Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy

Pu, Xue-xue; Wang, Jiong; Yan, Xinfeng; Jiang, Xueqin

doi:10.5847/wjem.j.1920-8642.2015.03.006

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…This is due to the high peak inspiratory pressure and tidal volume in the regular mechanical ventilation mode, which easily leads to lung injuries, such as the barometric and biological injuries. Moreover, patients often experience problems such as alveolar atrophy, pulmonary interstitial edema, and sporadic lung alveolar overinflation, conditions that are not conducive to the recovery of spontaneous respiratory function[ 16 ]. In contrast, sequential mechanical ventilation has a relatively low tidal volume, which reduces airway pressure, pressure injury, and ventilator-related lung injury.…”

Section: Discussionmentioning

confidence: 99%

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

Niu¹,

Wang²,

Li³

et al. 2022

WJCC

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BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance, alveolar capillary injury, pulmonary edema, refractory hypoxemia, and reduced lung compliance. Prolonged hypoxia can cause acid-base balance disorder, peripheral circulatory failure, blood-pressure reduction, arrhythmia, and other adverse consequences. AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure. METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial, with each group comprising 54 patients. The sequential group received invasive and non-invasive sequential mechanical ventilation, whereas the regular group received invasive mechanical ventilation. Blood-gas parameters, hemodynamic parameters, respiratory mechanical parameters, inflammatory factors, and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment. RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24, 48, and 72 h of treatment were higher than those of the conventional group ( P < 0.05). The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group ( P < 0.05). The pH value of the sequential group at 24 and 72 h of treatment, the central venous pressure value of the treatment at 24 h, and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group ( P < 0.05). The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group ( P < 0.05), the measured values of interleukin-6 and tumor necrosis factor-α in the sequential group at 72 h of treatment were lower than those in the conventional group ( P < 0.05), and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group, with a statistically significant difference ( P < 0.05). CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance, reducing inflammatory response, maintaining hemodynamic stability, and improving patient blood-gas levels; however, from this study’s perspective, it cannot reduce patient mortality.

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Section: Discussionmentioning

confidence: 99%

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

Niu¹,

Wang²,

Li³

et al. 2022

WJCC

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“…The noninvasive ventilator interfaces include oronasal mask (also called full-face mask), nasal mask (including nasal pillow), total face mask, 45 – 47 and helmet, 48 , 49 each of which has its own advantages and disadvantages 5 , 26 , 28 , 33 , we are familiar with these characteristics and will not dwell on them here. Another method, which is less used, is noninvasive ventilator connected to tracheotomy for ventilation.…”

Section: Discussionmentioning

confidence: 99%

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Liu

Shi

2023

Ther Adv Respir Dis

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Neuromuscular diseases (NMD) are indications for long-term home mechanical ventilation (HMV). Noninvasive ventilation is preferred to HMV. However, invasive mechanical ventilation (IMV) is more appropriate if the patient has uncontrollable airway secretions, the possibility of aspiration, failure to wean, or severe weakness of the respiratory muscles. But if the patient undergoes multiple intubation or tracheotomy, it will be more painful and unbearable. For some end-stage NMD patients who need long-term tracheostomy, HMV using noninvasive ventilator via tracheotomy may be a conservative care option. An 87-year-old male with myasthenia gravis underwent repeated IMV and failed to wean. We used a noninvasive ventilator connected to a tracheostomy tube for mechanical ventilation. One and a half years later, the patient weaned successfully. However, there was a lack of evidence-based medicine and standardized guidelines in such areas as indications, contraindications, and ventilator parameter setting. For the systematic review, a literature search was performed in PubMed, Embase, Cochrane, and CNKI (China National Knowledge Infrastructure) to identify reported cases of using noninvasive ventilator in patients undergoing tracheostomy. A total of 72 cases who performed ventilation via tracheotomy tube were identified. The main diagnoses included NMD, chronic obstructive pulmonary disease (COPD), pneumonia, and congenital central hypoventilation syndrome (CCHS). Indications included dysfunctional ventilatory weaning response (DVWR), apnea and cyanosis. Clinical outcome was as follows: 33 patients were weaned, and 24 patients underwent HMV. A total of 288 cases who performed ventilation through the mask after blocking the tracheostomy tube were identified. The primary diagnoses included COPD, NMD, thoracic restriction, spinal cord injured (SCI), and CCHS. Indications included DVWR, apnea and cyanosis, routine weaning. Clinical outcome was as follows: successful tracheostomy tube decannulations were performed in 254 patients and failed in 33 patients. So, in patients requiring HMV, selection of noninvasive ventilation (NIV) or IMV should be individualized. Tracheostomy preservation should be considered in some patients with advanced NMD if there is respiratory muscle weakness or the risk of aspiration. And attempts can be made to use a noninvasive ventilator because of its advantages of portability, ease of operation, and low cost. Noninvasive ventilators can be used in patients with tracheotomy, whether direct connection tracheotomy or mask ventilation after the tube is capped, especially in weaning and tracheostomy tube decannulation.

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“…The (Non-invasive Positive Pressure Ventilation) NPPV is an appealing option for patients requiring ventilatory assistance with potentially reversible conditions when tracheal intubation is not immediately necessary. Noninvasive ventilation has been shown to improve preoxygenation prior to intubation when compared to standard methods of oxygen delivery [6].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma

Mahran

El-Kalla

Sallam

et al. 2021

JAMMR

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Background: Chest injury was found to cause death in 20%–25% of multiple trauma patients. Thoracic trauma is, therefore, important in the overall management of multiple injury patients and may require a longer stay in the Intensive Care Unit (ICU) and use of mechanical ventilation. Methods: This prospective randomized clinical study was in Emergency Intensive Care, Tanta University Hospitals. For, 88 adult patients with blunt chest injury. Patients were enrolled in this study aged ≥18 years old classified into two equal groups: Group I (Non-Invasive Mechanical Ventilation group) = 44 patient: Patients in this group received BIPAP. Group II (Control group=44 patient: Patients in this group have received high flow O2 by mask O2 without use of non-invasive mechanical ventilation. Data of collection were: the demographic data, Frequent arterial blood gas analysis of all patients every 6 hrs. Respiratory rate, Arterial blood pressure, Heart rate were recorded: every 6 h. All Patients receive analgesia. Evaluate outcome: a-Primary outcome. Tracheal intubation, duration of ventilation. b-Secondary outcome. Mortality, ICU length stay. And Chest Trauma Scoring System. Results: Ten patients (22%) were intubated and mechanically ventilated in group I (BiPAP). with mean value of duration of ventilation 34.4 hrs. But at group II 16 patients (36%) were intubated and mechanically ventilated with mean value of duration of ventilation 34.12 hrs. ICU stay at group I (BiPAP) was statistically decrease of number of days when compared to group II (control). 6 days at group I and 12 days at group II. In this study no case of mortality was recorded with non-invasive ventilation, although three mortality cases were recorded with the control group. Conclusion: This study recommends the pre-emptive use of Non-Invasive Ventilation in the treatment for blunt chest injury in patients at risk for respiratory failure. Success of Non-Invasive Ventilation depends on improvement of hypercarbia and hypoxemia in patients impending respiratory failure due to reversible cause as blunt chest trauma with the expectation of a good outcome and avoidance of intubation.

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Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy

Cited by 7 publications

References 29 publications

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review

Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma

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