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Richard G Wunderink - One of the best experts on this subject based on the ideXlab platform.
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noninvasive face mask mechanical ventilation in patients with acute hypercapnic Respiratory Failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, C. B. Jones, Kenneth V Leeper, 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 FMMV was generally well accepted with only two patients withdrawn because of intolerance of the mask.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)
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noninvasive face mask mechanical ventilation in patients with acute hypercapnic Respiratory Failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, C. B. Jones, Kenneth V Leeper, Roy C Fox, 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 PCO2 (greater than 16 percent decrease) and in pH (from less than 7.30 to greater than 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.
Nicholas S Hill - One of the best experts on this subject based on the ideXlab platform.
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noninvasive ventilation in acute Respiratory Failure
Critical Care Medicine, 2007Co-Authors: Nicholas S Hill, John Brennan, Erik Garpestad, Stefano NavaAbstract:Background:Noninvasive ventilation has assumed an important role in the management of Respiratory Failure in critical care units, but it must be used selectively depending on the patient's diagnosis and clinical characteristics.Data:We review the strong evidence supporting the use of noninvasive ven
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does noninvasive positive pressure ventilation improve outcome in acute hypoxemic Respiratory Failure a systematic review
Critical Care Medicine, 2004Co-Authors: Sean P Keenan, Deborah J Cook, Tasnim Sinuff, Nicholas S HillAbstract:Context: The results of studies on noninvasive positive pressure ventilation (NPPV) for acute hypoxemic Respiratory Failure unrelated to cardiogenic pulmonary edema have been inconsistent. Objective: To assess the effect of NPPV on the rate of endotracheal intubation, intensive care unit and hospital length of stay, and mortality for patients with acute hypoxemic Respiratory Failure not due to cardiogenic pulmonary edema. Data Source: We searched the databases of MEDLINE (1980 to October 2003) and EMBASE (1990 to October 2003). Additional data sources included the Cochrane Library, personal files, abstract proceedings, reference lists of selected articles, and expert contact. Study Selection: We included studies if a) the design was a randomized controlled trial; b) patients had acute hypoxemic Respiratory Failure not due to cardiogenic pulmonary edema; c) the interventions compared noninvasive ventilation and standard therapy with standard therapy alone; and d) outcomes included need for endotracheal intubation, length of intensive care unit or hospital stay, or intensive care unit or hospital survival. Data Extraction: In duplicate and independently, we abstracted data to evaluate methodological quality and results. Data Synthesis: The addition of NPPV to standard care in the setting of acute hypoxemic Respiratory Failure reduced the rate of endotracheal intubation (absolute risk reduction 23%, 95% confidence interval 10–35%), ICU length of stay (absolute reduction 2 days, 95% confidence interval 1–3 days), and ICU mortality (absolute risk reduction 17%, 95% confidence interval 8–26%). However, trial results were significantly heterogeneous. Conclusion: Randomized trials suggest that patients with acute hypoxemic Respiratory Failure are less likely to require endotracheal intubation when NPPV is added to standard therapy. However, the effect on mortality is less clear, and the heterogeneity found among studies suggests that effectiveness varies among different populations. As a result, the literature does not support the routine use of NPPV in all patients with acute hypoxemic Respiratory Failure.
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noninvasive positive pressure ventilation for Respiratory Failure after extubation
The New England Journal of Medicine, 2004Co-Authors: Andres Esteban, Stefano Nava, Nicholas S Hill, Fernando Frutosvivar, Niall D Ferguson, Yaseen M Arabi, Carlos Apezteguia, Marco Gonzalez, Scott K Epstein, Marco Antonio SoaresAbstract:background The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positivepressure ventilation has been suggested as a promising therapy for patients with Respiratory Failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting. methods Patients in 37 centers in eight countries who were electively extubated after at least 48 hours of mechanical ventilation and who had Respiratory Failure within the subsequent 48 hours were randomly assigned to either noninvasive positive-pressure ventilation by face mask or standard medical therapy. results A total of 221 patients with similar baseline characteristics had been randomly assigned to either noninvasive ventilation (114 patients) or standard medical therapy (107 patients) when the trial was stopped early, after an interim analysis. There was no difference between the noninvasive-ventilation group and the standard-therapy group in the need for reintubation (rate of reintubation, 48 percent in both groups; relative risk in the noninvasive-ventilation group, 0.99; 95 percent confidence interval, 0.76 to 1.30). The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the standard-therapy group (25 percent vs. 14 percent; relative risk, 1.78; 95 percent confidence interval, 1.03 to 3.20; P=0.048), and the median time from Respiratory Failure to reintubation was longer in the noninvasive-ventilation group (12 hours vs. 2 hours 30 minutes, P=0.02). conclusions Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have Respiratory Failure after extubation.
Martha A Q Curley - One of the best experts on this subject based on the ideXlab platform.
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multiple organ dysfunction in children mechanically ventilated for acute Respiratory Failure
Pediatric Critical Care Medicine, 2017Co-Authors: Scott L Weiss, Lisa A Asaro, Heidi R Flori, Geoffrey L Allen, David Wypij, Martha A Q CurleyAbstract:OBJECTIVES The impact of extrapulmonary organ dysfunction, independent from sepsis and lung injury severity, on outcomes in pediatric acute Respiratory Failure is unclear. We sought to determine the frequency, timing, and risk factors for extrapulmonary organ dysfunction and the independent association of multiple organ dysfunction syndrome with outcomes in pediatric acute Respiratory Failure. DESIGN Secondary observational analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure cluster-randomized prospective clinical trial conducted between 2009 and 2013. SETTING Thirty-one academic PICUs in the United States. PATIENTS Two thousand four hundred forty-nine children mechanically ventilated for acute Respiratory Failure enrolled in Randomized Evaluation of Sedation Titration for Respiratory Failure. MEASUREMENTS AND MAIN RESULTS Organ dysfunction was defined using criteria published for pediatric sepsis. Multiple organ dysfunction syndrome was defined as Respiratory dysfunction one or more extrapulmonary organ dysfunctions. We used multivariable logistic regression to identify risk factors for multiple organ dysfunction syndrome, and logistic or proportional hazards regression to compare clinical outcomes. All analyses accounted for PICU as a cluster variable. Overall, 73% exhibited extrapulmonary organ dysfunction, including 1,547 (63%) with concurrent multiple organ dysfunction syndrome defined by onset on day 0/1 and 244 (10%) with new multiple organ dysfunction syndrome with onset on day 2 or later. Most patients (93%) with indirect lung injury from sepsis presented with concurrent multiple organ dysfunction syndrome, whereas patients with direct lung injury had both concurrent (56%) and new (12%) multiple organ dysfunction syndrome. Risk factors for concurrent multiple organ dysfunction syndrome included older age, illness severity, sepsis, cancer, and moderate/severe lung injury. Risk factors for new multiple organ dysfunction syndrome were moderate/severe lung injury and neuromuscular blockade. Both concurrent and new multiple organ dysfunction syndrome were associated with 90-day in-hospital mortality (concurrent: adjusted odds ratio, 6.54; 95% CI, 3.00-14.25 and new: adjusted odds ratio, 3.21; 95% CI, 1.48-6.93) after adjusting for sepsis, moderate/severe lung injury, and other baseline characteristics. CONCLUSIONS Extrapulmonary organ dysfunction was common, generally occurred concurrent with Respiratory dysfunction (especially in sepsis), and was a major risk factor for mortality in pediatric acute Respiratory Failure.
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early high frequency oscillatory ventilation in pediatric acute Respiratory Failure a propensity score analysis
American Journal of Respiratory and Critical Care Medicine, 2016Co-Authors: Scot T Bateman, Ira M Cheifetz, Lisa A Asaro, David Wypij, Santiago Borasino, Shelley Diane, Martha A Q CurleyAbstract:Rationale: The use of high-frequency oscillatory ventilation (HFOV) for acute Respiratory Failure in children is prevalent despite the lack of efficacy data.Objectives: To compare the outcomes of patients with acute Respiratory Failure managed with HFOV within 24–48 hours of endotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV.Methods: This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV.Measurements and Main Results: Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated withi...
Stefano Nava - One of the best experts on this subject based on the ideXlab platform.
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Use of nasal high flow oxygen during acute Respiratory Failure
Intensive Care Medicine, 2020Co-Authors: J D Ricard, Oriol Roca, Virginie Lemiale, Amanda Corley, Jens Braunlich, Peter Jones, Byung Ju Kang, François Lellouche, Stefano Nava, Nuttapol RittayamaiAbstract:Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute Respiratory Failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute Respiratory Failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various Respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic Respiratory Failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic Respiratory Failure, suggesting a possible indication in acute hypercapnic Respiratory Failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.
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determinants of noninvasive ventilation outcomes during an episode of acute hypercapnic Respiratory Failure in chronic obstructive pulmonary disease the effects of comorbidities and causes of Respiratory Failure
BioMed Research International, 2014Co-Authors: Angela Maria Grazia Pacilli, Ilaria Valentini, Paolo Carbonara, Antonio Marchetti, Stefano NavaAbstract:Objectives. To investigate the effect of the cause of acute Respiratory Failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute Respiratory Failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute Respiratory Failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered Failure. Results. NIV outcome was successful in 134 patients while 42 underwent Failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the Failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.
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noninvasive ventilation in acute Respiratory Failure
Critical Care Medicine, 2007Co-Authors: Nicholas S Hill, John Brennan, Erik Garpestad, Stefano NavaAbstract:Background:Noninvasive ventilation has assumed an important role in the management of Respiratory Failure in critical care units, but it must be used selectively depending on the patient's diagnosis and clinical characteristics.Data:We review the strong evidence supporting the use of noninvasive ven
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noninvasive positive pressure ventilation for Respiratory Failure after extubation
The New England Journal of Medicine, 2004Co-Authors: Andres Esteban, Stefano Nava, Nicholas S Hill, Fernando Frutosvivar, Niall D Ferguson, Yaseen M Arabi, Carlos Apezteguia, Marco Gonzalez, Scott K Epstein, Marco Antonio SoaresAbstract:background The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positivepressure ventilation has been suggested as a promising therapy for patients with Respiratory Failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting. methods Patients in 37 centers in eight countries who were electively extubated after at least 48 hours of mechanical ventilation and who had Respiratory Failure within the subsequent 48 hours were randomly assigned to either noninvasive positive-pressure ventilation by face mask or standard medical therapy. results A total of 221 patients with similar baseline characteristics had been randomly assigned to either noninvasive ventilation (114 patients) or standard medical therapy (107 patients) when the trial was stopped early, after an interim analysis. There was no difference between the noninvasive-ventilation group and the standard-therapy group in the need for reintubation (rate of reintubation, 48 percent in both groups; relative risk in the noninvasive-ventilation group, 0.99; 95 percent confidence interval, 0.76 to 1.30). The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the standard-therapy group (25 percent vs. 14 percent; relative risk, 1.78; 95 percent confidence interval, 1.03 to 3.20; P=0.048), and the median time from Respiratory Failure to reintubation was longer in the noninvasive-ventilation group (12 hours vs. 2 hours 30 minutes, P=0.02). conclusions Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have Respiratory Failure after extubation.
Gianfranco Umberto Meduri - One of the best experts on this subject based on the ideXlab platform.
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noninvasive face mask mechanical ventilation in patients with acute hypercapnic Respiratory Failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, C. B. Jones, Kenneth V Leeper, 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)
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noninvasive face mask mechanical ventilation in patients with acute hypercapnic Respiratory Failure
Chest, 1991Co-Authors: Gianfranco Umberto Meduri, Nabil Aboushala, C. B. Jones, Kenneth V Leeper, Roy C Fox, 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 PCO2 (greater than 16 percent decrease) and in pH (from less than 7.30 to greater than 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.
