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Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complicationsMosier, Jarrod M, Sakles, John C, Whitmore, Sage P, Hypes, Cameron D, Hallett, Danielle K, Hawbaker, Katharine E, Snyder, Linda S, Bloom, John W 06 March 2015 (has links)
UA Open Access Publishing Fund / Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with
respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding
the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The
objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV
compared to patients intubated primarily in the medical intensive care unit (ICU).
Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30
June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110
patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous
quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on
the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used,
and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication
(desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation.
Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of
intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute
respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts
and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79
(95% CI 1.03 to 3.12).
Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds
of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication
during intubation is associated with an increased odds of death in the ICU.
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Effectiveness of continuous or bilevel positive airway pressure versus standard medical therapy for acute asthmaHanekom, Silmara Guanaes 09 July 2008 (has links)
ABSTRACT
Patients with respiratory failure secondary to acute asthma exacerbation (AAE) frequently
present at emergency units. Some patients may develop respiratory muscle fatigue. Current
guidelines for the treatment of an AAE center on pharmacological treatment and invasive
mechanical ventilation. Noninvasive positive pressure ventilation (NPPV) has an
established role in COPD exacerbations. The role it can play in an AAE remains
unanswered although it is frequently used in the clinical setting. Aims: The present study
proposed to investigate if the early use of NPPV in the forms of continuous positive airway
pressure (CPAP) or bilevel positive pressure ventilation (BPPV) together with standard
medical therapy in AAE can decrease time of response to therapy compared to standard
medical therapy alone. We further tested the effect of BPPV against CPAP. Methods:
Asthmatic patients who presented with a severe AAE (PEFR % predicted < 60 %) at the
emergency unit were randomized to either standard medical therapy (ST), ST and CPAP or
ST and BPPV. Thirty patients fulfilled the inclusion criteria for the study. Groups
presented similar baseline characteristics. The mean age for the group was 42.1 ± 12.6
years. Mean baseline PEFR % predicted was 35.2 ± 10.7 % (ST), 30.5 ± 11.7 % (ST +
CPAP) and 33.5 ±13.8 % (ST + BPPV). Results: Hourly improvement (Δ) in respiratory
rate and sensation of breathlessness was significantly better in the BPPV intervention
group. Improvement (Δ) from baseline to end of treatment in respiratory rate and sensation
of breathlessness was significant for both CPAP and BPPV (p = 0.0463; p = 0.0132
respectively) compared to ST alone. Lung function was significantly improved in the
CPAP intervention group hourly and from baseline to end of treatment (p = 0.0403 for
PEFR and p = 0.0293 for PEFR % predicted) compared to ST + BPPV and ST alone. The
mean shift (Δ) in PEFR from baseline to 3 hours of treatment was 67.4, 123.5 and 86.8
L/min (p = 0.0445) for ST, ST + CPAP and ST + BPPV respectively. This corresponded to
a 38.1, 80.8 and 51.7 % improvement in lung function respectively. Discussion: The effect
of BPPV on the reduction of respiratory rate and sensation of breathlessness could be
related to the inspiratory assistance provided by BPPV. The significant improvement in
lung function in the CPAP group could be related to its intrinsic effect on the airway
smooth muscle and / or on the airway smooth muscle load. Conclusion: The present results
suggest that adding NPPV to standard treatment for an AAE not only improves clinical
signs faster but also improves lung function faster. CPAP seems to have an intrinsic effect
on the airway smooth muscle so rendering it more effective in ameliorating lung function.
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Successful Treatment of Respiratory Insufficiency Due to Adult Acid Maltase Deficiency With Noninvasive Positive Pressure VentilationPuruckherr, Michael, Pooyan, Payam, Girish, Mirle R., Byrd, Ryland P., Roy, Thomas M. 01 July 2004 (has links)
Acid maltase deficiency (AMD) is a rare autosomal recessive genetic disorder that results in an accumulation of glycogen in the lysosomal storage vacuoles. It is classified as a glycogen storage disease (type II) and is also known as Pompe's disease. The prognosis of the patient with AMD is poor and the main cause of death is respiratory failure. We report a female patient whose respiratory insufficiency was documented to occur most severely during rapid eye movement sleep and who benefited clinically from the institution of nocturnal noninvasive bilevel positive airway pressure.
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