Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency.

Minerva Anestesiol. 2012 Oct;78(10):1154-61

Authors: Pisani L, Carlucci A, Nava S

Abstract
Noninvasive mechanical ventilation (NIV) has become a standard of care in select patients with both hypercapnic and non-hypercapnic acute respiratory failure (ARF). Consequent to the increasing use of NIV, new interfaces of different designs, shapes, sizes, and materials have been proposed for clinical use in recent years. The aim of this report is to examine the most relevant physiological aspects related to the choice of interface with particular emphasis on the problems related to dead space and air leaks that may affect the synchrony between the patient and the machine, ultimately determining the patient's compliance and therefore NIV success.

PMID: 23059520 [PubMed - in process]

Related Articles

[Non-invasive ventilation era: Is there still a place for long-term tracheostomy?].

Rev Mal Respir. 2012 Oct;29(8):994-1006

Authors: Muir JF, Lamia B, Molano C, Declercq PL, Cuvelier A

Abstract
INTRODUCTION: At a time when non-invasive ventilation (NIV) is commonly used in acute as well as chronic respiratory failure, it is important to consider the current place, if any, of long-term tracheostomy. BACKGROUND: Except in emergency situations where tracheostomy is mandatory to ensure safe access to the airway, long-term ventilation with tracheostomy (LTVT) is generally considered in the case of inability to wean from NIV after an episode of acute respiratory failure requiring endotracheal ventilation or because of the development of bulbar signs (swallowing, phonation) in advanced neuromuscular disease. It is also appropriate when ventilatory dependence on NIV exceeds 20hours per day. Historical retrospective studies confirmed the feasibility of LTVT, but this has to be seen in perspective with the results obtained 20years later with NIV. VIEWPOINT AND CONCLUSION: Even if the indications for LTVT have diminished considerably since the emergence of NIV, tracheostomy remains mandatory in some situations of respiratory distress and it should be considered as a potential resource, possibly temporary in some cases in the light of recent work on the possibility of decanulation after LTVT.

PMID: 23101641 [PubMed - in process]

Six-Minute Walk Test in Chronic Respiratory Failure: Does Observed or Predictive Walk Distance Better Reflect Patient Functional Status?

Respir Care. 2012 Oct 26;

Authors: Güngör G, Karakurt Z, Adigüzel N, Aydin RE, Balci MK, Saltürk C, Sancar R, Solmaz S, Moçin OY

Abstract
BACKGROUND: Acquiring six- minute walk test (6MWT) data from patients undergoing non-invasive mechanical ventilaton due to chronic hypercapnic respiratory failure (CHRF) is limited. We aimed to assess whether the six-minute walk distance (6MWD) or the predictive value of 6MWD is a better reflection of the respiratory function of patients using non-invasive home ventilation (home NIV) due to CHRF. METHODS: This was a cross-sectional observational study. The 6MWT was performed in patients using home NIV. Diagnoses were grouped as chronic obstructive lung disease (COPD), obesity hypoventilation syndrome (OHS), kyphoscoliosis and parenchymal lung disease (PLD). Gender, age and body mass index (BMI) were used to calculate ideal 6MWD. Male: 1140m-(5.61 ×BMI)-(6.94 × age), and subtract 153m for the normal to lower limit (LLN); Female: 1017m-(6.24 ×BMI)-(5.83 × age), and subtract 139m for the LLN. The 6MWD and predictive 6MWD% were compared relative to arterial blood gas, spirometry values and diagnosis. RESULTS: The 6MWT was performed in 144 patients (median25%-75%) age was 62 55-71) years. The male/female ratio, median 6MWD (25%-75%), and predicted 6MWD% values were as follows: COPD: 32/6, 316m (226-390), 59.4% (42.5-68.9); OHS: 24/28, 303m (240-362), 73.0% (63.0-82.0); kyphoscoliosis: 16/7, 420m (318-462), 70.5% (56.0-75.2), and PLD: 19/12, 333m (273-372), 67.1% (46.7-74.7).The correlation of predicted 6MWD% with spirometry and ABG values were better than with the actual 6MWD. CONCLUSIONS: The predicted 6MWD% was better correlated with respiratory function than actual walk distance for patients using home NIV due to CHRF with COPD, OHS, kyphoscoliosis and parenchymal lung disease.

PMID: 23107072 [PubMed - as supplied by publisher]

Related Articles

Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses.

Intensive Crit Care Nurs. 2012 Nov 14;

Authors: Sørensen D, Frederiksen K, Grøfte T, Lomborg K

Abstract
OBJECTIVES: To describe the reasoning and actions of experienced nurses caring for patients with non-invasive ventilation due to acute respiratory failure from chronic obstructive pulmonary disease. INTRODUCTION: Treatment success for patients requiring non-invasive ventilation remains challenging. Understanding the reasoning and actions of experienced nurses that care for patients with non-invasive ventilation can identify how nurses contribute to treatment success, and this information can be used to train less experienced nurses to provide excellent care. DESIGN: Qualitative descriptive study. A secondary analysis on data of qualitative participant observations during non-invasive ventilation treatment and additional six interviews with experienced ICU nurses was carried out in 2012. RESULTS: The experienced nurses exhibited 'practical wisdom'. Each nurse could stay alert to the patient's condition and respond to NIV. Conceptualisation of the complexities in nurses' reasoning and actions illustrated their tendency to separate problematic situations into three interrelated components: (1) achieving non-invasive adaptation, (2) ensuring effective ventilation and (3) responding attentively to patients' perceptions of non-invasive ventilation. Each component comprises a set of nursing reasoning and actions that experienced nurses use to achieve treatment success. CONCLUSIONS: Understanding how experienced nurses think and act during non-invasive ventilation care may help to optimise continuing professional development and help educate junior nurses.

PMID: 23159242 [PubMed - as supplied by publisher]