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Invasive ventilatory strategy in COPD

Deog Kyeom Kim, Jungsil Lee, Ju Hee Park, Kwang Ha Yoo
Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics...
April 2018: Tuberculosis and Respiratory Diseases
Rongchang Chen, Lili Guan, Weiliang Wu, Xiaoying Li, Xin Chen, Bingpeng Guo, Yating Huo, Jiawen Xu, Yuqiong Yang, Luqian Zhou
High-pressure non-invasive positive pressure ventilation (NPPV) is a new strategy targeted at maximally reducing arterial carbon dioxide. However, high inspiratory positive airway pressure (IPAP) might cause respiratory adverse events likely to diminish the benefit of NPPV. In the setting of ventilatory support, monitoring NPPV efficacy and resolving problems promptly are critical. This study assessed the treatment effect of high and low-pressure NPPV in chronic hypercapnic COPD using home ventilator with built-in software...
December 1, 2017: Scientific Reports
Islem Ouanes, Lamia Ouanes-Besbes, Saoussen Ben Abdallah, Fahmi Dachraoui, Fekri Abroug
BACKGROUND: Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear. METHODS: In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome...
December 2015: Annals of Intensive Care
Nejat Altintas
Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature...
2016: COPD
S Jaber, A De Jong, A Castagnoli, E Futier, G Chanques
After surgery, hypoxemia and/or acute respiratory failure (ARF) mainly develop following abdominal and/or thoracic surgery. Anesthesia, postoperative pain and surgery will induce respiratory modifications: hypoxemia, pulmonary volumes decrease and atelectasis associated to a restrictif syndrome and a diaphragm dysfunction. Maintenance of adequate oxygenation in the postoperative period is of major importance, especially when pulmonary complications such as ARF occur. Although invasive endotracheal mechanical ventilation has remained the cornerstone of ventilatory strategy for many years for severe acute respiratory failure, several studies have shown that mortality associated with pulmonary disease is largely related to complications of postoperative reintubation and mechanical ventilation...
July 2014: Annales Françaises D'anesthèsie et de Rèanimation
Francisco José Parrilla, Indalecio Morán, Ferran Roche-Campo, Jordi Mancebo
Chronic obstructive pulmonary disease (COPD) is characterized by expiratory flow limitation (EFL) due to progressive airflow obstruction. The various mechanisms that cause EFL are central to understanding the physiopathology of COPD. At the end of expiration, dynamic inflation may occur due to incomplete emptying the lungs. This "extra" volume increases the alveolar pressure at the end of the expiration, resulting in auto-positive end-expiratory pressure (PEEP) or PEEPi. Acute exacerbations of COPD may result in increased airway resistance and inspiratory effort, further leading to dynamic hyperinflation...
August 2014: Seminars in Respiratory and Critical Care Medicine
Karen E A Burns, Maureen O Meade, Azra Premji, Neill K J Adhikari
BACKGROUND: Noninvasive positive-pressure ventilation (NPPV) provides ventilatory support without the need for an invasive airway. Interest has emerged in using NPPV to facilitate earlier removal of an endotracheal tube and to decrease complications associated with prolonged intubation. OBJECTIVES: We evaluated studies in which invasively ventilated adults with respiratory failure of any cause (chronic obstructive pulmonary disease (COPD), non-COPD, postoperative, nonoperative) were weaned by means of early extubation followed by immediate application of NPPV or continued IPPV weaning...
December 9, 2013: Cochrane Database of Systematic Reviews
A M Moga, M de Marchie, D Saey, J Spahija
Individuals with chronic obstructive pulmonary disease (COPD) are often limited in their ability to perform exercise due to a heightened sense of dyspnea and/or the occurrence of leg fatigue associated with a reduced ventilatory capacity and peripheral skeletal muscle dysfunction, respectively. Pulmonary rehabilitation programs have been shown to improve exercise tolerance and health related quality of life. Additional therapeutic approaches such as non-invasive ventilatory support (NIVS), heliox (He-O(2)) and supplemental oxygen have been used as non-pharmacologic adjuncts to exercise to enhance the ability of patients with COPD to exercise at a higher exercise-intensity and thus improve the physiological benefits of exercise...
May 2012: Respiratory Medicine
Karen Ea Burns, Neill Kj Adhikari, Sean P Keenan, Maureen O Meade
BACKGROUND: Noninvasive positive pressure ventilation (NPPV) provides ventilatory support without the need for an invasive airway approach. Interest has emerged in using NPPV to facilitate earlier removal of an endotracheal tube and decrease complications associated with prolonged intubation. OBJECTIVES: To summarize the evidence comparing NPPV and invasive positive pressure ventilation (IPPV) weaning on clinical outcomes in intubated adults with respiratory failure...
2010: Cochrane Database of Systematic Reviews
Nicholas S Oscroft, Timothy G Quinnell, John M Shneerson, Ian E Smith
BACKGROUND AND OBJECTIVE: Patients with ventilatory failure at discharge from hospital following an exacerbation of COPD (ECOPD) have increased work of breathing and reduced inspiratory muscle strength compared with those with a normal arterial carbon dioxide tension (PaCO(2)). They also have a significantly worse prognosis. Long-term non-invasive positive pressure ventilation (NIPPV) may offer a treatment strategy but benefits have not been established. METHODS: We examined the outcomes of 35 patients, with a PaCO(2) >7...
July 2010: Respirology: Official Journal of the Asian Pacific Society of Respirology
Sam Bayat, Liisa Porra, Heikki Suhonen, Tibor Janosi, Satu Strengell, Walid Habre, Ferenc Petak, Zoltan Hantos, Pekka Suortti, Anssi Sovijärvi
There is a growing interest in imaging techniques as non-invasive means of quantitatively measuring regional lung structure and function. Abnormalities in lung ventilation due to alterations in airway function such as those observed in asthma and COPD are highly heterogeneous, and experimental methods to study this heterogeneity are crucial for better understanding of disease mechanisms and drug targeting strategies. In severe obstructive diseases requiring mechanical ventilation, the optimal ventilatory strategy to achieve recruitment of poorly ventilated lung zones remains a matter of considerable debate...
December 2008: European Journal of Radiology
Killen Harold Briones Claudett, Mónica H Briones Claudett, Miguel A Chung Sang Wong, Michelle Grunauer Andrade, Christian X Cruz Pico, Cristhian X Cruz, Antonio Esquinas, Gumersindo Gonzalez Diaz
OBJECTIVES: The objective of this study was to assess the effectiveness of noninvasive motion ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD), having infectious exacerbation and severe hypercapnic neurological dysfunction in the emergency room. DESIGN: This is a prospective interventional study. SETTING: The study setting was the emergency room at the Military Hospital in Guayaquil, Ecuador. PATIENTS: A total of 24 patients were studied...
June 2008: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
R P Ho, M Boyle
Non-invasive positive pressure ventilation (NPPV) has been used as an alternative strategy to provide ventilatory support for patients with acute respiratory failure. Most studies demonstrate that the use of NPPV in acute respiratory failure results in a reduction in the need for endotracheal intubation and an overall survival advantage. However, current evidence, in the form of randomised controlled trials, suggests that these benefits may be restricted to patients suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD)...
November 2000: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Michael J Abramson, Alan J Crockett, Peter A Frith, Christine F McDonald
Long-acting beta(2) agonists are an effective and convenient treatment for chronic obstructive pulmonary disease (COPD), but do not significantly improve lung function. The long-acting anticholinergic tiotropium, which can be taken once daily, decreases exertional dyspnoea and increases endurance by reducing hyperinflation. The role in COPD of the combination of a long-acting beta(2) agonist and a glucocorticoid in a single inhaler remains unclear. The minimum duration of an effective pulmonary rehabilitation program that includes exercise training is 6 weeks...
April 3, 2006: Medical Journal of Australia
A K Simonds
Home ventilation is a growth area. Rapid expansion during the 1990s was stimulated by the development of noninvasive ventilation (NIV) via a mask and the recognition that an increased number of patient groups can benefit. Although patients receiving NIV in the home outnumber those receiving invasive ventilation via tracheostomy, there is substantial variation in practice between European countries. Evidence that individuals who develop ventilatory failure as a consequence of chest wall disease or stable neuromuscular disease such as old poliomyelitis benefit from nocturnal NIV is overwhelming...
November 2003: European Respiratory Journal. Supplement
B Kumle, G Haisch, S W Suttner, S N Piper, W Maleck, J Boldt
The status of non-invasive ventilation (NIV) in intensive care units (ICU) in Germany was analysed by a national survey. Questionnaires consisting of multiple-choice and short-answer questions were sent to ICUs of university hospitals, hospitals with >1000 beds, with 500 - 1000 beds, and hospitals with <500 beds separated with regard to different specialties (anesthesia ICUs, surgical ICUs, cardiac surgical ICUs, neurosurgical ICUs, internal ICUs, interdiscipline ICUs). Of the 716 questionnaires sent 223 (32 %) were returned and analysed...
January 2003: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Wolfram Windisch, Jan Hendrik Storre, Heinrich Matthys, Stephan Sorichter, Johann Christian Virchow
Only few data concerning weaning by nasal positive pressure ventilation (NPPV) are available, and successful weaning by using NPPV in patients with acute respiratory distress syndrome (ARDS) and severe complications has not yet been described. Two cases with ARDS and both preexisting thoracopulmonary disease (infundibulum abnormality and suspected COPD) and associated complications (recurrent sepsis, acute renal failure, need for lobectomy, severe malnutrition) could not be weaned by invasive ventilatory techniques...
2002: Respiration; International Review of Thoracic Diseases
M Moretti, C Cilione, A Tampieri, C Fracchia, A Marchioni, S Nava
BACKGROUND: The rate of failure of non-invasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insufficiency ranges from 5% to 40%. Most of the studies report an incidence of "late failure" (after >48 hours of NIMV) of about 10-20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly delay the time of intubation. METHODS: In this multicentre study the primary aims were to assess the rate of "late NIMV failure" and possible associated predictive factors; secondary aims of the study were evaluation of the best ventilatory strategy in this subset of patients and their outcomes in and out of hospital...
October 2000: Thorax
H Burchardi, M Sydow
In acute respiratory failure interstitial oedema, alveolar collapse, and multiple atelectasis are the main mechanisms which lead to increased venous admixture and impaired oxygenation. Thus the lung volume available for pulmonary gas exchange is considerably reduced. Since there is strong evidence that alveolar overdistension causes lung damage ('barotrauma/volutrauma') large tidal volumes and high airway pressures in mechanical ventilation have to be strictly avoided, even allowing hypoventilation ('permissive hypercapnia')...
January 1994: European Journal of Anaesthesiology
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