How should we monitor patients with acute respiratory failure treated with noninvasive ventilation?
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Noninvasive ventilation (NIV) is currently one of the most commonly used support methods in hypoxaemic and hypercapnic acute respiratory failure (ARF). With advancing technology and increasing experience, not only are indications for NIV getting broader, but more severe patients are treated with NIV. Depending on disease type and clinical status, NIV can be applied both in the general ward and in high-dependency/intensive care unit settings with different environmental opportunities. However, it is important to remember that patients with ARF are always very fragile with possible high mortality risk. The delay in recognition of unresponsiveness to NIV, progression of respiratory failure or new-onset complications may result in devastating and fatal outcomes. Therefore, it is crucial to understand that timely action taken according to monitoring variables is one of the key elements for NIV success. The purpose of this review is to outline basic and advanced monitoring techniques for NIV during an ARF episode.Keywords:
Noninvasive Ventilation
Acute respiratory failure
Objective To investigate the effect of artificial controlled mechanical ventilation in the treatment of patients with acute life-threatening respiratory failure.Methods 36 patients with acute life-threatening respiratory failure were treated with artificial controlled mechanical ventilation.Results In all patients, 29 patients successfully received, 7 patients died, 5 patients occurred complication. Conclusion Artificial controlled mechanical ventilation is an effective method in the treatment of patients with acute life-threatening respiratory failure.
Acute respiratory failure
Artificial ventilation
Life saving
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Acute respiratory failure
Positive pressure ventilation
Noninvasive Ventilation
Chronic respiratory failure
Pressure support ventilation
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Objective:To investigate the effect of mechanical ventilation on the patients with respiratory failure caused by acute poisoning. Methods: 28 patients with respiratory failure as a result of acute poisoning treated by mechanical ventilation were analyzed retrospectively. Results: 25 cases were cured and 3 cases were died. The time of mechanical ventilation were from 10 hrs to 9 days, the average time was 49.6 hrs. The complication associated with mechanical ventilation was that 21 cases suffered from pneumonia and 3 cases had low blood pressure. Conclusion: Mechanical ventilation on the case with respiratory failure as a result of acute poisoning is effective.
Acute respiratory failure
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Objective To investigate the clinical value of mechanical ventilation on the patients with acute severe organo phosphorus pesticide poisoning and respiratory failure.Methods From May 2003 to December 2010,a total of 92 cases with ASOPP and respiratory failure were analyzed retrospectively.In these cases,47 patients were treated with mechanical ventilation(group A) and 45 patients were not treated with mechanical ventilation(group B).The length of hospitalization and curative effect were compared.Results The length of hospitalization was significant shorter and the curative effect was more apparent in the group A than those in the group B(P0.01).Conclusion Mechanical ventilation is an important method to treat ASOPP with respiratory failure.It can remarkably increase the incidence of clinical healing and shorten the length of hospitalization.
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Objective To explore the methods and to evaluate the efficacy of sequential invasive and non-invasive mechanical ventilation in the treatment of patients with pulmonary heart disease complicated with type-Ⅱ respiratory failure.Methods 60 PHD patients complicated with type-Ⅱ respiratory failure were all intubated and given mechanical ventilation.The patients were randomly and evenly divided into two groups when the indications of ventilator replacement appeared.The treatment group were extubated and given non-invasive mechanical ventilation,and the control group were continuously given invasive mechanical ventilation.Blood gas analysis,mortality,incidence of VAP,duration of mechanical ventilation and hospital stay were observed and compared between the two groups.Results There was no significant difference of curative effect between the two groups(P0.05),but the improvement of mortality,incidence of VAP,duration of mechanical ventilation and hospital stay were more pronounced in the treatment group than in the control group(P0.05).Conclusion The sequential invasive and non-invasive mechanical ventilation can lower the incidence of VAP and mortality and shorten the duration of mechanical ventilation and hospital stay in the treatment of pulmonary heart disease patients complicated with type-Ⅱ respiratory failure.
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The authors analyse their experience with 41 patients with ARF
in COPD on the ICU. The APACHE score and concomitant disease,
among others, were regitred to pedict factors inluencihg the
sccess of noninvasive mechanical ventilation.
Concomitant
Acute respiratory failure
Noninvasive Ventilation
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Objective To investigate the role of sequential in-noninvasive mechanical ventilation in AECOPD with severe respiratory failure.Methods From July 2006 to July 2008,32 patients with AECOPD with severe respiratory failure(the therapy group)were treated with sequential in-noninvasive mechanical ventilation.The other 30 patients From June 2004 to June 2006(the contrast group)were treated with invasive mechanical ventilation.The two groups were compared on the measures of progress of the disease,the rate of VAP and death,duration of invasive mechanical ventilation,total mechanical ventilation and days in ICU and hospital.Results Compared with the contrast group,the therapy group had lower rate of VAP and death,shorter duration of invasive mechanical ventilation and total mechanical ventilation,and fewer days in ICU and hospital.Conclusion Using properly while changing sequential in-nonivvasive mechanical ventilation,the therapeutic effects can be improved obviously.
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Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients.URGENT was a prospective multicenter trial designed to address these issues.Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement.Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients.Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients.The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients.By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea.The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours. P2
Acute respiratory failure
Noninvasive Ventilation
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Aim To approach the therapeutic effect of mechanical ventilation on neonatal respiratory failure and the incidence of compli-cation.Methods Retrospective analysis was made of the clinical data that the patients who are diagnosed as respiratory failure received mechanical ventilation therapy in Anhui Provincial Hospital from the July of 2008 to the September of 2009.Results Of 36 cases with neonatal respiratory failure,20 cases were cured,2 died,14 gave up treatment,4 suffered from ventilator-associated pneumonia,1 from chronic lung disease.The differences between pre therapy and 1 hour post-treatment had statistical significance.Conclusion Mechani-cal ventilation therapy is an effective method in treating neonatal respiratory failure.
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Introduction It has been suggested that delayed intensive care unit (ICU) transfer is associated with increased mortality for patients with community-acquired pneumonia (CAP). However, ICU admission policies and patient epidemiology vary widely across the world depending on local hospital practices and organizational constraints. We hypothesized that the time from the onset of CAP symptoms to invasive mechanical ventilation could be a relevant prognostic factor. Methods One hundred patients with a CAP and necessitating invasive mechanical ventilation were included. Prospectively collected data were retrospectively analysed. Two study groups were identified based on the time of the initiation of invasive mechanical ventilation (rapid respiratory failure requiring mechanical ventilation within 72 h of the onset of CAP and progressive respiratory failure requiring invasive mechanical ventilation 4 or more days after the onset of CAP). Results Excepting more COPD patients in the rapid respiratory failure group and more patients with diabetes in the progressive respiratory failure group, these patients had similar characteristics. The overall in-hospital mortality rate was 28% in the rapid respiratory failure group and 51% in the progressive respiratory failure group (P = 0.03). The ICU and the day 30 mortality rates were higher in the progressive respiratory failure group (47% vs. 23%, P = 0.02; and 37.7% vs. 21.3%, P = 0.03; respectively). After adjusting for the propensity score and other potential confounding factors, progressive respiratory failure remained associated with hospital mortality only after 12 days of invasive mechanical ventilation. Conclusions This study suggested that the duration or delay in the time to intubation from the onset of CAP symptoms was associated with the outcomes in those patients who ultimately required invasive mechanical ventilation.
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