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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.
Use of non-invasive mechanical ventilation in the Emergency Department, clinical outcomes and correlates of failure
Paolo Groff,Fabrizio Giostra,Stefania Ansaloni,Lucilla Piccari
Italian Journal of Public Health , 2008, DOI: 10.2427/5826
Abstract: Background: Despite several studies having been carried in this organizational context, there is an absence of information about the effectiveness of non-invasive mechanical ventilation (NIV) in Emergency Departments (ED), based on a number of suitable patients with acute respiratory failure (ARF) of different aetiology. In particular, it has not yet been defined as to whether the context of the ED suits the necessary requirement of quality for the correct application of the method and if the obtained results are different from those taken in other studies in general or respiratory intensive care unit. Finally there are few data related to the predictive factors to NIV failure (endotracheal intubation, in-hospital mortality) when applied in the emergency setting. Methods: To answer these questions we have retrospectively studied a population of 210 patients (95 with COPD exsacerbation ; 92 with acute cardiogenic pulmonary oedema; 23 with severe community acquired pneumonia) treated for ARF in the “critical area” of four Italian level II Emergency Departments. For all patients demographic data; some comorbidities (diabetes, dementia, sopraventricular arrhythmias, obesity); the physiological scores (Kelly, SAPS II, Apache II); the need for pharmacological sedation; vital and blood gas parameters (evaluated at entry, after one hour of treatment and before its suspension); the ventilatory modality applied (CPAP or PSV + PEEP) and some parameters of in-hospital stay (duration of the hospitalization in the critical area, duration of ventilation, compliance to the treatment, patient's refusal to continue it, development of skin necrosis, need for endotracheal intubation, in-hospital mortality) were considered. Finally demographic, event of death with Cox regression or to the need for ETI through linear regression analysis. Results: Globally, in-hospital mortality reached 13,3%, the percentage of failure with consequent endotracheal intubation amounted to 10,4% . Considering the single aetiologic groups in the patients with COPD, exsacerbation mortality and ETI percentage were 12,6% and 13,7% respectively; in ACPO patients these data respectively amounted to 3,3% and 4,3%; while for patients with severe CAP they respectively reached 34,7% and 21,7%. The following factors were independently correlated with in-hospital mortality: SAPS II > 35, presence of dementia for COPD patients; SAPS II > 35; presence of dementia, presence of sopraventricular arrhythmias for ACPO patients; SAPS II > 35, presence of sopraventricular arrhythmias, presence of dementia for CAP pat
Non Invasive Mechanical Ventilation  [PDF]
Dr U. D. Sharma
Indian Anaesthetists' Forum , 2004,
Abstract: Negative pressure ventilators (Tank and Cuirass ventilators) were the only non-invasive methods of assisting ventilation for many years mainly for ventilating large number of victims of Polio during their acute illness. In 1980s it was recognized that delivery of continuous positive airway pressure by close fitting nasal masks for treatment of obstructive sleep apnoea could also be used to deliver an intermittent positive pressure. This was followed by improvements in the interface and establishment of role of NIMV in patients of COPD. The use of NIMV has increased in last decade in various conditions to avoid complications of intubation.
Non-invasive mechanical ventilation
BL Giles
Southern African Journal of Critical Care , 2005,
Abstract: Non-invasive ventilation (NIV) is a modality of providing airway and pulmonary support in both acute and chronic diseases of the lung. The method of mechanical ventilation without the use of an endotracheal tube was developed over a century ago, but its utility has only been explored recently with advances in technology. NIV is the method of choice when there is a desire to avoid the inherent complications that arise from using artificial airway supports such as endotracheal tubes and tracheostomies. NIV can be used in the intensive care unit and in the outpatient setting in appropriately selected patients. Adult and paediatric critical care and respiratory divisions have a wealth of experience in successful use of NIV. The history, use and experience will be discussed along with recommendations for initiating NIV. SAJCC Vol. 21 (1) 2005: pp. 10-15
Invasive pulmonary aspergillosis caused by Aspergillus versicolor in a patient on mechanical ventilation  [PDF]
MV Pravin Charles,Noyal Mariya Joseph1,Joshy M Easow1,M Ravishankar2
Australasian Medical Journal , 2011,
Abstract: Aspergillus spp. often colonise the respiratory tract of critically ill patients in intensive care units and subsequently cause invasive disease. The risk of developing invasive disease is more in immunocompromised patients. Here we report a case of fatal invasive pulmonary aspergillosis caused by Aspergillus versicolor in a post-operative patient on mechanical ventilation, who did not respond to intravenous itraconazole. We then discuss the challenges involved in the accurate diagnosis of this condition and appropriate management.
Invasive home mechanical ventilation, mainly focused on neuromuscular disorders
Geiseler, Jens,Karg, Ortrud,B?rger, Sandra,Becker, Kurt
GMS Health Technology Assessment , 2010,
Abstract: Introduction and background: Invasive home mechanical ventilation is used for patients with chronic respiratory insufficiency. This elaborate and technology-dependent ventilation is carried out via an artificial airway (tracheal cannula) to the trachea. Exact numbers about the incidence of home mechanical ventilation are not available. Patients with neuromuscular diseases represent a large portion of it. Research questions: Specific research questions are formulated and answered concerning the dimensions of medicine/nursing, economics, social, ethical and legal aspects. Beyond the technical aspect of the invasive home, mechanical ventilation, medical questions also deal with the patient’s symptoms and clinical signs as well as the frequency of complications. Economic questions pertain to the composition of costs and the differences to other ways of homecare concerning costs and quality of care. Questions regarding social aspects consider the health-related quality of life of patients and caregivers. Additionally, the ethical aspects connected to the decision of home mechanical ventilation are viewed. Finally, legal aspects of financing invasive home mechanical ventilation are discussed. Methods: Based on a systematic literature search in 2008 in a total of 31 relevant databases current literature is viewed and selected by means of fixed criteria. Randomized controlled studies, systematic reviews and HTA reports (health technology assessment), clinical studies with patient numbers above ten, health-economic evaluations, primary studies with particular cost analyses and quality-of-life studies related to the research questions are included in the analysis. Results and discussion: Invasive mechanical ventilation may improve symptoms of hypoventilation, as the analysis of the literature shows. An increase in life expectancy is likely, but for ethical reasons it is not confirmed by premium-quality studies. Complications (e. g. pneumonia) are rare. Mobile home ventilators are available for the implementation of the ventilation. Their technical performance however, differs regrettably. Studies comparing the economic aspects of ventilation in a hospital to outpatient ventilation, describe home ventilation as a more cost-effective alternative to in-patient care in an intensive care unit, however, more expensive in comparison to a noninvasive (via mask) ventilation. Higher expenses arise due to the necessary equipment and the high expenditure of time for the partial 24-hour care of the affected patients through highly qualified personnel. However, none of the stud
Non-invasive mechanical ventilation therapy in patients with heart failure  [cached]
Dursun Dursuno?lu,Ne?e Dursuno?lu
Anadolu Kardiyoloji Dergisi , 2012,
Abstract: Non-invasive mechanical ventilation (NIMV) therapy in patients with acute heart failure (HF) improves left ventricular functions via decreasing left ventricular afterload and reduces intubation rate and short-term mortality. In patients with chronic HF, NIMV therapy eliminates central and obstructive apneas and Cheyne-Stokes respiration, and improves morbidity. There are essentially three modes of NIMV that are used in the treatment of HF: Continuous positive airway pressure (CPAP), bilevel positive airway pressure (BIPAP) and adaptive servo-ventilation (ASV). Hereby, NIMV therapy in patients with acute and chronic HF is reviewed as well as methods, indications, effectiveness and complications.
Core Topics in Mechanical Ventilation
Lluis Blanch
Critical Care , 2009, DOI: 10.1186/cc7951
Abstract: The contents of Core Topics in Mechanical Ventilation edited by Ian Mackenzie can be separated into two general parts. Several chapters cover general respiratory physiology, which is essential to understand how mechanical ventilation works and interacts with cardio-respiratory performance. It is worth mentioning the good contributions on the physiology of gas exchange, carbon dioxide balance and cardio-respiratory interactions. Some chapters are dedicated to adjuncts of mechanical ventilation, including both general and custom adjuncts used in mechanically ventilated patients. Of note are the chapters dedicated to the effects and administration of oxygen and heliox, and to sedation, analgesia, paralysis and nutrition.The second part is devoted to mechanical ventilation. The reader can find recommendations about how to set the ventilator in several clinical scenarios such as asthma, chronic obstructive pulmonary disease, and chest, burn and blast injuries. One specific chapter is devoted to adverse effects and complications of mechanical ventilation. This chapter deals in a very comprehensive manner with management of the difficult airway, unplanned extubation and how to minimize and manage ventilation-induced lung injury (barotrauma, volutrauma, and atelectrauma), among others. The management of acute lung injury and acute respiratory distress syndrome are not covered in dedicated chapters, but major principles are included as paragraphs in distinct parts of the book. The same is the case for non-invasive mechanical ventilation, which nowadays can be considered an independent discipline that extends beyond anesthesia and intensive care departments. Three chapters deserve mention for their particular relevance: Management of the artificial airway, Modes of mechanical ventilation, and Mechanical ventilation for transport. These chapters are extensive and comprehensive and include technical documentation as well as tables and figures that are self-explanatory. I am als
Profile of patients in invasive mechanical ventilation in an intensive care unit  [cached]
Débora D’Agostini Jorge Lisboa,Everton Fleith de Medeiros,Luis Guilherme Alegretti,Daiane Badalotto
Journal of Biotechnology and Biodiversity , 2012,
Abstract: It was investigated a sample of 55 patients underwent invasive mechanical ventilation in an intensive care unit of amedium-size hospital between April and May 2008. The objective was to investigate the most frequent pathologies,the main causes of use of mechanical ventilation, final outcome, length of stay in the intensive care unit and themean time of ventilatory support use. It was elaborated a questionnaire for data collection contained in the recordsfiled in the Department of Medical Records and Statistics (SAME) of the hospital. The main findings indicated thatfemale was the most prevalent; the mean age was 61.62± 21.29 years; the most incident pathological group wasneurology; the main cause of ventilatory support was acute respiratory failure in 63.64%; the average time ofmechanical ventilation was 6.21± 8.06 days and the mean length of stay in the intensive care unit was 8.54± 9.59days. The profile found can provide knowledge about the investigated population, as a basis for team working in theICU enhances its actions, improving the quality of care. Similar studies with larger samples are suggested todetermine regional differences.
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