1,256 research outputs found
Neurally adjusted non-invasive ventilation in patients with chronic obstructive pulmonary disease: Does patient-ventilator synchrony matter?
No full textPatient-ventilator interaction represents an important clinical challenge during non-invasive ventilation (NIV). Doorduin and colleagues' study shows that non-invasive neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction compared with pressure support ventilation in patients with chronic obstructive pulmonary disease. There is no doubt nowadays that NAVA is the most effective mode of improving the synchrony between patient and machine, but the key question for the clinicians is whether or not this will make a difference to the patient's outcome. The results of the study still do not clarify this issue because of the very low clinically important dyssynchrony, like wasted efforts, in the population studied. Air leaks play an important role in determining patient-ventilator interaction and therefore NIV success or failure. Apart from the use of a dedicated NIV ventilator or specific modes of ventilation like NAVA, the clinicians should be aware that the choice of interface, the humidification system and the appropriate sedation are key factors in improving patient-ventilator synchrony
Invited Review Series Introduction
No full textThe presence of acute or chronic respiratory failure is often seen and considered as a terminal phase of COPD
At present, however, we do not have firm predictive parameters of mortality in COPD patients. In a review, Curtis speculated that a patient with two or more of the following characteristics has a bad prognosis in a time frame of 1 to 3 years: FEV1 70 yrs.
At this stage of the disease, it seems that no pharmacological treatment is able to influence the survival of these patients, except the use of long term oxygen therapy (LTOT) and possibly home noninvasive ventilation (NIV
Getting dark, too dark to see
No full textDr. Levy and colleagues
in their extremely important article, NIV
may help our patients to pass over with
less distress (better in a private room as
suggested in the editorial) or give them a
chance, if they wish, to survive a few
more days or months
Patient-Ventilator Synchronization During Non-invasive Ventilation: A Pilot Study of an Automated Analysis System
No full textBackground: Patient-ventilator synchronization during non-invasive ventilation (NIV) can
be assessed by visual inspection of flow and pressure waveforms but it remains time
consuming and there is a large inter-rater variability, even among expert physicians.
SYNCSMART
TM software developed by Breas Medical (Mölnycke, Sweden) provides an
automatic detection and scoring of patient-ventilator asynchrony to help physicians
in their daily clinical practice. This study was designed to assess performance of the
automatic scoring by the SYNCSMART software using expert clinicians as a reference in
patient with chronic respiratory failure receiving NIV.
Methods: From nine patients, 20 min data sets were analyzed automatically by
SYNCSMART software and reviewed by nine expert physicians who were asked to
score auto-triggering (AT), double-triggering (DT), and ineffective efforts (IE). The study
procedure was similar to the one commonly used for validating the automatic sleep
scoring technique. For each patient, the asynchrony index was computed by automatic
scoring and each expert, respectively. Considering successively each expert scoring
as a reference, sensitivity, specificity, positive predictive value (PPV), κ-coefficients, and
agreement were calculated.
Results: The asynchrony index assessed by SYNSMART was not significantly different
from the one assessed by the experts (18.9 ± 17.7 vs. 12.8 ± 9.4, p = 0.19). When
compared to an expert, the sensitivity and specificity provided by SYNCSMART for DT, AT,
and IE were significantly greater than those provided by an expert when compared to
another expert.
Conclusions: SYNCSMART software is able to score asynchrony events within
the inter-rater variability. When the breathing frequency is not too high (< 24), it
therefore provides a reliable assessment of patient-ventilator asynchrony; AT is over
detected otherwis
Ethics, attitude and practice in end-of-life care decision: an European perspective
No full textOnly in the last decade in Europe has there been increased attention dedicated to the end-of-life care in the hospital, especially in the Intensive Care Unit (ICU). The definitions of the potential decision are extremely important. Withholding is a planned decision not to institute therapies that were otherwise warranted, Withdrawal is the discontinuation of treatments that had been started, Terminal sedation consists of pain and symptom treatment with the possible side effect of shortening life, while Euthanasia means that a doctor is intentionally killing a person who is suffering unbearably and hopelessly at the latter's explicit informed request. The overall incidence of these practices in Europe is only partially known, but there are important differences between Countries or regions, reflecting the absence of a common strategy even within the European Community. Only <15% of ICU patients retain decision making capacity, allowing the impossibility of discussing the decision with them. It is rare that the patient's family is involved in the decision and when such case does arise, the relatives rate the communication with hospital staff poor. The "shared decision" taken together by physicians, nurses, and the patient's family may be the best approach for end-of-life decision, therefore common European guidelines are needed
Preoperative inspiratory muscle training and postoperative complications
No full textFinally, the authors did not mention the potential risks
of IMT. It has been shown in animal studies3 and human
studies4 that IMT may be deleterious and may produce injury
of the diaphragm, even though it may benefit the external
intercostal muscles.
The use of bronchoscopy in critically ill patients: considerations and complications
No full textIntroduction: Flexible bronchoscopy has been well established for diagnostic and therapeutic purposes in critically ill patients. Areas covered: This review outlines the clinical evidence of the utility and safety of flexible bronchoscopy in the intensive care unit, as well as specific considerations, including practical points and potential complications, in critically ill patients. Expert commentary: Its ease to learn and perform and its capacity for bedside application with relatively few complications make flexible bronchoscopy an indispensable tool in the intensive care unit setting. The main indications for flexible bronchoscopy in the intensive care unit are the visualization of the airways, sampling for diagnostic purposes and management of the artificial airways. The decision to perform flexible bronchoscopy can only be made by trade-offs between potential risks and benefits because of the fragile nature of the critically ill. Flexible bronchoscopy-associated serious adverse events are inevitable in cases of a lack of expertise or appropriate precautions
Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations
No full textChronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO2) is â¤55 mmHg and moderate if PaO2 is between 56 and 69 mmHg. Although current guidelines consider LTOT only in patients with severe resting hypoxemia, many COPD patients with moderate to severe disease experience moderate hypoxemia at rest or during special circumstances, such as while sleeping or exercising. The efficacy of LTOT in these patients who do not meet the actual recommendations is still a matter of debate, and extensive research is still ongoing to understand the possible benefits of LTOT for survival and/or functional outcomes such as the sensation of dyspnea, exacerbation frequency, hospitalizations, exercise capacity, and quality of life. Despite its frequent use, the administration of âpalliativeâ oxygen does not seem to improve dyspnea except for delivery with high-flow humidified oxygen. This narrative review will focus on current evidence for the effects of LTOT in the presence of moderate hypoxemia at rest, during sleep, or during exercise in COPD
I want to break free: liberation from noninvasive ventilation
No full textA lot of emphasis has been placed on the weaning process from invasive mechanical ventilation, since
prolonged ventilation has been associated with increased length of intensive care unit stay, increased levels of
complications and increased costs. Weaning in this respect may be considered as an “all or none” phenomenon,
since the patients are abruptly removed from any form of ventilator support after extubation unless they are
placed on noninvasive ventilation (NIV). In patients with acute hypercapnic respiratory failure (AHRF),
particularly those with chronic obstructive pulmonary disease (COPD), the use of NIV is considered to be the
first line treatment
- …
