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Tuberkuloz Ve Toraks Jun 2022The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular...
The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular Dystrophy was successfully ventilated. Since then, the use of NIV has been on the rise throughout the world. Although a very modern and safe therapy, complications during its application are inevitable. In addition to some well-known complications, others have described more rare entities. In this article, we described such rare complications as pneumoperitoneum, pneumocephalus, parotitis, gastric perforation, and barotrauma. The purpose of this review was to describe unusual complications of NIV, their prevalence, and the mechanisms by which such complications arise. We performed a clinical review by searching PubMed, Embase, and Cochrane libraries with Mesh terms: 'non-invasive mechanical ventilation', 'high-flow nasal cannula', 'rare complication', 'unusual complication', and 'unexpected complication'. These terms were cross-referenced with other keywords: 'pneumoperitoneum', 'parotitis', 'pneumocephalus', 'gastric insufflation', and 'barotrauma'. We included 26 research papers. When applying mechanical ventilation, it is necessary to have a strong knowledge of the mechanics of the device as well as familiarity with the complications that may occur during its use, including less common ones. Prompt and effective treatment of such complications is required, as well as careful consideration of the potential causes of such events, during the application of NIV or HFNC.
Topics: Cannula; Humans; Noninvasive Ventilation; Oxygen Inhalation Therapy; Respiration, Artificial; Treatment Outcome
PubMed: 35785884
DOI: 10.5578/tt.20229810 -
American Journal of Respiratory and... May 2011
Topics: Animals; Humans; Respiration, Artificial; Stress, Physiological; Swine; Ventilator-Induced Lung Injury
PubMed: 21596829
DOI: 10.1164/rccm.201102-0195ED -
Critical Care (London, England) Jul 2016It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute... (Meta-Analysis)
Meta-Analysis Review
Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.
BACKGROUND
It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients.
METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence.
RESULTS
Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance.
CONCLUSIONS
For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary compliance. Strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay, whereas strategy D (lower VT + ZEEP) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance.
Topics: Acute Lung Injury; Bayes Theorem; Humans; Intensive Care Units; Lung Compliance; Network Meta-Analysis; Positive-Pressure Respiration; Respiration, Artificial; Survival Analysis; Tidal Volume
PubMed: 27448995
DOI: 10.1186/s13054-016-1396-0 -
Respiratory Care Jun 2016Movement of the mechanically ventilated patient may be for a routine procedure or medical emergency. The risks of transport seem manageable, but the memory of a... (Review)
Review
Movement of the mechanically ventilated patient may be for a routine procedure or medical emergency. The risks of transport seem manageable, but the memory of a respiratory-related catastrophe still gives many practitioners pause. The risk/benefit ratio of transport must be assessed before movement. During transport of the ventilated patients, should we always use a transport ventilator? What is the risk of using manual ventilation? How are PEEP and FIO2 altered? Is there an impact on the ability to trigger during manual ventilation? Is hyperventilation and hypoventilation a common problem? Does hyperventilation or hypoventilation result in complications? Are portable ventilators worth the cost? What about the function of portable ventilators? Can these devices faithfully reproduce ICU ventilator function? The following pro and con discussion will attempt to address many of these issues by reviewing the current evidence on transport ventilation.
Topics: Equipment Design; Hospitals; Humans; Respiration, Artificial; Transportation of Patients; Ventilators, Mechanical
PubMed: 27235317
DOI: 10.4187/respcare.04745 -
Critical Care (London, England) Mar 2017
Topics: Humans; Point-of-Care Systems; Respiration, Artificial; Respiratory Insufficiency; Ultrasonography; Ventilator Weaning
PubMed: 28298212
DOI: 10.1186/s13054-017-1649-6 -
Critical Care (London, England) Mar 2021We conducted a systematic review following the PRISMA protocol primarily to identify publications that assessed any links between mechanical ventilation (MV) and either...
We conducted a systematic review following the PRISMA protocol primarily to identify publications that assessed any links between mechanical ventilation (MV) and either cognitive impairment or brain insult, independent of underlying medical conditions. Secondary objectives were to identify possible gaps in the literature that can be used to inform future studies and move toward a better understanding of this complex problem. The preclinical literature suggests that MV is associated with neuroinflammation, cognitive impairment, and brain insult, reporting higher neuroinflammatory markers, greater evidence of brain injury markers, and lower cognitive scores in subjects that were ventilated longer, compared to those ventilated less, and to never-ventilated subjects. The clinical literature suggests an association between MV and delirium, and that delirium in mechanically ventilated patients may be associated with greater likelihood of long-term cognitive impairment; our systematic review found no clinical study that demonstrated a causal link between MV, cognitive dysfunction, and brain insult. More studies should be designed to investigate ventilation-induced brain injury pathways as well as any causative linkage between MV, cognitive impairment, and brain insult.
Topics: Brain; Cognitive Dysfunction; Humans; Lung; Respiration, Artificial
PubMed: 33691752
DOI: 10.1186/s13054-021-03521-9 -
Respiratory Care Apr 2020Patient-ventilator synchrony is a popular topic of research on mechanical ventilation. This review puts this research into both contemporary and historical perspective.... (Review)
Review
Patient-ventilator synchrony is a popular topic of research on mechanical ventilation. This review puts this research into both contemporary and historical perspective. Five areas of research are described: literature reviews, manual detection of synchrony problems, automated detection of synchrony problems, modes for improving synchrony, and effects of sedation. We note that this type of research lacks a standardized vocabulary and associated taxonomy, which generates difficulty in communication among students and researchers, as well as in comparison of results. Hence, we conclude this paper with some suggestions for improvement in that regard.
Topics: Humans; Respiration, Artificial; Respiratory Mechanics; Ventilators, Mechanical
PubMed: 32213603
DOI: 10.4187/respcare.07635 -
Critical Care (London, England) Oct 2019
Topics: Humans; Lung; Respiration, Artificial; Ventilator-Induced Lung Injury
PubMed: 31639025
DOI: 10.1186/s13054-019-2638-8 -
Critical Care (London, England) May 2024Tidal expiratory flow limitation (EFL) complicates the delivery of mechanical ventilation but is only diagnosed by performing specific manoeuvres. Instantaneous analysis...
BACKGROUND
Tidal expiratory flow limitation (EFL) complicates the delivery of mechanical ventilation but is only diagnosed by performing specific manoeuvres. Instantaneous analysis of expiratory resistance (Rex) can be an alternative way to detect EFL without changing ventilatory settings. This study aimed to determine the agreement of EFL detection by Rex analysis and the PEEP reduction manoeuvre using contingency table and agreement coefficient. The patterns of Rex were explored.
METHODS
Medical patients ≥ 15-year-old receiving mechanical ventilation underwent a PEEP reduction manoeuvre from 5 cmHO to zero for EFL detection. Waveforms were recorded and analyzed off-line. The instantaneous Rex was calculated and was plotted against the volume axis, overlapped by the flow-volume loop for inspection. Lung mechanics, characteristics of the patients, and clinical outcomes were collected. The result of the Rex method was validated using a separate independent dataset.
RESULTS
339 patients initially enrolled and underwent a PEEP reduction. The prevalence of EFL was 16.5%. EFL patients had higher adjusted hospital mortality than non-EFL cases. The Rex method showed 20% prevalence of EFL and the result was 90.3% in agreement with PEEP reduction manoeuvre. In the validation dataset, the Rex method had resulted in 91.4% agreement. Three patterns of Rex were identified: no EFL, early EFL, associated with airway disease, and late EFL, associated with non-airway diseases, including obesity. In early EFL, external PEEP was less likely to eliminate EFL.
CONCLUSIONS
The Rex method shows an excellent agreement with the PEEP reduction manoeuvre and allows real-time detection of EFL. Two subtypes of EFL are identified by Rex analysis.
TRIAL REGISTRATION
Clinical trial registered with www.thaiclinicaltrials.org (TCTR20190318003). The registration date was on 18 March 2019, and the first subject enrollment was performed on 26 March 2019.
Topics: Humans; Male; Female; Respiration, Artificial; Middle Aged; Aged; Tidal Volume; Positive-Pressure Respiration; Exhalation; Adult
PubMed: 38773629
DOI: 10.1186/s13054-024-04953-9 -
CMAJ Open 2022Mechanical ventilation is an important component of patient critical care, but it adds expense to an already high-cost setting. This study evaluates the cost-utility of...
BACKGROUND
Mechanical ventilation is an important component of patient critical care, but it adds expense to an already high-cost setting. This study evaluates the cost-utility of 2 modes of ventilation: proportional-assist ventilation with load-adjustable gain factors (PAV+ mode) versus pressure-support ventilation (PSV).
METHODS
We adapted a published Markov model to the Canadian hospital-payer perspective with a 1-year time horizon. The patient population modelled includes all patients receiving invasive mechanical ventilation who have completed the acute phase of ventilatory support and have entered the recovery phase. Clinical and cost inputs were informed by a structured literature review, with the comparative effectiveness of PAV+ mode estimated via pragmatic meta-analysis. Primary outcomes of interest were costs, quality-adjusted life years (QALYs) and the (incremental) cost per QALY for patients receiving mechanical ventilation. Results were reported in 2017 Canadian dollars. We conducted probabilistic and scenario analyses to assess model uncertainty.
RESULTS
Over 1 year, PSV had costs of $50 951 and accrued 0.25 QALYs. Use of PAV+ mode was associated with care costs of $43 309 and 0.29 QALYs. Compared to PSV, PAV+ mode was considered likely to be cost-effective, having lower costs (-$7642) and increased QALYs (+0.04) after 1 year. In cost-effectiveness acceptability analysis, 100% of simulations would be cost-effective at a willingness-to-pay threshold of $50 000 per QALY gained.
INTERPRETATION
Use of PAV+ mode is expected to benefit patient care in the intensive care unit (ICU) and be a cost-effective alternative to PSV in the Canadian setting. Canadian hospital payers may therefore consider how best to optimally deliver mechanical ventilation in the ICU as they expand ICU capacity.
Topics: Adult; Canada; Cost-Benefit Analysis; Critical Care; Critical Care Outcomes; Female; Health Care Costs; Humans; Intensive Care Units; Life Expectancy; Male; Markov Chains; Patient Acceptance of Health Care; Quality-Adjusted Life Years; Respiration, Artificial
PubMed: 35168935
DOI: 10.9778/cmajo.20210078