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Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department  [cached]
Rose L
Open Access Emergency Medicine , 2012,
Abstract: Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive and invasively ventilated patients are discussed, with a particular emphasis on initiation and ongoing monitoring priorities focused on maintaining patient safety and improving patient outcomes.Keywords: mechanical ventilation, emergency department, noninvasive ventilation, critical illness, acute respiratory failure
Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department
Rose L
Open Access Emergency Medicine , 2012, DOI: http://dx.doi.org/10.2147/OAEM.S25048
Abstract: nagement of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department Review (2689) Total Article Views Authors: Rose L Published Date March 2012 Volume 2012:4 Pages 5 - 15 DOI: http://dx.doi.org/10.2147/OAEM.S25048 Received: 20 December 2011 Accepted: 02 February 2012 Published: 22 March 2012 Louise Rose Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Abstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive and invasively ventilated patients are discussed, with a particular emphasis on initiation and ongoing monitoring priorities focused on maintaining patient safety and improving patient outcomes.
Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies  [PDF]
Hiroaki Murata, Yoko Yamaguchi
Open Journal of Nursing (OJN) , 2018, DOI: 10.4236/ojn.2018.89045
Abstract: Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
Noninvasive Mechanical Ventilation
Sait KARAKURT
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.
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
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.
Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients
Nery, Patricia;Pastore, Laerte;Carvalho, Carlos Roberto Ribeiro;Schettino, Guilherme;
Clinics , 2011, DOI: 10.1590/S1807-59322011000500009
Abstract: background: prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation. methods: we conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. the population consisted of patients who had been intubated for at least 2 days. results: the baseline characteristics were similar between the groups. the intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). similar reintubation rates within 72 hours were observed for both groups. in addition, a lower icu mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). multivariate analysis showed that the intervention was an independent factor associated with survival (rr: 2.77; ci 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (rr: 0.27; ci 0.11-0.65; p = 0.01). conclusion: the intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.
Elderly homeless: a challenge for nursing interventions
Augusta Bispo dos Santos, Fernanda Santos Rodrigues Araújo, Rose Mary Costa Rosa Andrade Silva, Fátima Helena do Espírito Santo, Eliane Ramos Pereira, Marcos Andrade Silva
Revista de Enfermagem UFPE On Line , 2009,
Abstract: Objectives: to describe the elderly homeless process and the implications in this group and discuss the possibilitiesof nursing care from intervention in the Nursing Interventions Classification (NIC) to the homeless in sheltersinstitutions. Methods: it’s a qualitative approach from a literature review in the databases of the Program ofBibliographic Switching (COMUT), Brazilian Institute for Information in Science and Technology (IBICT), DigitalLibrary of Nursing (BDENF) and Scientific Literature of the Caribbean and Latin America (LILACS), in addition toconsulting the manual journals and books. The search was through the words: elderly, homeless, aging, socialexclusion and population in situation of street. Results: the elderly homeless process as a social exclusion due toalcoholism, poverty and family conflicts, is a challenge for nursing, at the need for effective action on healthespecially in institutions that host temporarily the homeless. Accordingly, twelve interventions were proposedseconds Nursing Interventions Classification (NIC) to such clients supported in that institution. Conclusion: thegerontological nursing must know the psychosocial problems of elderly homeless, creating strategic and jointactions with other professionals in search of effective solutions that address the prevention the elderly homelessprocess.
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