Inhalotherapy in Noninvasive Ventilation

2020 ◽  
pp. 180-192
Author(s):  
Mónica Helena Correia Pereira ◽  
João Miguel Bettencourt Sena Carvalho ◽  
Paula Maria Gonçalves Pinto ◽  
Maria do Carmo Oliveira Cordeiro
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Noninvasive Positive Pressure Ventilation ◽  
Standard Of Care ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Invasive Ventilation ◽  
Pharmaceutical Aerosols ◽  
Obstructive Pulmonary Disease ◽  
Acute Cardiogenic Pulmonary Edema

The use of non-invasive ventilation (NIV) has markedly increased over the last decades, and NIV has now become an important alternative to invasive ventilation and has gained popularity particularly as treatment option for patients with obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), and acute respiratory failure. The most prominent forms of NIV are noninvasive positive pressure ventilation (NPPV) and the recently introduced high-flow nasal cannula (HFNC) therapy. Many patients who received NIV may also benefit from the administration of pharmaceutical aerosols, typically bronchodilators, which are best delivered without interrupting respiratory support. For example, nowadays, the use of NIV is considered the standard of care for some forms of acute respiratory failure such as COPD exacerbation and acute cardiogenic pulmonary edema. Patients with COPD exacerbation also benefit from inhaled bronchodilator therapy.

scholarly journals Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

2015 ◽  
Vol 9 (1) ◽  
pp. 120-126 ◽  
Author(s):  
V Hidalgo ◽  
C Giugliano-Jaramillo ◽  
R Pérez ◽  
F Cerpa ◽  
H Budini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Mode Selection ◽  
Standard Of Care ◽  
Chronic Obstructive ◽  
Noninvasive Mechanical Ventilation ◽  
Respiratory Therapist ◽  
Obstructive Pulmonary Disease ◽  
Acute Cardiogenic Pulmonary Edema

Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physiotherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physiotherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for respiratory therapists.

scholarly journals Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

2015 ◽  
Vol 9 (1) ◽  
pp. 97-103 ◽  
Author(s):  
C Romero-Dapueto ◽  
H Budini ◽  
F Cerpa ◽  
D Caceres ◽  
V Hidalgo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Cardiogenic Pulmonary Edema ◽  
Non Invasive ◽  
Copd Patients ◽  
Immunosuppressed Patients

Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

scholarly journals Factors Predicting the Outcome of Noninvasive Ventilation in Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Exacerbation

2021 ◽  
Author(s):  
Pugazhendhi Selvam ◽  
Subramani Suriyan ◽  
Rowhit Yanamadala ◽  
Rathish Manimohan ◽  
Vandhana Pagadal ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Pulmonary Disease ◽  
Respiratory Medicine ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease

Introduction: Non-invasive Mechanical Ventilation (NIV) is a better alternative for treating respiratory failures of any cause compared to invasive ventilation. Various factors influence the outcomes of patients treated with NIV in acute respiratory failure secondary to Chronic Obstructive Pulmonary Disease (COPD). Aim: To determine the possible early predictors and associated factors influencing the outcome of NIV in acute respiratory failure due to COPD patients. Materials and Methods: This was hospital-based observational study undertaken at SRM Medical Hospital and Research Centre in the Respiratory Medicine Department, after obtaining ethical clearance and informed patient consent. All patients with COPD exacerbation were admitted to the respiratory medicine ward. An Arterial Blood Gas (ABG) analysis was carried out, and those patients with type 2 respiratory failure were included in the study. This study included 42 patients with acute respiratory failure secondary to COPD requiring NIV. Data of patient's ABG parameter, heart rate, blood pressure, and respiratory rate baseline values were noted and at an interval of one hour, six hours, and every 24 hours were recorded. The outcome was divided into two categories depending upon whether patients improved or required invasive ventilation. Data were entered in Microsoft Excel datasheet and was analysed using Statistical Package For The Social Sciences (SPSS) 22 version software. Results: Of 42 patients, 30 (71.42%) were treated successfully with NIV, while 12(28.57%) required invasive ventilation and were declared NIV failure (requiring invasive ventilation). Among the patients, it was observed that patients with mean age >60 years, BMI >26.5, baseline pH <7.2, PaCO2 >78, heart rate >120, respiratory rate >40, co-morbidities and infective exacerbation were requiring invasive ventilation. It was also observed that among the failure category patients treated with conventional Spontaneous and Timed (S/T) mode showed more failure rates than Average Volume Assured Pressure Support (AVAPS) S/T mode. Conclusion: Patients with acute respiratory failure secondary to COPD responds well to NIV. The baseline pH, PaCO2, HR and Respiratory Rate (RR) before initiation of NIV predicts outcome. Also, age, BMI, associated comorbidities and mode of NIV predicts the outcome.

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