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Fiber optic bronchoscopy in patients with acute hypoxemic respiratory failure requiring noninvasive ventilation - a feasibility study
Hans Baumann, Hans Klose, Marcel Simon, Tarik Ghadban, Stephan A Braune, Jan K Hennigs, Stefan Kluge
Critical Care , 2011, DOI: 10.1186/cc10328
Abstract: We prospectively investigated 40 consecutive, critically ill, adult patients with acute hypoxemic respiratory failure (14 women, 26 men, age 61 ± 15 years, partial pressure for oxygen/fraction of inspired oxygen (PaO2/FiO2) < 300 under noninvasive ventilation, Simplified Acute Physiology scores (SAPS II) 47 ± 9.9 points). All patients required noninvasive ventilation prior to the decision to perform bronchoscopy (median 10.5 h; range 2.2 to 114). Blood gases, heart rate, blood pressure and ventilation were monitored before, during and up to 120 minutes after bronchoscopy.Bronchoscopy could be completed in all patients without subsequent complications. Oxygen saturation fell to < 90% in two patients (5%), and the lowest value during the procedure was 84%. The mean PaO2/FiO2 ratio improved from 176 ± 54 at baseline to 240 ± 130 (P < 0.001) at the end of bronchoscopy and 210 ± 79 after 120 minutes. The transient mean partial pressure of carbon dioxide in the arterial blood (PaCO2) increase was 9.4 ± 8.1 mm Hg. Four patients (10%) required endotracheal intubation during the first eight hours after the procedure. Bronchoalveolar lavage yielded diagnostic information in 26 of 38 (68%) patients.In critically ill patients with acute hypoxemic respiratory failure requiring noninvasive ventilation, bronchoscopy can be performed with an acceptable risk. Since these patients per se have a high likelihood of subsequent endotracheal intubation due to failure of NIV, bronchoscopy should only be performed by experienced clinicians.Noninvasive ventilation (NIV) constitutes a cornerstone in the treatment of acute respiratory failure of various etiologies [1-3]. Some patients treated for acute respiratory failure in the intensive care unit will require diagnostic or therapeutic bronchoscopy. While bronchoscopy is generally considered a safe intervention [4], it is well known that bronchoscopy and especially bronchoalveolar lavage (BAL) may induce significant hypoxemia [5]. Therefore,
Prospective evaluation of noninvasive positive pressure ventilation (NPPV) in acute hypoxemic respiratory failure (AHRF) following lung resection
I Auriant, AA Jallot, P Hervé, J Cerrina, F Le Roy Ladurie, JL Fournier, B Lescot, F Parquin
Critical Care , 2001, DOI: 10.1186/cc1085
Abstract: On 2280 patients who had undergone thoracic surgery between May 1999 and July 2000, those who had pulmonary resection and experienced AHRF were prospectively recruited. Patients were enrolled if they met at least three of the following criteria: dyspnea at rest defined by a respiratory rate of 25 breaths/min or more, active contraction of the accessory respiratory muscles or abdominal paradox, a ratio PaO2/FiO2 < 200 and radiologic lesions on the chest radiograph. They were randomly assigned to receive either conventional therapy or conventional therapy and noninvasive positive pressure ventilation (NPPV) through a nasal mask. NPPV was provided with the BiPAP? Vision Ventilator System (Respironics Inc., Murrysville, PA, USA). The primary end point of the study was 'need for endotracheal intubation'. Secondary endpoints included: in-hospital mortality, the length of stay in the ICU, length of stay in the hospital, and the need for fiberoptic bronchoscopy. An interim analysis was designed at the middle of the study.Over this 16 month period, 912 patients were admitted to the Intensive Care Unit. Forty-eight patients were enrolled.Because endotracheal intubation is the most important predisposing factor for ventilator associated pneumonia, bronchial stump disruption and bronchopleural fistula, postoperative re-intubation must be avoided. This is the first prospective, randomized study which demonstrates an improvement in survival and in avoiding endotracheal intubation in the postoperative care of patients undergoing lung resection surgery.
Noninvasive ventilation in acute respiratory failure due to H1N1 influenza  [cached]
Mohapatra Prasanta,Dutt Naveen,Khanduri Sushant,Mishra Baijayantimala
Lung India , 2011,
Abstract: We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.
Noninvasive Mechanical Ventilation
Marmara Medical Journal , 2011,
Abstract: Respiratory failure in patients hospitalized in the intensive care unit is a common clinical problem. These patients need respiratory support until the effect of medical treatment begins. Positive pressure ventilation is used to support patients with respiratory failure. Mechanical ventilatory support may be given to the patient via face interface during noninvasive mechanical ventilation (NIMV) or via entubation tube during invasive mechanical ventilation (IMV). Although the degree of support are the same, complication rates are lower in NIMV than IMV.
Use of noninvasive positive pressure ventilation during pregnancy: Case series
Al-Ansari Mariam,Hameed Akmal,Al-jawder Suhaila,Saeed Hassan
Annals of Thoracic Medicine , 2007,
Abstract: Mechanical ventilation is commonly required in critically ill pregnant patients, requiring ICU admission, with higher morbidity and mortality related to airway management. Alternatively, noninvasive positive pressure ventilation (NIPPV) is increasingly used to treat nonpregnant patients. Pregnancy has been a contraindication to its use. We would like to report a case series of successful use of NIPPV in pregnancy. NIPPV is increasingly used to treat hypoxemic respiratory failure. It has rarely been used during pregnancy. On the other hand, acute respiratory failure (ARF) remains a leading cause of ICU admission in obstetric patients. The use of NIPPV in managing ARF in pregnant patients was not investigated. We report the outcome of treatment with NIPPV of four sickle cell disease pregnant patients with ARF caused by acute chest syndrome. Median APACHE II score for the four cases was 27. Intubation was avoided in all cases. None had aspiration. Mean duration of NIPPV was 40 h with ICU discharge after a mean of 4 days.
Noninvasive ventilation in acute exacerbations of COPD
M. W. Elliott
European Respiratory Review , 2005,
Abstract: Noninvasive ventilation has been a major advance in the management of acute exacerbations of chronic obstructive pulmonary disease, reducing the need for endotracheal intubation, thereby reducing complications and hospital costs, as well as improving survival. It has been used in a variety of different clinical environments including the emergency room, on general wards, in intermediate respiratory care units and in the intensive care unit. It should now be regarded as part of standard therapy for patients who continue to have a respiratory acidosis after standard medical therapy.
Ventilación no invasiva Noninvasive ventilation
Mario Santiago Puga Torres,Héctor Palacios Pérez,Roberto García Valdés,Danilo Morejón Carbonell
Revista Cubana de Medicina Militar , 2006,
Abstract: La ventilación mecánica no invasiva es la administración del soporte ventilatorio sin la colocación de una vía aérea artificial como un tubo endotraqueal o una traqueostomía, sino mediante una máscara facial, nasal o un sistema de casco. Sus efectos beneficiosos se logran mediante la disminución del trabajo respiratorio, la mejoría de la ventilación alveolar y sobre todo la reducción de la frecuencia de intubación, por lo que se recomienda en el tratamiento de la IRA. Se realizó una exposición de las principales indicaciones basadas en numerosos estudios que soportan su uso con distintos grados de evidencia. Se presentaron los diferentes criterios clínicos de selección, así como los criterios de exclusión, y se describieron diferentes tipos de interfases y de respiradores; se se ala que lo que hace a la ventilación no invasiva es la interfase no el ventilador. Se expusieron criterios acerca de los predictores de éxito para la ventilación no invasiva en el contexto agudo. Finalmente, se presentaron conclusiones diagnósticas de empleo de diferentes trastornos de la función respiratoria. Noninvasive mechanical ventilation is the administration of ventilating support without placing an artificial airway such as endotracheal tube or tracheostomy, but using either a face or nasal mask, or a helmet system. The beneficial effects of this ventilation are the reduction of respiratory work, improvement of alveolar ventilation and above all, the reduction of frequency of intubation, therefore, this noninvasive ventilation is recommended for treating acute respiratory failure. The main indications based on a number of studies that support its use with different evidence were also presented. Several clinical inclusion and exclusion criteria were stated together with the description of various types of interfaces and respirators. It was pointed out that the interface and not the ventilator is the one that renders the ventilation noninvasive. Finally, some diagnostic conclusions about the use of different methods for respiratory function disorders.
Noninvasive ventilation for acute respiratory failure in children – a systematic review  [PDF]
Carolina Silva Gonzaga,Dafne Cardoso Bourguignon da Silva,Carolina Figueira Rabello Alonso,Carlos Augusto Cardim de Oliveira
Einstein (S?o Paulo) , 2011,
Abstract: Objective: To assess the role of noninvasive ventilation in the treatment of children with acute respiratory failure. Methods: A systematic review of literature on noninvasive ventilation in MEDLINE, LILACS, EMBASE, and Cochrane databases, besides references in articles. The outcomes evaluated were responses in blood oxygenation and ventilation, and patient survival. Results: A total of 120 studies on noninvasive ventilation were found as of May, 2010. Of these, only 19 were about noninvasive ventilation in children. On the other hand, there are prospective and cohort clinical trials leading to a level II quality of evidence concerning the use of noninvasive ventilation in children. Conclusion: There is scientific evidence for proposing the use of noninvasive ventilation, with a B-II degree of recommendation.
Another step for noninvasive ventilation in chronic obstructive pulmonary disease patients!
Samir Jaber, Gerald Chanques
Critical Care , 2010, DOI: 10.1186/cc9023
Abstract: For patients with an exacerbation of chronic obstructive pulmonary disease (COPD), noninvasive positive pressure ventilation (NPPV) is considered the standard of care [1] and should be available as first-line therapy in any institution that treats acutely ill COPD patients [2]. Most randomised control trials of NPPV for acute respiratory failure, however, have excluded patients without efficient clearance of secretions [2]. As a matter of a fact, the inability to spontaneously remove respiratory secretions has been considered a relative contraindication to applied NPPV in acute respiratory failure, especially if the inability occurs in patients with impaired consciousness and depressed cough [2,3].Few studies have shown that, within expert units, NPPV is feasible and may be applied with success in moderate to severe hypercapnic encephalopathy due to COPD [4,5]. Diagnostic or therapeutic flexible fibreoptic bronchoscopy (FBO) is often necessary in severely ill patients, especially in hypoxemic and/or COPD patients. Studies have reported that NPPV may be helpful in performing a diagnostic FBO with bronchoalveolar lavage for suspected pneumonia [6,7]. Limited data exist, however, supporting the use of NPPV in COPD patients who are not eligible for the technique because of their incapability to spontaneously eliminate accumulated secretions associated with hypercapnic encephalopathy.In the previous issue of Critical Care, Scala and colleagues provide data that support the use of NPPV with early FBO performed by an experienced team in acutely decompensated COPD patients with hypercapnic en cephalopathy and an inability to spontaneously clear copious secretions [1]. They suggested safety and effective ness of this strategy including early therapeutic FBO during NPPV performed by an experienced team [1].The authors performed a 12-month, prospective, matched case-control study including 15 decompensated COPD patients with copious secretion retention and hypercapnic encephal
The role of noninvasive ventilation in acute cardiogenic pulmonary edema
Ashar Salman, Eric B Milbrandt, Michael R Pinsky
Critical Care , 2010, DOI: 10.1186/cc8889
Abstract: Edited by: Eric B Milbrandt. University of Pittsburgh Department of Critical Care MedicineGray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J: Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008, 359:142-151 [1].Noninvasive ventilation (NIV) (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure ventilation [NIPPV]) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality.To determine whether noninvasive ventilation reduces mortality and whether there are important differences in outcome associated with the method of treatment (CPAP or NIPPV).Open, prospective, randomized controlled trial.26 emergency departments in hospital in the UK between July 2003 and April 2007.1069 patients age >16 years with a clinical diagnosis of acute cardiogenic pulmonary edema, as determined by chest radiograph, respiratory rate >20 breaths/min, and arterial pH < 7.35. Exclusion criteria included a requirement for a lifesaving or emergency intervention, inability to give consent, or previous recruitment in the trial.All patients received standard concomitant therapy. Patients were randomly assigned to standard oxygen therapy (up to 15 liters per minute via face mask), CPAP (5 to 15 cm of water), or NIPPV (inspiratory pressure, 8 to 20 cm of water; expiratory pressure, 4 to 10 cm of water).The primary end point for the comparison between noninvasive ventilation and standard oxygen therapy was death within 7 days after the initiation of treatment, and the primary end point for the comparison between NIPPV and CPAP was death or intubation within 7 days.A total of 1069 patients (mean [± SD] age, 77.7 ± 9.7 years; female sex, 56.9%) were assigned to standard oxygen therapy (367 patients), CPAP (346 patients), or NIPPV (356 patients). There was no significant difference in 7-day mortality between patients receiving standard oxygen therapy (9.8%) and th
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