Bubble CPAP (BCPAP) is used in the neonatal intensive care unit (NICU) as a form of non-invasive ventilation and is commonly employed in neonates demonstrating respiratory distress. BCPAP may be used to avoid the need for intubation and mechanical ventilation thereby reducing lung injury and other morbidities as well as decrease hospital stay. PURPOSE: The purpose of this study is to retrospectively investigate the length of stay on bubble CPAP (BCPAP) considering gestational age, birth weight, and surfactant delivery in the neonatal population born at an urban tertiary high load level three (NICU). METHODS: A retrospective study using existing data from an urban tertiary high load level three NICU was completed. DATA ANALYSIS: Data analysis was performed using SPSS 16.0. Descriptive statistics were run for each variable. Contingency tables were run to determine if gestational age at birth, birth weight, and length of time on BCPAP had significance compared to surfactant delivery. Intercorrelations were run to determine if gestational age at birth, birth weight, and length of time on BCPAP had an effect on each other. Davis conventions were used to analyze the results. RESULTS: Descriptive statistics indicated the mean gestational age at birth to be 32.263 weeks, SD = +2.978, mean neonatal weight to be 1.899 kg, SD = +0.728, and mean length of time on BCPAP to be 124.430 hours, SD = +185.474. Contingency statistics showed a substantial association (reta = 0.562) between the gestational age at birth and surfactant delivery, a very strong association (reta = 1.000) between the birth weight and surfactant delivery, and a very strong association (reta = 0.914) between the length of time the neonate was on BCPAP and surfactant delivery. Pearson product-moment correlation coefficients showed gestational age at birth had a very strong positive association with birth weight (r = 0.811, p < 0.01) and a moderate negative association with length of time on BCPAP (r = -0.439, p < 0.01). Intercorrelations also showed birth weight had a moderate negative association with length of time on BCPAP (r = -0.306, p < 0.01). CONCLUSIONS: The neonate was less likely to receive surfactant if, their gestational age was older at birth, they had a heavier birth weight, and their length of time on BCPCP was shorter. The data also demonstrated that the older the neonate’s gestational age at birth and the heavier the neonatal birth weight equated to a shorter length of time on BCPAP. Lastly the data demonstrated that the heavier the neonate’s birth weight, the shorter length of time on BCPAP.

Abstract Introduction: Physiotherapy in the human intensive care setting is in common use and supported by Level 1 evidence. In the canine intensive care setting, however, physiotherapy is novel, despite many studies published to support aspects of human physiotherapy being conducted on experimental dogs and there being 83 canine intensive care beds in Sydney alone. As veterinary care progresses and people place more importance on their pet’s health care, an opportunity arises to examine the potential for physiotherapy to augment the veterinary care of client-owned dogs in a veterinary referral hospital setting. The first objective of this thesis was therefore to determine which common conditions cause dogs to present recumbent to veterinary referral hospitals, and then to conduct a literature review on these conditions and ways in which physiotherapy has the potential to add to the treatment of them. The next objective was to describe the short-term effects of recumbency on a number of key body systems in clinically unwell dogs, as concern was that recumbency itself may contribute to pathogenesis and/or poorer recovery, however this could not be investigated before preliminary studies like this were performed. The next objective was to conduct clinical trials of the use of two well-proven techniques in human physiotherapy on dogs with conditions commonly reported in the earlier studies of this thesis. The chosen techniques were continuous positive airway pressure (CPAP) to assist in the recovery of dogs with brachycephalic airway obstructive syndrome (BAOS) from general anaesthetic, and the use of manual chest physiotherapy in dogs with aspiration pneumonia following tick (Ixodes holocyclus) poisoning. Design: Retrospective epidemiological study; Literature review; Cross-sectional descriptive study; Randomised controlled trial; Clinical trial. Results: Dogs admitted recumbent represented 3.18% of total admissions, however had a confirmed survival rate of only 43.5%. Sydney canine intensive care units have a combined capacity of 83 beds, so many other dogs experience recumbency as part of their veterinary management, despite being admitted ambulant, and therefore also have the potential to benefit from physiotherapy. Diagnoses were split into categories, with suspected intervertebral disc disease the most common neurological diagnosis, hit by car the most common orthopaedic diagnosis, collapse the most common diagnosis in the ‘otherwise unwell’ category and tick (Ixodes holocyclus) poisoning and poison (e.g. metaldehyde) ingestion the most common toxicology diagnosis, all of which have the potential to be just as amenable to physiotherapy in dogs as they are in people. However, interspecies comparisons revealed that although the dogs studied had broadly comparable diagnoses to humans, they had a higher mortality rate and received much less physiotherapy than humans. Key body systems were therefore measured in recumbent dogs, with the finding that the dogs included under the strict definition of recumbency in this study maintained a fairly consistent clinical state in the short-term of their period of recumbency (median days 3 to 5 of hospitalization). This finding supported the investigation of physiotherapy as a potential to not only reduce the mortality rate but to speed return to function, which has the potential to also lower the economic burden of prolonged hospitalization on owners. Continuous positive airway pressure was therefore investigated for its potential to improve the safety of recovery from general anaesthetic in dogs with BAOS. Tolerance and effect of CPAP were investigated with positive results demonstrated to improve time to recovery, with no additional distress, in dogs with BAOS recovering from a general anaesthetic. An evidence-based protocol of manual chest physiotherapy was then tested on dogs with aspiration pneumonia following tick (Ixodes holocyclus) poisoning. Demeanour, saturation of peripheral oxygen and auscultation all improved following the first manual chest physiotherapy session, demonstrating tolerance and effect. Conclusions: Primary recumbency is an uncommon but serious condition in dogs that warrants attention by physiotherapy researchers, as dogs admitted ambulant but who spend part of their hospitalization recumbent also have the potential to benefit. This thesis determined the common causes of recumbency in dogs and determined that key body systems of recumbent dogs are clinically stable without the assistance of physiotherapy to improve their short-term rate of recovery. Positive short-term results were yielded from the use of CPAP and manual chest physiotherapy that may benefit other clinically unwell dogs with similar respiratory conditions. Further research should be conducted into other ways in which physiotherapy can augment the care of recumbent dogs, as well as lower the mortality rate and speed the return to function in dogs in the intensive care setting, as it is possible that not all positive findings in human research were replicated in these studies due to Type II error resulting from small sample sizes due to abnormal weather patterns that reduced the number of presentations of dogs with BAOS or tick poisoning during the study period.

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Bakgrund:  Non-invasiv ventilering (NIV) är ett andningsstöd som med gott resultat kan behandla respiratorisk svikt vilket är vanligt förekommande på Intensivvårdsavdelningar (IVA). Med NIV minskar mortalitet, vårdtiden på IVA, behovet av invasiv ventilering samt förekomsten av ventilatorassocierad pneumoni. Behandlingen avslutas dock ofta i förtid på grund av att patienten inte accepterar den. Syfte: Syftet med studien var att belysa upplevelserna av NIV vid akut respiratorisk svikt och interaktionen mellan patient och sjuksköterska för att optimera behandlingen. Metod: Metoden för studien är en litteraturöversikt med beskrivande design baserad på kvalitativa studier Resultat: Patienten upplever sig som fånge bakom masken och lägger stor vikt på att lära sig hantera NIV och återfå kontroll. Behandlingen beskrivs som en nödvändig men obehaglig väg till överlevnad. Interaktionen mellan patient och sjuksköterska påverkas av hur sjuksköterskan kan tillgodose patientens behov av delaktighet, information och kontroll. Slutsats: Interaktionen mellan patient och sjuksköterska har stor betydelse för toleransen av behandlingen. Sjuksköterskans roll är att stötta patienten genom att skapa förståelse för behandlingen samt att göra patienten delaktig, på så vis kan patienten återvinna kontroll och behandlingen kan optimeras. / Background: Non-invasive ventilation (NIV) is a treatment that with good result can treat respiratory failure, a common syndrome in ICU units. NIV decrease mortality, invasive ventilation, time spent in ICU and ventilator- associated pneumonia. The treatment is often being terminated early due to that the patient does not accept it. Aim: The aim of the study was to illustrate the experience of NIV used during acute respiratory failure and the interaction between patient and nurse to optimize the treatment. Method: The study is a literature review with a descriptive design based on qualitative studies. Results: The patient experience a feeling of being trapped behind the mask and put a great effort in acceptance of NIV and to regain control. The treatment is described as a necessary but uncomfortable path to survival. The interaction between patient and nurse is affected by the way the nurses meet the patients need of participation, information and control.  Conclusion: For the tolerans of the treatment the interaction between patient and nurse have a great importance. The role of the nurse is to support the patient through create understanding and make the patient participate. Trough that the patient can regain control and the treatment can be optimized.

Non invasiv ventilatorbehandling, NIV, är en behandlingsmetod för patienter med akut respiratorisk svikt. Både ventilatoriska och hypoxiska tillstånd kan behandlas med denna metod som blivit vanligare inom akutsjukvården de senaste decennierna. Det ställs stora krav på sjuksköterskan att arbeta både patientsäkert och personcentrerat inom akutsjukvården. Krav om behandlingsmetod, effekt och omvårdnadsåtgärder vid biverkningar leder till att sjuksköterskan kan arbeta självständigt och effektivt. För att kunna minska patientlidande och vårdskador som kan leda till höga kostnader för hälso- och sjukvården krävs att kunskapen om NIV-behandling följer normen för aktuell evidens samt riktlinjer. Syftet med studien var att belysa sjuksköterskors erfarenheter av att genomföra non invasiv ventilatorbehandling av patienter med akut respiratorisk svikt. Litteraturöversikt valdes som metod. Datainsamlingen genomfördes i databaserna CINAHL, PubMed och PsycINFO samt manuell sökning med hjälp av sökord som bedömds besvara studiens syfte. Sökningarna genererade 16 vetenskapliga originalartiklar av både kvantitativ och kvalitativ design, publicerade år 2008 – 2018, som inkluderades i studien. Artiklarna analyserades med en integrerad analys. Tre huvudteman framkom i analysen: fördelning vid riskbedömning och ansvar, samverka i interprofessionellt team och faktorer som påverkar omvårdnad vid NIV-behandling. Alla teman hade i sin tur två till fyra underkategorier. Samarbete och kommunikation var ett av de mest framträdande teman som framkom i studien. Slutsatsen av sjuksköterskors erfarenheter av att genomföra NIV-behandling involverar flera olika faktorer. Såsom kunskapen om behandlingen, interaktion med patienten och samarbete samt kommunikation med läkaren som var otillräckliga för att genomföra och upprätthålla en högkvalitativ vård för patienten. För att kunna bedriva en god vård krävs att sjuksköterskan erhålls kunskap, utbildning och träning samt får stöd och återkoppling för sitt arbete. Stödet kan erhållas från både kollegor och organisationsledningen för att kunna skapa förutsättningar för ökat samarbete. Genom att tillse personal och arbeta för goda arbetsförhållanden. / Non-invasive ventilation treatment, NIV, is a treatment method for patients with acute respiratory failure. Both ventilatory and hypoxic conditions can be treated with this method, which has become more common in emergency care in recent decades. There are great demands on the nurse to work both patient-safe and person-centered in emergency care. Requirements for treatment method, effect and nursing measures in case of side effects lead to the nurse being able to work independently and efficiently. In order to reduce patient suffering and healthcare injuries that can lead to high costs for health and medical care, knowledge of NIV treatment must comply with the norm for current evidence and guidelines.  The aim of this study was to highlight nurses' experiences of carry out non-invasive ventilator treatment to patients with acute respiratory failure. A literature review was chosen as a method. The data collection was carried out in the databases CINAHL, PubMed and PsycINFO as well as manual search using keywords that were judged to respond to the purpose of the study. The searches generated 16 original scientific articles of both quantitative and qualitative design, published year 2008 – 2018, which were included in the study. The articles were analyzed with integrated analysis. Three main themes emerged from the analysis: distribution of risk assessment and responsibility, collaborate in interprofessional teams and factors that affect nursing in NIV treatment. The themes in turn had two to four subcategories. Cooperation and communication were one of the most prominent themes that emerged in this study. The conclusion of the nurse's experience of carrying out NIV treatment is lined with several different factors. Such as the knowledge of the treatment, interaction with the patient and collaboration as well as communication with the doctor who were insufficient to carry out and maintain a high-quality care for the patient. In order to be able to carry out good care, the nurse must receive knowledge, education and training, and receive support and feedback for their work effort. The support can also be obtained from colleague and the organization management in order to be able to create the conditions for increased cooperation by ensuring staff and work for good working conditions.

Bakgrund: Akut respiratorisk svikt är en vanlig sökorsak på akutmottagningar. Studier har visatatt NIV kan minska behovet av intubation och öka chansen för överlevnad hos patienter medsvåra andningsbesvär. Då specialistsjuksköterskan arbetar personcentrerat kan patientensupplevelse höras och därmed kan utfallet av NIV förbättras genom förståelse för patienterserfarenheter. Syfte: Syftet var att beskriva patienters erfarenheter av non-invasiv ventilation vid akutrespiratorisk svikt. Metod: Integrativ litteraturstudie med systematisk litteratursökning i databaserna PubMed,Cinahl och PsychInfo. Resultat: Resultatet baseras på 14 artiklar och är indelat i tre huvudkategorier: Behandlingenspåverkan, Vårdpersonalens påverkan och Psykosocial påverkan. Nio underkategorierpresenteras: Att bli hjälpt av behandlingen, Att uppleva besvär av behandlingen, Att känna stödfrån vårdpersonal, Att vara utlämnad, Att ha behov av information, Att utveckla strategier, Att haett behov av kontroll samt Att bli påverkad av personliga relationer. Slutsats: Patienters erfarenheter av NIV vid akut respiratorisk svikt varierade och både positivaoch negativa upplevelser beskrevs. Att genomgå behandling med NIV försätter patienten i ensårbar situation och om akutsjuksköterskan implementerar principerna för personcentreradomvårdnad kan patienters behov mötas vilket kan förbättra utfallet av behandlingen. / Background: Acute respiratory failure is a common reason for seeking emergency services.Studies have shown that NIV can reduce the need for intubation and increase the chance ofsurvival in patients with severe respiratory distress. As the specialist nurse works person-centred,the patient's experience can be heard and thus the outcome of NIV can be improved throughunderstanding the patients' experiences. Aim: The aim was to describe patients’ experiences of non-invasive ventilation in acuterespiratory failure. Method: Integrative literature study with systematic literature search in the databases PubMed,Cinahl and PsychInfo. Result: The result is based on 14 articles and is divided into three main categories: Impact of thetreatment, Impact of the healthcare staff and Psychosocial impact. Nine subcategories arepresented: Being helped by the treatment, Experiencing discomfort from the treatment, Feelingsupported by healthcare personnel, Being left out, Having a need for information, Developingstrategies, Having a need for control and Being affected by personal relationships. Conclusion: Patients' experiences of NIV in acute respiratory failure varied and both positiveand negative experiences were described. Undergoing treatment with NIV puts the patient in avulnerable situation and if the emergency nurse implements the principles of person-centerednursing, patients' needs can be met, which can improve the outcome of the treatment.

Bakgrund De flesta patienter som läggs in på en intensivvårdsavdelning för invasiv ventilation får sedering någon gång under vårdtillfället. Dagens forskning visar att det finns stora fördelar för patienten att vårdas lätt sederad eller vaken vid invasiv ventilation. Dagens sederingspraxis har gått mot att hålla patienten mer vaken. Invasiva metoder används inom intensivvård vilket kan upplevas som smärtsamt eller obehagligt. Även den högteknologiska vårdmiljön är speciell vilket kan bidra till obehag för patienten. Vårdpersonal beskriver att det tar mer tid i anspråk att vårda en patient som är vaken eller lätt sederad samtidigt som de upplever fördelar med att ha en mer vaken patient. Det finns då möjlighet att kommunicera och interagera med patienten i större utsträckning. Det framkommer även att vårdpersonal ser en utmaning i att vårda lätt sederade eller vakna patienter där de bland annat är oroliga för patientens trygghet och välbefinnande. Syfte Beskriva intensivvårdspatienters upplevelse av att vårdas lätt sederade eller vakna vid invasiv ventilation på en intensivvårdsavdelning. Metod En systematisk litteraturstudie har använts som metod. Kvalitativa artiklar har analyserats med hjälp av Bettany-Saltikov och McSherrys (2016) nio steg. Resultat De tre huvudkategorier som framkom under analysen var upplevelsen av fysiskt och psykiskt lidande, upplevelsen av att kommunicera och upplevelsen av sammanhang eller avsaknad av sammanhang. Slutsats Patienternas upplevelse av att vårdas lätt sederade eller vakna var både obehaglig och smärtsam. Många av patienterna föredrog trots detta att vårdas vakna eller lätt sederade. Dels för att ha kontroll men även för att kunna kommunicera och interagera. Däremot så framkom att just upplevelsen av kommunikation kunde vara mycket frustrerande då framförallt intubation var ett stort hinder för att kunna kommunicera. / Background Most patients admitted to an intensive care unit for invasive ventilation get sedation at some point during the stay. Today's research shows that there are great advantages for the patient to be cared for ligthly sedated or consious during invasive ventilation. Today's sedation practice has moved towards keeping the patient more awake. Invasive procedures are used in the intensive care, which can be experienced as painful or unpleasant. The high-tech care environment is also special, which can contribute to the discomfort of the patient. Nurses describe that it takes more time to care for patients who are awake or lightly sedated. They also experienced advantages of having a more alert patient, such as the possibility of communicating and interacting with the patient. Healthcare professionals also see a challenge in caring for easily sedated or conscious patients, where they are worried about the patient’s safety and well-being. Purpose Describe intensive care patients' experience of being cared for lightly sedated or consious during invasive ventilation in an intensive care unit. Method A systematic literature review has been used as a method. Qualitative articles have been analyzed with the help of Bettany-Saltikov and McSherrys (2016) nine steps. Results The three main categories that emerged during the analysis were the experience of physical and psychological suffering, the experience of communication and the experience of context or lack of context. Conclusion The patients' experience of being cared for lightly sedated or awake was both unpleasant and painful. Many of the patients nevertheless preferred to be cared for awake or lightly sedated. Partly to have control but also to be able to communicate and interact. On the other hand, it emerged that the experience of communication could be frustrating, as intubation was a major obstacle to communicating.

The thesis begins with a theoretical part containing a general description of artificial pulmonary ventilation, invasive pulmonary ventilation and a detailed description of non-invasive pulmonary ventilation and chronic obstructive pulmonary disease. This section also focuses on a detailed description of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease. The aim of this thesis is to find out the real usability and success of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease received in 2018 at the department of ARO in the Hospital Jindřichův Hradec. The data was obtained from the patient documentation for 2018 from the ARO department and subsequently entered in the tables. The research found that in 2018, 162 patients had undergone the selected department, of whom 63 patients suffered from chronic obstructive pulmonary disease. Noninvasive pulmonary ventilation was used in 75 patients. Of the total number of non-invasive pulmonary ventilation applications, 30 were used in patients with chronic obstructive pulmonary disease. The success of non-invasive pulmonary ventilation in chronic patients reached 90 %. The main benefit is the fact that the number of patients with chronic obstructive pulmonary disease is increasing and that indeed chronic obstructive pulmonary disease is aggravated in the winter months. Another benefit is the finding that the success and true utility of non-invasive pulmonary ventilation in patients with chronic obstructive pulmonary disease is very good.

Kommt es zu einer akuten respiratorischen Insuffizienz, stellt die Beatmung einen wichtigen Eckpfeiler der Therapie dar. Da eine invasive Beatmung über einen endotrachealen Tubus mit Risiken verbunden ist, sollte wann immer möglich, eine nicht-invasive Beatmung eingesetzt werden. Neben den absoluten Kontraindikationen limitieren Undichtigkeit, Ulzerationen im Gesichtsbereich und ein schlechter Tragekomfort die Praktikabilität der Gesichtsmasken. Ziel dieser Arbeit war die Evaluation eines neuartigen Beatmungshelms in einem Lungenmodell und einer Probandenstudie im Hinblick auf Beatmungsparameter (Beatmungsdruck, AZV, AMV, PEEP) Resistance, Compliance, Delay-Zeiten, CO2, SpO2, Triggerzeit und Komfort. Es zeigte sich, dass eine Steigerung des PEEP auf 8 mbar zu einer signifikanten Reduktion der DelayTrigger und DelayPeep-Zeiten führte. Höhere PEEP-Werte gingen hingegen mit einer zunehmenden Leckage und Gefahr einer Desynchronität zwischen Proband und Ventilator einher. Eine zusätzliche Druckunterstützung konnte das AMVLunge signifikant steigern, was zu einem Abfall der CO2-Konzentration sowohl in der transkutanen Messung als auch im Helm führte. Problematisch zeigte sich aufgrund der Compliance des Helms, dass ein hoher Anteil des AMV zum Druckaufbau im Helm verloren geht. Dieser Effekt war abhängig von PEEP, ASB sowie Compliance und Resistance der Lunge. Der Beatmungshelm ist als eine gute Alternative zu betrachten, wenn eine Aufrecherhaltung eines PEEPs im Vordergrund steht, wie etwa bei einer Oxygenierungstörung bei Parenchymversagen.

L’aérosolthérapie est une modalité thérapeutique complexe souvent prescrite dans les services de réanimation et de surveillance continue, les services d’urgences et les unités de soins intensifs, notamment chez les patients obstructifs, ce qui fait des bronchodilatateurs la classe médicamenteuse la plus prescrite par voie aérosolisée. Les patients de ces unités de soins aiguë nécessitent aussi fréquemment un support ventilatoire parmi lesquels le haut débit nasal humidifié se montre être une modalité prometteuse en raison de ses effets physiologiques, y compris chez les patients obstructifs. La question de l’administration d’aérosols de médicaments et notamment de bronchodilatateurs chez des patients soumis au haut débit nasal est donc posée. L’administration d’aérosols médicamenteux au cours du haut débit nasal directement dans le circuit de ce support ventilatoire pourrait être une méthode simple, efficace, voire même bénéfique. / Aerosol therapy is a complex method of drug delivery frequently used in intensive care units, step down units and emergency departments, especially in obstructive patients which makes bronchodilators the most prescribed drug class in critical care. Critically ill patients often require ventilatory support, including nasal high flow therapy which showed promising clinical benefits. Given the physiologic effects of nasal high flow therapy, its implementation may be beneficial for obstructive patients. Consequently, the question of aerosol administration, especially bronchodilators, in patients undergoing nasal high flow arises. Aerosol administration during nasal high flow therapy directly in the high flow circuit could be a simple, efficient and possibly beneficial method. However, technical and physiological issues may jeopardize efficacy of this combined administration.