Noninvasive Mechanical Ventilation for Post Acute Care
Section snippets
RATIONALE FOR THE USE OF NONINVASIVE VENTILATION
Noninvasive ventilation has gained acceptance because it offers the potential of avoiding the complications of airway invasion.70, 82 These include trauma to the upper airway, hemorrhage, and esophageal or tracheal perforation that occurs during airway insertion. Subsequent complications include subcutaneous emphysema, pneumothoraces, and peritracheal abscesses. The invasive airway bypasses the normal airway defense system, promoting chronic aspiration and entry of irritants and infectious
Acute Care Setting
To anticipate which patients will use NPPV in the post acute setting, it is necessary to understand the appropriate indications for NPPV in the acute and long-term settings. Many applications of NPPV in the acute care setting have been described over the past decade.
APPLICATIONS OF NONINVASIVE POSITIVE-PRESSURE VENTILATION IN THE ACUTE SETTING Obstructive diseases
Chronic obstructive pulmonary disease Asthma Cystic fibrosis Upper airway obstruction Obstructive sleep apnea or obesity hypoventilation
Hypoxemic respiratory failure
Acute respiratory
MONITORING AND ADAPTATION OF NONINVASIVE POSITIVE-PRESSURE VENTILATION IN THE POST ACUTE SETTING
Monitoring of NPPV is determined by the goals established by the clinician (Table 1). Improvements in symptoms and gas exchange are major goals of NPPV. Subjective indicators of improvement, including alleviation of respiratory distress, daytime hypersomnolence, and morning headaches, therefore should be sought. Vital signs, subjective comfort, and measures of gas exchange are other key variables to monitor. As an objective correlate of respiratory distress, respiratory rate almost invariably
ADVERSE EFFECTS AND COMPLICATIONS OF NONINVASIVE VENTILATION
In properly selected patients, adverse effects and complications of noninvasive ventilation are generally not life threatening and can be ameliorated by appropriate measures (Table 2). Most are mask-related, result from excessive air pressure or flow, or derive from problems with patient–ventilator interaction or airway secretion management.
SUMMARY
The increasing use of NPPV in both acute and chronic settings has added to ventilator options in the post acute setting. Some patients start NPPV during their acute presentation and continue use during their post acute stay. Others are difficult to wean from invasive mechanical ventilation, and, if selected carefully, can be extubated and weaned using NPPV. Still others may initiate NPPV in the post acute setting with the anticipation of long-term use. In any care settings, principles of
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The role of non-invasive ventilation in weaning and decannulating critically ill patients with tracheostomy: A narrative review of the literature
2021, PulmonologyCitation Excerpt :However, this may not be borne out as most of the studies did not report on exact ventilator settings during NIV. Of course, the underlying cause of acute respiratory failure needs to be considered when planning the weaning process with NIV.33 An underlying obstructive or restrictive disease such as COPD or a neuromuscular respiratory failure require completely different NIV settings.
Expiratory peak flow and respiratory system resistance in mechanically ventilated patients undergoing two different forms of manually assisted cough
2012, Revista Brasileira de Terapia IntensivaEffects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support
2008, Jornal Brasileiro de Pneumologia
Address reprint requests to Nicholas Hill, MD, Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, APC 475, 543 Eddy Street, Providence, RI 02903, e-mail: [email protected]
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Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, Providence, Rhode Island