Ventilation invasive

Mayordomo Colrmga J, Rey Gal n C, Gonzalez Sanchez M. Ipratropium bromide-induced anisocoria during non-invasive ventilation. An Pediatr (Bare) November 2012 77(5) 346-7. 

Baydur A, Layne E, Aral H, et al. Long term non-invasive ventilation in the community for patients with musculoskeletal disorders 46 year experience and review. Thorax 2000 55 4—11. Buyse B, Messerman W, Demerits M. Treatment of ehronic respiratory failure in kyphoscoliosis oxygen or ventilation Eur Respir J 2003 22 525-528. 

The prevalence of PMV depends upon the definition used. Most patients (65-85%) are easily weaned from ventilatory support after less than one week. In a multicenter observational study of >5000 medical and surgical ICU patients, 25% required greater than seven days of MV (23). In the acute physiology and chronic health evaluation III (APACHE III) database of medical and surgical ICUs, one in five patients remained ventilated for at least seven days (24). When the definition of PMV is extended to >21 days, the incidence predictably falls. In a cohort of nearly 600 medical patients admitted to a tertiary care medical intensive care unit, approximately 10% remained invasively ventilated at day 21... 

Quinnell TG, Pilsworth S, Shneerson JM, et al. Prolonged invasive ventilation following acute ventilatory failure in COPD weaning results, survival and the role of noninvasive ventilation. Chest 2006 129(1) 133-139. 

Ferrer M, Esquinas A, Arancibia F, et al. Non-invasive ventilation during persistent weaning failure a randomized controlled trial. Am J Respir Crit Care Med 2003 168 70-76. 

Single organ respiratory failure Acute respiratory failure— monitoring but not necessarily mechanical ventilation Tracheotomy patients from ICU-post acute or weaning Noninvasive ventilation Availability of life suppmt— invasive ventilation followed by ICU transfer Minimum monitraing requited— oximetry, vital signs, etc. 1 4 nursing for 24 hours MD available 24 hr/day Unit supervised by an MD with expertise in... 

The expanding use of NPPV, especially for averting or weaning from invasive ventilation, should reduce the population of patients requiring PMV. Despite the... 

Aged >18 years and require invasive ventilation for all or part of the day... 

British Thoracic Society Standards of Care Committee BTS Guideline Non-invasive ventilation in acute respiratory failure. Thorax 2002 57(3) 192—211. 

Ward S, Chatwin M, Heather S, et al. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 2005 60 1019-1024. 

Piepers S, Van den Berg J-P, Kalmijn S, et al. Effect of non-invasive ventilation on survival, quality of life, respiratory function and cognition a review of the literature. Amyotroph Lateral Scler 2006 7 195-200. 

Bourke SC, Tomlison M, Williams TL, et al. Effects of non-invasive ventilation on survival and quality of life in patients with amyotophic lateral sclerosis a randomised controlled trial. Lancet Neurol 2006 5 140-147. 

Tuggey JM, Plant PK, Elliott MW. Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD an economic analysis. Thorax 2003 58 867-871. 

Holland AE, Denehy L, Ntoumenopoulos G, et al. Non-invasive ventilation assists chest physiothen5)y in adults with acute exacerbations of cystic fibrosis. Thorax 2003 58 880-884. 

Invasive ventilation Pressure modes with volume security or volume ventilation Alarms Battery if >16 hr dependency... 

Clini E, Sturani C, Viaggi S, et al. The Italian multicentric study on non invasive ventilation in COPD patients. Eur Resp J 2002 20 529-538. 

Bach and colleagues reported on the use of NTV to treat 257 patients with severe chronic respiratory failure and intact bulbar function (3). NIV was used for approximately 10 years with 144 patients receiving NTV > 20 hr/day. Sixty-seven patients were successfully switched to NTV from IPPV. In a subsequent retrospective observational study, Bach noted that the hospitalization rate and days in hospital for 24 patients with Duchenne s muscular dystrophy (DMD) treated with NIV and cough assistance was significantly lower than for 22 DMD patients treated with invasive ventilation (5). NTV has also been applied for up to 24 hr/day over several months in patients with amyotrophic lateral sclerosis (6). 

Gregoretti C, Confalonieri M, Navalesi P, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation a multi-center study. Intensive Care Med 2002 28 278-284. 

The term weaning encompasses two different stages with specific requirements (i) discontinuation of invasive ventilation and (//) removal of the artificial airway (Fig. 1). The first step is to assess the potential to discontinue invasive ventilation either to autonomous breathing or to NTV support. If the patient fulfills the necessary criteria, a formal spontaneous breathing test (SET) is performed. If successful, the patient can then be disconnected from the ventilator, or in case of a failed SET transitioned to NIV. The next step includes removal of the artificial airway, provided secretion management or upper airway obstruction is not an issue. 

As the underlying condition improves, there should be daily assessment of the potential for discontinuing invasive ventilation. Criteria include adequate mentation, absence of fever or anemia, cessation of neuromuscular-blocking agents and sedatives, hemodynamic stability, correction of electrolyte and metabolic disorders, and adequate oxygenation (5,14-17, 27,28) (Fig. 1). After these criteria are met an SET should be considered. 

The ability to generate a PCF, whether unassisted or manually assisted, > 160 L/min is considered critical for successful extubation and adequacy of long-term NIV. The threshold criteria are higher for elective, noninvasive respiratory management, non-invasive ventilation, volume recruitment, and assisted coughing of neuromuscular ventilatory failure (49). Intubated patients with a PCF <60 L/min (measured through the ETT) have a fivefold reduction in successful extubation and are up to 19 times more likely to die in hospital (35). 

Plant PK, Owen JL, Elliot MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease long term survival and predictors of in-hospital outcome. Thorax 2001 56 708-712. 

In this case, patient refusal to tolerate NIPPY eventually resulted in invasive ventilation. Serial follow-up studies confirmed clinical stability and a leak around her tracheostomy tube were addressed by increasing her cuff volume. 

Chouri-Pontarollo N, Btnel J-C, Tamisier R, et aL Impaired objeetive daytime vigilance in obesity-hypoventilation syndrcnne impact of non-invasive ventilation. Chest 2007 131 148-155. 

Nickol AH, Hart N, HopkiiiscHi NS, et al. Mechaiiisms of improvement of respiratory failure in patients with restrictive thcnacic disease treated with non-invasive ventilation. Thorax 2005 60(9) 754-760. 

Most children are managed with NPPV (1,50). However, some require invasive ventilation through a tracheostomy. The main indications for a tracheostomy in children are airway abnormalities such as tracheobronchomalacia or tracheal stenosis, chronic disease of prematurity, and NMD (1,51,52). The indications for a tracheostomy are comparable to those of the adult population. They include the persistence of hypercapnia despite NPPV and additional measures such as daytime mouthpiece ventilation, aspiration, and bulbar dysfunction (53). In children, NPPV is more difficult to perform in those who might be 24-hour dependent, than in adults. Infants with primaiy alveolar hypoventilation (Ondine s curse) are preferentially ventilated by means of a tracheostomy (18). Tracheostomy ventilation favors airway inflammation (54) and may affect speech and language development (55). In children with progressive NMD, the decision of a tracheostomy has to be discussed on an individual basis, taking into account the familial environment and the parent s and child s perspective (52,56). In any case, sending children home with invasive ventilation is more difficult than when noninvasive ventilation is used (52). 

Fauroux B, Louis B, Hart N, et aL The effect of back-up rate during non-invasive ventilation in young patients with cystic fitaosis. Intensive Cate Med 2004 30 673-681. 

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