Noninvasive ventilation for acute respiratory distress syndrome: the importance of ventilator settings

Tucci, Mauro R.; Costa, Eduardo L. V.; Nakamura, Maria Aparecida Miyuki; Morais, Caio C. A.

doi:10.21037/jtd.2016.09.29

Cited by 16 publications

(7 citation statements)

References 33 publications

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“…However, we do not have any specific data supporting the association. Instead, as initial SOFA score and pre-NIV PaCO 2 were lower and pre-NIV PaO 2 / FiO 2 was higher in the PSV group, it is possible that the lower disease severity influenced the lower level of IPAP and higher rate of NIV success (27). In addition, as mentioned above, the occurrence of large leaks, which can compromise patient-ventilator synchrony with PSV mode, was uncommon in our patients.…”

Section: Discussionmentioning

confidence: 64%

Non-invasive ventilation for acute respiratory failure: pressure support ventilation vs. pressure-controlled ventilation

et al. 2020

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Background: The best ventilator mode for patients receiving non-invasive ventilation (NIV) has not been clarified. This study compared the effectiveness of two pressure-targeted modes, i.e., pressure support ventilation (PSV) and pressure-controlled ventilation (PCV), in patients receiving NIV. Methods: This was a prospective multicentre observational study of NIV use for acute respiratory failure (ARF) in adult patients. We compared the two pressure-targeted modes in terms of NIV success and complication rates. Results: Among 176 patients receiving NIV, 88 patients were included in the study (PCV mode, n=29; PSV mode, n=59). The study population had a median age of 73.0 years and median body mass index of 20.8 kg/m 2 .The applied inspiratory positive airway pressure (IPAP) was higher in patients with PCV than in those with PSV [18.0 cmH 2 O (15.0-20.5 cmH 2 O) vs. 15.0 cmH 2 O (12.0-17.0 cmH 2 O), respectively, P=0.001]. More patients with PCV received sedatives and experienced dry mouth than those with PSV; however, the incidences of large leaks were low in both groups (n=5 vs. n=2, respectively). With regard to NIV outcomes, 24 (27.2%) patients experienced NIV failure and 13 (14.8%) died in hospital. PSV mode was a significant factor for NIV success [odds ratio (OR), 2.303; 95% confidence interval (CI), 1.216 to 4.360] in multivariate analyses and this association remained significant in a 1:1 matched cohort (n=29 per group). Conclusions:In contrast to PCV mode, PSV mode was significantly associated with NIV success in the intensive care unit setting, particularly when large leaks were not a major concern. Nevertheless, further well-designed multicenter, protocol-driven randomized controlled trials are warranted.

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Section: Discussionmentioning

confidence: 64%

Non-invasive ventilation for acute respiratory failure: pressure support ventilation vs. pressure-controlled ventilation

et al. 2020

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“…Reports on the effects of NIV on patients with ARDS are conflicting. However, based on recent studies, NIV (via helmet) might be beneficial in these populations once optimal PEEP levels with less leakage have been obtained via interfaces1429.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Noninvasive Ventilation Use in Korean Intensive Care Units: A Prospective Multicenter Observational Study

et al. 2019

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Background Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results A total of 156 patients treated with NIV were enrolled (mean age, 71.9±11.6 years). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.

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“…Non-invasive ventilation (NIV) has an important role in the management of hypercapnic respiratory failure, however, its role in the management of acute hypoxic respiratory failure and ARDS is controversial [48,49]. The goal of NIV in ARDS, as well as in other forms of respiratory failure, is to avoid endotracheal intubation and its associated complications.…”

Section: Non-invasive Ventilationmentioning

confidence: 99%

Evidence-Based Mechanical Ventilatory Strategies in ARDS

Liaqat

Mason

Foster

et al. 2022

JCM

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Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO2 (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS.

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Noninvasive ventilation for acute respiratory distress syndrome: the importance of ventilator settings

Cited by 16 publications

References 33 publications

Non-invasive ventilation for acute respiratory failure: pressure support ventilation vs. pressure-controlled ventilation

Non-invasive ventilation for acute respiratory failure: pressure support ventilation vs. pressure-controlled ventilation

Current Status of Noninvasive Ventilation Use in Korean Intensive Care Units: A Prospective Multicenter Observational Study

Evidence-Based Mechanical Ventilatory Strategies in ARDS

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