Published in:
Open Access
01-04-2013 | Year in Review 2012
Year in review in Intensive Care Medicine 2012: III. Noninvasive ventilation, monitoring and patient–ventilator interactions, acute respiratory distress syndrome, sedation, paediatrics and miscellanea
Authors:
Massimo Antonelli, Marc Bonten, Maurizio Cecconi, Jean Chastre, Giuseppe Citerio, Giorgio Conti, J. R. Curtis, Goran Hedenstierna, Michael Joannidis, Duncan Macrae, Salvatore M. Maggiore, Jordi Mancebo, Alexandre Mebazaa, Jean-Charles Preiser, Patricia Rocco, Jean-François Timsit, Jan Wernerman, Haibo Zhang
Published in:
Intensive Care Medicine
|
Issue 4/2013
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Excerpt
In 2012, the journal published several articles dealing with the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF). Carrillo et al. [
1] prospectively evaluated the characteristics and outcomes of 184 patients with severe ARF due to community-acquired pneumonia treated with NIV, and determined the factors predicting NIV failure and mortality. NIV was successful in 63 % of patients. Confirming previous findings, the authors found that patients with “de novo” ARF failed NIV more frequently than those with previous cardiac or other respiratory disease (46 vs. 26 %). Worsening radiologic infiltrate 24 h after admission, maximum Sepsis-Related Organ Failure Assessment (SOFA) score, and higher heart rate and lower PaO
2/FiO
2 after 1 h of NIV were among the factors predicting NIV failure. NIV failure, maximum SOFA, and older age independently predicted hospital mortality. In patients with de novo ARF only, delayed intubation was consistently associated with a decreased survival. In 13 patients (six with chronic obstructive pulmonary disease), Piquilloud et al. [
2] compared short-term patient–ventilator interaction during NIV with pressure support (PS) and neurally adjusted ventilatory assist (NAVA). As compared with PS, NAVA improved patient–ventilator synchrony during NIV by reducing trigger delay and severe asynchrony and by abolishing ineffective efforts and both delayed and premature cycling. Vaschetto et al. [
3] performed a pilot study to assess the feasibility of using NIV to facilitate discontinuation of invasive mechanical ventilation in patients with resolving hypoxaemic ARF. Twenty patients randomly received immediate NIV after early extubation or conventional weaning. At the end of the study, arterial blood gas, success of extubation, septic complications, ICU length of stay, and mortality were similar, but the number of days without invasive ventilation at day 28 was higher in the NIV group than in the control group. The authors concluded that, in a highly experienced centre, early extubation followed by NIV is feasible and might facilitate liberation from mechanical ventilation in selected patients with hypoxaemic ARF. These findings were discussed in the editorial by Laghi and Fernandez [
4]. …