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Pneumonia, asthma, copd, ventilator

Mihaela S Stefan, Patrick Eckert, Bogdan Tiru, Jennifer Friderici, Peter K Lindenauer, Jay S Steingrub
OBJECTIVE: To examine the use of high flow nasal cannula oxygen therapy (HFNC) between 2008 and 2014 in patients 18 years or older at a community teaching hospital. METHODS: Yearly utilization rates of HFNC, noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were calculated among admissions with a set of cardiopulmonary diagnoses (heart failure, COPD, asthma or pneumonia). RESULTS: Among the 41,711 admissions with at least one of the above cardiopulmonary condition, HFNC was utilized in 1,128 or 27...
April 2018: Hospital Practice (Minneapolis)
Nikita Joshi, Molly K Estes, Kayla Shipley, Hyun-Chul Danny Lee, Milana Zaurova
Over the last 20 years, noninvasive ventilation (NIV) strategies have been used with increasing frequency. The ease of use of NIV makes it applicable to patients presenting in a variety of types of respiratory distress. In this review, the physiology of positive pressure ventilation is discussed, including indications, contraindications, and options for mask type and fit. Characteristics of patients who are most likely to benefit from NIV are reviewed, including those in respiratory distress from chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema...
February 22, 2017: Emergency Medicine Practice
Daniel Lichtenstein
This review article is an update of what should be known for practicing basic lung ultrasound in the critically ill (LUCI) and is also of interest for less critical disciplines ( e.g. pulmonology). It pinpoints on the necessity of a professional machine (not necessarily a sophisticated one) and probe. It lists the 10 main signs of LUCI and some of the main protocols made possible using LUCI: the BLUE protocol for a respiratory failure, the FALLS protocol for a circulatory failure, the SESAME protocol for a cardiac arrest and the investigation of a ventilated acute respiratory distress syndrome patient, etc ...
June 2017: Breathe
Yukiyo Sakamoto, Yasuhiro Yamauchi, Hideo Yasunaga, Hideyuki Takeshima, Wakae Hasegawa, Taisuke Jo, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
BACKGROUND AND OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of their disease, sometimes requiring hospital admission and being associated with increased mortality. Although previous studies have reported mortality from exacerbations of COPD, there is limited information about prediction of individual in-hospital mortality. We therefore aimed to use data from a nationwide inpatient database in Japan to generate a nomogram for predicting in-hospital mortality from patients' characteristics on admission...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Nikita Joshi, Molly K Estes, Kayla Shipley, Hyun-Chul Danny Lee
Over the last 20 years, noninvasive ventilation (NIV) strategies have been used with increasing frequency. The ease of use of NIV makes it applicable to patients presenting in a variety of types of respiratory distress. In this review, the physiology of positive pressure ventilation is discussed, including indications, contraindications, and options for mask type and fit. Characteristics of patients who are most likely to benefit from NIV are reviewed, including those in respiratory distress from chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema...
February 2017: Emergency Medicine Practice
Sean D Levy, Jehan W Alladina, Kathryn A Hibbert, R Scott Harris, Ednan K Bajwa, Dean R Hess
In this Series paper, we review the current evidence for the use of high-flow oxygen therapy, inhaled gases, and aerosols in the care of critically ill patients. The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failure. Heliox might prevent intubation or improve gas flow in mechanically ventilated patients with severe asthma. Additionally, it might improve the delivery of aerosolised bronchodilators in obstructive lung disease in general...
April 30, 2016: Lancet
Djillali Annane
Neuromuscular blocking agents and corticosteroids are widely used in medicine and in particular in the intensive care unit (ICU). Neuromuscular blockade is commonly used to ease tracheal intubation, to optimize mechanical ventilation and oxygenation in acute respiratory disorders such as status asthmaticus and acute respiratory distress syndrome (ARDS), to prevent shivering during therapeutic hypothermia, and also in patients with elevated intracranial pressure. In the ICU, patients with sepsis, ARDS, community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, severe asthma, or trauma may receive corticosteroids...
February 2016: Seminars in Respiratory and Critical Care Medicine
Hironori Ishizaki, Yoshiaki Terao, Miwa Taniguchi, Sojiro Matsumoto, Akiko Sakai, Satoshi Egashira, Chikako Tsuji, Makoto Fukusaki, Tetsuya Hara
BACKGROUND: Non-invasive positive pressure ventilation (NPPV) reduces the incidences of ventilator-associated pneumonia, the duration of ICU stay and the mortality rate compared with conventional respiratory management of the patients with acute respiratory failure (ARF). Recently, helmet NPPV equipment became available. Because of the high tolerability, the helmet seems to be the best NPPV interface when prolonged and continuous assistance is needed. In this study, we analyzed several factors related to failure of helmet NPPV in ARF patients in intensive care unit (ICU), retrospectively...
October 2015: Masui. the Japanese Journal of Anesthesiology
Şerife Savaş Bozbaş, Gaye Ulubay, Füsun Öner Eyüboğlu, Atilla Sezgin, Mehmet Haberal
OBJECTIVES: Heart transplant is the best treatment for end-stage heart failure. Respiratory insufficiency after heart transplant is a potentially serious complication. Pulmonary complications, pulmonary hypertension, allograft failure or rejection, and structural heart defects in the donor heart are among the causes of hypoxemia after transplant. In this study, we evaluated the prevalence of hypoxemia and respiratory insufficiency in patients with orthotopic heart transplant during the early postoperative period...
November 2015: Experimental and Clinical Transplantation
Rosa T Roldán, María Elena P Torres, Daniel M Gallardo, Marisol C Arias, Fernando P Saldías
BACKGROUND: Day hospitals can reduce health care costs without increasing the risks of patients with lower respiratory tract infection. AIM: To report the experience of a respiratory day hospital care delivered to adult patients with community-acquired pneumonia (CAP) in a public hospital. MATERIAL AND METHODS: During the fall and winter of 2011 and 2012, adult patients with CAP of intermediate risk categories were assessed in the emergency room, their severity was stratified according to confusion, respiratory rate, blood pressure, 65 years of age or older (CRB-65) score and the Chilean CAP Clinical Guidelines, and were admitted to the respiratory day hospital...
April 2015: Revista Médica de Chile
Ashley Y Metcalf, James K Stoller, Timothy D Fry, Marco Habermann
BACKGROUND: Organizational factors associated with adoption and use of respiratory care protocols have received little attention. This study examines patterns of protocol use and features of a hospital and providers that are associated with respiratory care protocol use. METHODS: Forty-four hospitals and their health-care providers responded to an online survey regarding perceived outcomes of protocol use and their level of support for using protocols. Hospital features (ie, size, teaching status, and use of information systems) were also assessed...
May 2015: Respiratory Care
Arantxa Mas, Josep Masip
After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation...
2014: International Journal of Chronic Obstructive Pulmonary Disease
Sun Li-dong, Guo Chang-sheng, Zhao Zi-yu
OBJECTIVE: To study the clinical effect of body mass index (BMI) in the optimal time of weaning from sequential invasive-noninvasive mechanical ventilation (MV) by treating severity chronic obstructive pulmonary disease (COPD) patients. METHODS: 94 patients with severity COPD were divided into the control group (BMI<21) and the study group (BMI>21). These two groups were treated by similar symptomatic therapies such as mechanical ventilation, antibacterial, antispasmodic, relieving asthma, antitussive, expectorant, correction of electrolyte imbalance and acid-base balance disorders, strengthen nutritional support, etc...
2013: BMC Emergency Medicine
Imran Khalid, Nahid Sherbini, Ismael Qushmaq, Mohammad R Qabajah, Amina Nisar, Tabindeh J Khalid, Wasfy J Hamad
BACKGROUND: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical emergency teams (METs) provide acute care and monitoring to deteriorating patients on the general wards. Whether it is safe for an MET to start NIV in ward patients with respiratory distress remains unclear. METHODS: We evaluated 1,123 MET calls in 30,217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital...
February 2014: Respiratory Care
Dean R Hess
Noninvasive ventilation (NIV) for acute respiratory failure has gained much academic and clinical interest. Despite this, NIV is underutilized. The evidence strongly supports its use in patients presenting with an exacerbation of COPD and in patients with acute cardiogenic pulmonary edema. As reviewed in this paper, there is now evidence supporting or not supporting the use of NIV in various other presentations of acute respiratory failure. It is important not only to know when to initiate NIV, but also when this therapy is failing...
June 2013: Respiratory Care
Vijay Vanam, Viswanath Vasudevan, Praveen Jinnur, Rana Ali, Farhad Arjomand, In Suk Seo, Pooja Vasudevan, Ou Yang
SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: CTPA is the procedure of choice in the diagnosis of PE . It has a high sensitivity and specificity and diagnoses other diseases. However CTPA is contraindicated in patients with renal failure, allergy to iodinated contrast and in pregnancy. In such patients diagnosis is solely made on V/Q .PIOPED study noted that most patients with ultimate diagnosis of PE had non- high probability lung scan (Intermediate+ Low probability) and many needed additional studies to confirm/exclude PE...
October 1, 2012: Chest
Kim Hoong Yap, Poh Seo Quek, Benjamin C H Ho
SESSION TYPE: Outcomes/Quality Control PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Non-invasive ventilation (NIV) is well established in reversing hypercapnic respiratory failure from exacerbation of chronic obstructive pulmonary disease (COPD) although its use for other etiologies remains controversial. In patients with "do-not intubate" (DNI) orders, NIV can be used as a ceiling of therapy. We aim to describe characteristics and outcomes of patients admitted to a dedicated non-invasive ventilation unit (NIVU)...
October 1, 2012: Chest
Bryan E Bledsoe, Eric Anderson, Ryan Hodnick, Larry Johnson, Steven Johnson, Eric Dievendorf
OBJECTIVE: The objective of this study was to determine the effects of low-fractional concentration of inspired oxygen (FiO(2)) continuous positive airway pressure (CPAP) in prehospital noninvasive ventilation (NIV). With increasing concerns about the detrimental effects of hyperoxia, we sought to determine whether CPAP using a low FiO(2) (28%-30%) was effective in the prehospital setting. METHODS: The study was a six-month prospective, nonblinded observational study conducted in a large, busy urban emergency medical services (EMS) system (Las Vegas, NV)...
April 2012: Prehospital Emergency Care
Bruce K Rubin, Rajiv Dhand, Gregg L Ruppel, Richard D Branson, Dean R Hess
The purpose of this paper is to review the recent literature related to asthma, COPD, pulmonary function testing, and ventilator-associated pneumonia. Topics covered related to asthma include genetics and epigenetics; exposures; viruses; diet, obesity and exercise; exhaled nitric oxide; and drug therapy (β agonists, macrolides, tiotropium and monteleukast). Topics covered related to COPD include childhood disadvantage factors and COPD; vitamin D deficiency and COPD; β-blockers and COPD; corticosteroid therapy during COPD exacerbations; oxygen administration during pre-hospital transport of patients with COPD exacerbation; and prognosis of patients admitted to the hospital for COPD exacerbation...
April 2011: Respiratory Care
G Gursel, M Aydogdu, G Gulbas, S Ozkaya, S Tasyurek, F Yildirim
BACKGROUND: Obesity rates are increasing in the general population and are also prevalent in intensive care units (ICUs). Patients are sometimes admitted to ICUs for hypercapnic respiratory failure or cor pulmonale, but more often, they are admitted for pneumonia, excessive daytime sleepiness, heart failure, chronic obstructive pulmonary disease (COPD), asthma attacks or pulmonary embolism, and hypercapnic respiratory failure is coincidentally noticed during this period. The optimal noninvasive mechanical ventilation strategy is often not used during ICU treatment...
January 2011: Minerva Anestesiologica
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