducted with 147 nurses who are working at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital in İstanbul. Questionnaire form of 36 questions prepared by investigators was used to collect data. For the analysis of the results, numerical, percentages, Mann-Whitney U and Kruskal Wallis tests were used.'Results: 40.8% nurses had received training about NIMV. By contrast, 24.5% stated that they had learned NIMV practices on their own. The lowest rate (26.5%) of correct answered question was "disadvantages of oronasal mask". The most answered statement as true was "Face masks should be established to the patient's face with no gaps for prevention of leaks and the mask should be worn not to pressure on nasal bridge" (78.9%). Female and postgraduate nurses' total scores obtained from NIMV questions were higher than others and were statistically significant (p<0.05). Conclusion:The effective NIMV practices requires trained personnel. Nurses who have active role in NIMV practices should receive basic training in this topic. How will be started treatment, indications, who will be responsible for follow-up and points to take into consideration are mentioned clearly in the training program. This training programme should include processing of clinical experience as well as theoretical information.

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Noninvasive ventilation and the upper airway: should we pay more attention?

Cited by 19 publications

References 43 publications

Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Laryngeal Muscle Activity during Nasal High-Frequency Oscillatory Ventilation in Nonsedated Newborn Lambs

Noninvasive Mechanical Ventilation Knowledge Level of the Nurses: A Questionnaire Survey in a Tertiary Care Training and Research Hospital

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