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    Noninvasive airway approaches for acute neuromuscular respiratory failure in emergency departments.
    Pediatr Pulmonol 2017 Oct;52(10):E55-E57
    Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
    Emerging evidence advocates for noninvasive ventilation (NIV) combined with mechanical in-exsufflation (MIE) as a first-line approach for acute respiratory failure (ARF) in patients with neuromuscular disorders (NMD). To date, most NIV studies of ARF in NMD patients have been performed in intensive care units or in hospital settings. However, the utility of using combined NIV/MIE in the emergency department (ED) settings is unclear. Read More

    Are we fully utilizing the functionalities of modern operating room ventilators?
    Curr Opin Anaesthesiol 2017 Sep 21. Epub 2017 Sep 21.
    aDepartment of Anesthesiology,the first affiliated hospital of Harbin Medical University, Harbin, China bDepartment of Respiratory Care, Massachusetts General Hospital, Boston, MA, and Department of Anesthesiology, Harvard University, Boston, MA cDepartment of Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan.
    Purpose Of Review: The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities.

    Recent Findings: Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Read More

    The efficacy of initial ventilation strategy for adult immunocompromised patients with severe acute hypoxemic respiratory failure: study protocol for a multicentre randomized controlled trial (VENIM).
    BMC Pulm Med 2017 Sep 20;17(1):127. Epub 2017 Sep 20.
    Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
    Background: Acute respiratory failure (ARF) is still one of the most severe complications in immunocompromised patients. Our previous systematic review showed noninvasive mechanical ventilation (NIV) reduced mortality, length of hospitalization and ICU stay in AIDS/hematological malignancy patients with relatively less severe ARF, compared to invasive mechanical ventilation (IMV). However, this systematic review was based on 13 observational studies and the quality of evidence was low to moderate. Read More

    Diagnosis and management of acute exacerbations of chronic obstructive pulmonary disease
    Emerg Med Pract 2017 10;19(10):1-24
    Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine; Director, Pulmonary and Critical Care Medicine Fellowship Program, University of Maryland School of Medicine, Baltimore, MD
    Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a clinical diagnosis that is based on changes in dyspnea, cough, and/or sputum production in a COPD patient; however, patients presenting with an acute exacerbation may be undiagnosed or have a variety of comorbid conditions that can complicate diagnosis. This issue presents strategies and algorithms for the early use of evidence-based interventions, including appropriate use of antibiotics, bronchodilators, and corticosteroids, along with noninvasive ventilation with capnography, to minimize morbidity and mortality associated with this disease. Read More

    Volume-Targeted Versus Pressure-Limited in Noninvasive Ventilation in Hypercapnic Respiratory Failure. What Could Be Established in Real Practice?-Reply.
    Respir Care 2017 Oct;62(10):1377-1378
    Department of Respiratory and Critical Care Medicine Beijing Engineering Research Center of Respiratory and Critical Care Medicine Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing, China.

    Noninvasive ventilation in difficult endotracheal intubation: systematic and review analysis.
    Anaesthesiol Intensive Ther 2017 Sep 18. Epub 2017 Sep 18.
    Division of Pulmonary and Critical Care, David Geffen School of Medicine, Univeristy of California Los Angeles, USA.
    Noninvasive ventilation has been widely used in the management of acute respiratory failure in appropriate clinical settings. In addition to known benefit of alleviating the need for invasive mechanical ventilation, recent literature suggested its beneficial use in the process of endotracheal intubation. Search of the PubMed database and manual review of selected articles investigating the methods and outcomes of endotracheal intubation in difficult airway due to hypoxemic respiratory failure and the role of noninvasive ventilation in this process. Read More

    Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department.
    J Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
    Background: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). Read More

    The effect of sedation and/or analgesia as rescue treatment during noninvasive positive pressure ventilation in the patients with Interface intolerance after Extubation.
    BMC Pulm Med 2017 Sep 15;17(1):125. Epub 2017 Sep 15.
    Department of Respiratory and Critical Care, No.37 Guoxue Alley, Chengdu, 610041, China.
    Background: Sedation and/or analgesia can relieve the patient-ventilator asynchrony. However, whether sedation and/or analgesia can benefit the clinical outcome of the patients with interface intolerance is still unclear.

    Methods: A retrospective study was performed on patients with interface intolerance who received noninvasive positive pressure ventilation (NIPPV) after extubation in seven intensive care units (ICU) of West China Hospital, Sichuan University. Read More

    The comparative effectiveness of noninvasive and invasive ventilation in patients with pneumonia.
    J Crit Care 2017 May 23;43:190-196. Epub 2017 May 23.
    Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA; Division of General Medicine, Baystate Medical Center, Springfield, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
    Purpose: To compare the outcomes of patients hospitalized with pneumonia treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV).

    Materials And Methods: Using the HealthFacts multihospital electronic medical record database, we included patients hospitalized with a diagnosis of pneumonia and treated with NIV or IMV. We developed a propensity model for receipt of initial NIV and assessed the outcomes in a propensity-matched cohort, and in a covariate adjusted and propensity score weighted models. Read More

    Beneficial Effects of Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure: Caution With Findings From Meta-Analyses.
    Crit Care Med 2017 Oct;45(10):e1100-e1101
    CHU de Poitiers, Service de Réanimation Médicale, Poitiers, France, INSERM, CIC-1402, Poitiers, France, and Université de Poitiers, Poitiers, France; INSERM, CIC-1402, Poitiers, France and CHU de Poitiers, Service des Urgences, Poitiers, France; CHU de Poitiers, Service de Réanimation Médicale, Poitiers, France and INSERM, CIC-1402, Poitiers, France; CHU de Poitiers, Service de Réanimation Médicale, Poitiers, France, INSERM, CIC-1402, Poitiers, France, and Université de Poitiers, Poitiers, France.

    Mathematics of Ventilator-induced Lung Injury.
    Indian J Crit Care Med 2017 Aug;21(8):521-524
    Department of Critical Care Medicine, King Saud Medical City, Riyadh, Saudi Arabia.
    Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Read More

    Can the analysis of built-in software of CPAP devices replace polygraphy in children?
    Sleep Med 2017 Sep 24;37:46-53. Epub 2017 Jun 24.
    AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, Paris, France; INSERM U 955, Equipe 13, Créteil, France.
    Objectives: Polysomnography (PSG) is the gold standard for the scoring of residual respiratory events during continuous positive airway pressure (CPAP). Studies comparing PSG scoring with automatic scoring by the built-in software of CPAP devices have reported acceptable agreements except for the hypopnea index (HI) in adult patients, but no study has yet been conducted in children. The aim of the present study was to compare the automatic scoring by CPAP device and manual scoring using the software tracings of the CPAP device integrating pulse oximetry (SpO2) with in-lab polygraphy (PG). Read More

    Prognostic Significance of Central Apneas Throughout a 24-Hour Period in Patients With Heart Failure.
    J Am Coll Cardiol 2017 Sep;70(11):1351-1364
    Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
    Background: Large trials using noninvasive mechanical ventilation to treat central apnea (CA) occurring at night ("sleep apnea") in patients with systolic heart failure (HF) have failed to improve prognosis. The prevalence and prognostic value of CA during daytime and over an entire 24-h period are not well described.

    Objectives: This study evaluated the occurrence and prognostic significance of nighttime, daytime, and 24-h CA episodes in a large cohort of patients with systolic HF. Read More

    Percutaneous endoscopic gastrostomy under conscious sedation in patients with amyotrophic lateral sclerosis is safe: an observational study.
    Eur J Gastroenterol Hepatol 2017 Sep 4. Epub 2017 Sep 4.
    aDepartment of Gastroenterology and Hepatology, Catharina Hospital Eindhoven bDepartment of Rehabilitation Medicine, Blixembosch, Eindhoven cDepartment of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
    Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease that causes muscle weakness with respiratory and swallowing dysfunction, eventually leading to death. Permanent enteral feeding is indicated in almost all patients. A percutaneous endoscopic gastrostomy (PEG) tube is considered the first choice, usually performed under conscious sedation (intravenous midazolam). Read More

    [Extreme obesity-particular aspect of invasive and noninvasive ventilation].
    Med Klin Intensivmed Notfmed 2017 Sep 5. Epub 2017 Sep 5.
    Klinik für Innere Medizin und Internistische Intensivmedizin, EVK Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
    The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Read More

    Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions.
    BMC Anesthesiol 2017 Sep 4;17(1):122. Epub 2017 Sep 4.
    Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
    Background: Noninvasive ventilation is used worldwide in many settings. Its effectiveness has been proven for common clinical conditions in critical care such as cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbations. Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s, thousands of studies and articles have been published on this topic. Read More

    Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure.
    Respir Care 2017 Aug 31. Epub 2017 Aug 31.
    Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
    Background: The objective of this work was to describe the use of negative-pressure ventilation (NPV) in a heterogeneous critically ill, pediatric population.

    Methods: A retrospective chart review was conducted of all patients admitted to a pediatric ICU with acute respiratory failure supported with NPV from January 1, 2012 to May 15, 2015.

    Results: Two hundred thirty-three subjects at a median age of 15. Read More

    Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure.
    Eur Respir J 2017 Aug 31;50(2). Epub 2017 Aug 31.
    Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.
    Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature.The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. Read More

    Med Lav 2017 Aug 28;108(4):283-287. Epub 2017 Aug 28.
    Azienda USL Toscana Centro UO Pneumologia - Ospedale San Jacopo Pistoia.
    The Obstructive Sleep Apnea Syndrome (OSAS) consists of recurring episodes of complete or partial obstruction of the pharynx. The application of a continuous positive pressure in the airways (CPAP) is the first therapeutic option that is found to ensure complete patency of the pharynx during sleep, avoiding apneas and hypopneas with resolution of the symptoms. More recently, other devices have been proposed as OSAS treatment. Read More

    The Chinese version of the Severe Respiratory Insufficiency questionnaire for patients with chronic hypercapnic chronic obstructive pulmonary disease receiving non-invasive positive pressure ventilation.
    BMJ Open 2017 Aug 28;7(8):e017712. Epub 2017 Aug 28.
    State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
    Objectives: The Severe Respiratory Insufficiency (SRI) questionnaire is the best assessment tool for health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) receiving non-invasive positive pressure ventilation (NIPPV). This study aimed to translate the SRI Questionnaire into Chinese and to validate it.

    Design: Prospective validation study. Read More

    Assessing regional lung mechanics by combining electrical impedance tomography and forced oscillation technique.
    Biomed Tech (Berl) 2017 Aug 29. Epub 2017 Aug 29.
    There is a lack of noninvasive pulmonary function tests which can assess regional information of the lungs. Electrical impedance tomography (EIT) is a radiation-free, non-invasive real-time imaging that provides regional information of ventilation volume regarding the measurement of electrical impedance distribution. Forced oscillation technique (FOT) is a pulmonary function test which is based on the measurement of respiratory mechanical impedance over a frequency range. Read More

    A case of delayed exacerbation of interstitial lung disease after discontinuation of temsirolimus.
    Respir Med Case Rep 2017 11;22:158-163. Epub 2017 Aug 11.
    Department of Respiratory Medicine, The University of Tokyo Hospital, Japan.
    Temsirolimus is an inhibitor of mammalian target of rapamycin and interstitial lung disease (ILD) is known to be one of the adverse events associated with temsirolimus, which usually improves rapidly after discontinuation of the drug and rarely worsens thereafter. Herein, we report a case of delayed exacerbation of ILD after discontinuation of temsirolimus for metastatic renal cell carcinoma in an 86-year-old male with chronic ILD. The patient developed gradually worsening dyspnea five weeks after an initiation of temsirolimus and was admitted to our facility. Read More

    Development of acute parotitis after non-invasive ventilation.
    J Thorac Dis 2017 Jul;9(7):E605-E608
    Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
    A 90-year-old woman underwent laparoscopic exploratory laparotomy for evaluation of suspected mesenteric ischemia. She was promptly extubated postoperatively and transferred to the intensive care unit, where on the first postoperative day she developed hypoxemia necessitating initiation of noninvasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). After 8 hours of BiPAP, she was noted to have swelling, erythema and tenderness in the right preauricular area. Read More

    Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report.
    J Med Case Rep 2017 Aug 23;11(1):234. Epub 2017 Aug 23.
    Service de Physiologie-Explorations Fonctionnelles, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France.
    Background: Noninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive end-expiratory pressure can induce or worsen a right-to-left shunt through a patent foramen ovale associated with systemic hypoxemia. Thus, in obese patients treated with noninvasive positive pressure ventilation, a paradoxical worsening of hypoxemia may reveal the existence of a patent foramen ovale. Read More

    Evaluation of diaphragmatic function in mechanically ventilated children: An ultrasound study.
    PLoS One 2017 22;12(8):e0183560. Epub 2017 Aug 22.
    College of Medicine, Chang Gung University, Taoyuan, Taiwan.
    Background: The recovery of diaphragmatic function is vital for successful extubation from mechanical ventilation. Recent studies have detected diaphragm atrophy in ventilated adults by using ultrasound, but no similar report has been conducted in children. In the current study, we hypothesized that mechanically ventilated children may also develop diaphragm atrophy and diaphragmatic dysfunction. Read More

    High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure.
    Ann Transl Med 2017 Jul;5(14):297
    CHU de Poitiers, Réanimation Médicale, Poitiers, France.
    High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF. Read More

    [Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)].
    Emergencias 2017 07;29(4):223-230
    Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Universidad Complutense de Madrid, España.
    Objectives: To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received.

    Material And Methods: We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Read More

    [Noninvasive mechanical ventilation in emergency services in Catalonia: the VNICat registry cohort study].
    Emergencias 2017 Feb;29(1):33-38
    Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
    Objectives: To study how noninvasive ventilation (NIV) is used in prehospital emergency services and hospital emergency departments. To explore associations between NIV use and hospital mortality.

    Material And Methods: Prospective analysis of a consecutive multicenter cohort of patients who were treated with NIV between February and March 2015. Read More

    Comprehensive Echocardiographic and Cardiac Magnetic Resonance Evaluation Differentiates Among Heart Failure With Preserved Ejection Fraction Patients, Hypertensive Patients, and Healthy Control Subjects.
    JACC Cardiovasc Imaging 2017 Aug 11. Epub 2017 Aug 11.
    School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom. Electronic address:
    Objectives: The aim of this study was to investigate the utility of a comprehensive imaging protocol including echocardiography and cardiac magnetic resonance in the diagnosis and differentiation of hypertensive heart disease and heart failure with preserved ejection fraction (HFpEF).

    Background: Hypertension is present in up to 90% of patients with HFpEF and is a major etiological component. Despite current recommendations and diagnostic criteria for HFpEF, no noninvasive imaging technique has as yet shown the ability to identify any structural differences between patients with hypertensive heart disease and HFpEF. Read More

    Noninvasive mechanical ventilation in early acute respiratory distress syndrome.
    Pol Arch Intern Med 2017 Aug 17. Epub 2017 Aug 17.
    Non invasive ventilation (NIV) has a well established role in the treatment of acute-on-chronic respiratory failure and cardiogenic pulmonary oedema. Its role in acute hypoxaemic respiratory failure has been increasingly investigated, but its impact on the management and the outcome of the subset of patients affected by acute respiratory distress syndrome (ARDS) is still to be determined. ARDS could be a risk factor for NIV failure and in these patient delayed endotracheal intubation can lead to an increased mortality. Read More

    Therapeutic flexible airway endoscopy of small children in a tertiary referral center-11 years' experience.
    PLoS One 2017 17;12(8):e0183078. Epub 2017 Aug 17.
    Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
    Objectives: Use of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center.

    Methods: This is a retrospective cohort study. Read More

    Enteral Nutrition Practices in Critically Ill Children Requiring Noninvasive Positive Pressure Ventilation.
    Pediatr Crit Care Med 2017 Aug 12. Epub 2017 Aug 12.
    1Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO. 2Department of Pediatrics, Section of General Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO. 3Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO. 4Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, CO.
    Objectives: Evaluate the practice of providing enteral nutrition in critically ill children requiring noninvasive positive pressure ventilation.

    Design: Retrospective cohort study.

    Setting: PICU within a quaternary care children's hospital. Read More

    Pathophysiological mechanism of long-term noninvasive ventilation in stable hypercapnic patients with COPD using functional respiratory imaging.
    Int J Chron Obstruct Pulmon Dis 2017 28;12:2197-2205. Epub 2017 Jul 28.
    Department of Respiratory Medicine, University Hospital Antwerp.
    Introduction: Patients with severe COPD often develop chronic hypercapnic respiratory failure. Their prognosis worsens and they are more likely to develop exacerbations. This has major influence on the health-related quality of life. Read More

    Cardio-Pulmonary Stethoscope: Clinical Validation with Heart Failure and Hemodialysis Patients.
    IEEE Trans Biomed Eng 2017 Aug 14. Epub 2017 Aug 14.
    Objective: The purpose of this study is to evaluate the accuracy of a noninvasive radiofrequency-based device, the Cardio-Pulmonary Stethoscope (CPS), to monitor heart and respiration rates and detect changes in lung water content in human experiments and clinical trials.

    Methods: Three human populations (healthy subjects (n=4), heart failure (n=12) and hemodialysis (n=13) patients) were enrolled in this study. The study was conducted at the University of Hawaii and The Queen's Medical Center in Honolulu, HI. Read More

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