The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Richard G Wunderink - One of the best experts on this subject based on the ideXlab platform.
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noninvasive mechanical ventilation via Face Mask in patients with acute respiratory failure who refused endotracheal intubation
Critical Care Medicine, 1994Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, K V Leeper, Richard G WunderinkAbstract:OBJECTIVE: To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation. DESIGN: Case series. SETTING: Medical intensive care units (ICUs) in a university health science center. PATIENTS: Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs. INTERVENTION: Mechanical ventilation was delivered via a Face Mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of < 25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. MEASUREMENTS AND MAIN RESULTS: Mechanical ventilation via Face Mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via Face Mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the Mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via Face Mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication. CONCLUSIONS: We conclude that mechanical ventilation via Face Mask offers an effective, comfortable, and dignified method of supporting patients with end-stage disease and acute respiratory failure.
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noninvasive Face Mask mechanical ventilation in patients with acute hypercapnic respiratory failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, K V Leeper, C B Jones, Richard G WunderinkAbstract:Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a Face Mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in Pco 2 (>16 percent decrease) and in pH (from 7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the Mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the Face Mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency. (Chest 1991; 100:445-54)
Qian Li - One of the best experts on this subject based on the ideXlab platform.
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continuous positive airway pressure and ventilation are more effective with a nasal Mask than a full Face Mask in unconscious subjects a randomized controlled trial
Critical Care, 2013Co-Authors: Qian Li, William R Kimball, Jingping Wang, Abdolnabi S Sabouri, Priscilla G Harrell, Robert M Kacmarek, Yandong JiangAbstract:Introduction Upper airway obstruction (UAO) is a major problem in unconscious subjects, making full Face Mask ventilation difficult. The mechanism of UAO in unconscious subjects shares many similarities with that of obstructive sleep apnea (OSA), especially the hypotonic upper airway seen during rapid eye movement sleep. Continuous positive airway pressure (CPAP) via nasal Mask is more effective at maintaining airway patency than a full Face Mask in patients with OSA. We hypothesized that CPAP via nasal Mask and ventilation (nCPAP) would be more effective than full Face Mask CPAP and ventilation (FmCPAP) for unconscious subjects, and we tested our hypothesis during induction of general anesthesia for elective surgery.
Gianfranco Umberto Meduri - One of the best experts on this subject based on the ideXlab platform.
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noninvasive mechanical ventilation via Face Mask in patients with acute respiratory failure who refused endotracheal intubation
Critical Care Medicine, 1994Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, K V Leeper, Richard G WunderinkAbstract:OBJECTIVE: To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation. DESIGN: Case series. SETTING: Medical intensive care units (ICUs) in a university health science center. PATIENTS: Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs. INTERVENTION: Mechanical ventilation was delivered via a Face Mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of < 25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. MEASUREMENTS AND MAIN RESULTS: Mechanical ventilation via Face Mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via Face Mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the Mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via Face Mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication. CONCLUSIONS: We conclude that mechanical ventilation via Face Mask offers an effective, comfortable, and dignified method of supporting patients with end-stage disease and acute respiratory failure.
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noninvasive Face Mask mechanical ventilation in patients with acute hypercapnic respiratory failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, K V Leeper, C B Jones, Richard G WunderinkAbstract:Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a Face Mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in Pco 2 (>16 percent decrease) and in pH (from 7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the Mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the Face Mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency. (Chest 1991; 100:445-54)
Didier Thevenin - One of the best experts on this subject based on the ideXlab platform.
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rescue therapy by switching to total Face Mask after failure of Face Mask delivered noninvasive ventilation in do not intubate patients in acute respiratory failure
Critical Care Medicine, 2013Co-Authors: Malcolm Lemyze, Jihad Mallat, Olivier Nigeon, Stephanie Barrailler, Florent Pepy, Gaelle Gasan, Nicolas Vangrunderbeeck, Philippe Grosset, Laurent Tronchon, Didier TheveninAbstract:Objective:To evaluate the impact of switching to total Face Mask in cases where Face Mask-delivered noninvasive mechanical ventilation has already failed in do-not-intubate patients in acute respiratory failure.Design and Setting:Prospective observational study in an ICU and a respiratory stepdown u
Colin J Morley - One of the best experts on this subject based on the ideXlab platform.
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improved techniques reduce Face Mask leak during simulated neonatal resuscitation study 2
Archives of Disease in Childhood-fetal and Neonatal Edition, 2008Co-Authors: Fiona E Wood, Colin J Morley, Jennifer A Dawson, Omar C F Kamlin, Louise S Owen, Susan Donath, Peter G DavisAbstract:Background: Techniques of positioning and holding neonatal Face Masks vary. Studies have shown that leak at the Face Mask is common and often substantial irrespective of operator experience. Aims: (1) To identify a technique for Face Mask placement and hold which will minimise Mask leak. (2) To investigate the effect of written instruction and demonstration of the identified technique on Mask leak for two round Face Masks. Method: Three experienced neonatologists compared methods of placing and holding Face Masks to minimise the leak for Fisher & Paykel 60 mm and Laerdal size 0/1 Masks. 50 clinical staff gave positive pressure ventilation to a modified manikin designed to measure leak at the Face Mask. They were provided with written instructions on how to position and hold each Mask and then received a demonstration. Face Mask leak was measured after each teaching intervention. Results: A technique of positioning and holding the Face Masks was identified which minimised leak. The mean (SD) Mask leaks before instruction, after instruction and after demonstration were 55% (31), 49% (30), 33% (26) for the Laerdal Mask and 57% (25), 47% (28), 32% (30) for the Fisher & Paykel Mask. There was no significant difference in Mask leak between the two Masks. Written instruction alone reduced leak by 8.8% (CI 1.4% to 16.2%) for either Mask; when combined with a demonstration Mask leak was reduced by 24.1% (CI 16.4% to 31.8%). Conclusion: Written instruction and demonstration of the identified optimal technique resulted in significantly reduced Face Mask leak.
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neonatal resuscitation 3 manometer use in a model of Face Mask ventilation
Archives of Disease in Childhood-fetal and Neonatal Edition, 2005Co-Authors: Colm P F Odonnell, Peter G Davis, Peter A Dargaville, Lex W Doyle, Colin J MorleyAbstract:Background: Adequate ventilation is the key to successful neonatal resuscitation. Positive pressure ventilation (PPV) is initiated with manual ventilation devices via Face Masks. These devices may be used with a manometer to measure airway pressures delivered. The expiratory tidal volume measured at the Mask (V TE(Mask) ) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. Aim: To assess the effect of viewing a manometer on the peak inspiratory pressures used, the volume delivered, and leakage from the Face Mask during PPV with two manual ventilation devices in a model of neonatal resuscitation. Methods: Participants gave PPV to a modified resuscitation mannequin using a Laerdal infant resuscitator and a Neopuff infant resuscitator at specified pressures ensuring adequate chest wall excursion. Each participant gave PPV to the mannequin with each device twice, viewing the manometer on one occasion and unable to see the manometer on the other. Data from participants were averaged for each device used with the manometer and without the manometer separately. Results: A total of 7767 inflations delivered by the 18 participants were recorded and analysed. Peak inspiratory pressures delivered were lower with the Laerdal device. There were no differences in leakage from the Face Mask or volumes delivered. Whether or not the manometer was visible made no difference to any measured variable. Conclusions: Viewing a manometer during PPV in this model of neonatal resuscitation does not affect the airway pressure or tidal volumes delivered or the degree of leakage from the Face Mask.
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neonatal resuscitation 1 a model to measure inspired and expired tidal volumes and assess leakage at the Face Mask
Archives of Disease in Childhood-fetal and Neonatal Edition, 2005Co-Authors: Colm P F Odonnell, Peter G Davis, C O F Kamlin, Colin J MorleyAbstract:BACKGROUND: Neonatal resuscitation is a common and important intervention, and adequate ventilation is the key to success. In the delivery room, positive pressure ventilation is given with manual ventilation devices using Face Masks. Mannequins are widely used to teach and practise this technique. During both simulated and real neonatal resuscitation, chest excursion is used to assess tidal volume delivery, and leakage from the Mask is not measured. OBJECTIVE: To describe a system that allows measurement of Mask leakage and estimation of tidal volume delivery. METHODS: Respiratory function monitors, a modified resuscitation mannequin, and a computer were used to measure leakage from the Mask and to assess tidal volume delivery in a model of neonatal resuscitation. RESULTS: The volume of gas passing through a flow sensor was measured at the Face Mask. This was a good estimate of the tidal volume entering and leaving the lung in this model. Gas leakage between the Mask and mannequin was also measured. This occurred principally during inflation, although gas leakage during deflation was seen when the total leakage was large. A volume of gas that distended the Mask but did not enter the lung was also measured. CONCLUSION: This system can be used to assess the effectiveness of positive pressure ventilation given using a Face Mask during simulated neonatal resuscitation. It could be useful for teaching neonatal resuscitation and assessing ventilation through a Face Mask.
