phenylephrine-hydrochloride and Respiratory-Insufficiency

Topics: Catheterization; Catheters; Equipment Design; Humans; Nose; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Insufficiency

High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F(IO2), and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.

Topics: Adult; Cannula; Critical Illness; Female; Humans; Humidity; Male; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency; Work of Breathing

Topics: Acute Disease; Chronic Disease; Female; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Pregnancy; Pregnancy Complications; Pulmonary Edema; Respiratory Insufficiency; Ventilator Weaning

Topics: Acute Disease; Child; Female; Humans; Hypoxia; Masks; Nose; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Insufficiency

Chondrodysplasia punctata is a heterogeneous skeletal dysplasia characterized by small focal calcifications in articular and other cartilages in infancy, referred to as stippled epiphyses, with subsequent epiphysial dysplasia and associated anomalies of the face, eyes and skin. Nasal hypoplasia is commonly seen but secondary respiratory distress is infrequently described. We present two siblings with different degrees of involvement and a review of the different forms of this disorder. When an infant presents with a small nasal airway, the diagnosis of chondrodysplasia punctata should be considered and appropriate evaluations obtained.

Topics: Chondrodysplasia Punctata; Female; Humans; Infant; Infant, Newborn; Male; Nasal Obstruction; Nose; Nose Diseases; Respiratory Insufficiency

Topics: Acute Disease; Ambulatory Care; Blood Pressure; Brain; Chronic Disease; Diphosphoglyceric Acids; Erythrocytes; Follow-Up Studies; Humans; Hypertension, Pulmonary; Hypoxia; Intubation; Lung Diseases, Obstructive; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Physical Exertion; Polycythemia; Prognosis; Psychology; Respiratory Insufficiency; Spirometry; Vascular Resistance

Topics: Air Pollution; Anti-Bacterial Agents; Burns; Humans; Humidity; Intubation, Intratracheal; Laryngoscopy; Nose; Oxygen Inhalation Therapy; Pneumonia; Positive-Pressure Respiration; Prognosis; Pulmonary Edema; Respiratory Insufficiency; Respiratory Tract Diseases; Sepsis; Steroids; Tracheotomy

Due to the prolonged use of face mask in noninvasive ventilation, pressure ulcer is a common complication. Pressure ulcer can occur within a few hours at the site where the mask contacts in 2-70% of cases.. The aim of this study is to conduct a randomized controlled trial to investigate the effects of transparent film use on the duration of pressure ulcer formation in the nasal region in patients undergoing noninvasive ventilation.. This study was a randomized controlled trial. 46 patients who met the sample selection criteria and agreed to participate in the study were included in the study at a university hospital in İzmir, Turkey. Of them, 25 were assigned to the intervention group and 21 to the control group. Data were collected using the Socio-demographic and Disease-related Characteristics Questionnaire, The Noninvasive Ventilation Parameters Monitoring Form, and The Pressure Ulcer Classification Form at 4-hour intervals.. The duration of pressure ulcer formation in intervention group was longer than that in control group, and the difference between them was statistically significant (P < 0.05).. In this study, the use of nasal protective film (transparent film) prolonged the duration of pressure ulcer formation on the nasal bridge in patients who underwent noninvasive mechanical ventilation.

Topics: Adult; Female; Humans; Male; Masks; Middle Aged; Noninvasive Ventilation; Nose; Pressure Ulcer; Respiratory Insufficiency; Surgical Tape; Turkey

Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment.. The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation <92%/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis.. Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team.. ACTRN12618000210279.

Topics: Child, Preschool; Early Medical Intervention; Humans; Infant; Multicenter Studies as Topic; Nose; Oxygen Inhalation Therapy; Randomized Controlled Trials as Topic; Respiratory Insufficiency

The ROX (Respiratory rate-OXygenation) index is an early predictor of failure of nasal high flow (NHF), with lower values indicating higher risk of intubation. We measured the ROX index at set flow rate of 30 and 60 l/min in 57 hypoxemic patients on NHF. Patients with increased ROX index values at higher flow (n = 40) showed worse baseline oxygenation, higher respiratory rate and lower ROX index in comparison to patients with unchanged or decreased ROX index values (n = 17). The ROX index variation between flows was correlated with the change in end expiratory lung volume. Set flow rate during NHF might impact the ROX index value.

Topics: Aged; Blood Gas Analysis; Cross-Over Studies; Female; Humans; Hypoxia; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen Inhalation Therapy; Prospective Studies; Respiratory Insufficiency; Respiratory Rate

Topical cooling with ice slush as an adjunct for myocardial protection during cardiac surgery has been shown to cause freezing injury of the phrenic nerves. This can cause diaphragmatic dysfunction and respiratory complications.. Twenty (n=20) male patients between the ages of 40 and 60 years were equally randomised to undergo elective coronary artery bypass grafting (CABG) with either cold cardioplegic arrest with topical ice slush cooling or cold cardioplegic arrest without the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to compare inspiratory muscle strength.. There was no difference in the preoperative SNIF in the two randomised groups. In the immediate postoperative period, the ice slush group had worse SNIF (33.5±9.6cm H2O versus 47.8±12.2cm H2O; p=0.009). The pre-home discharge SNIF was still significantly lower for the ice slush group despite a noted improvement in SNIF recovery in both groups (38.3±10.6cm H2O versus 53.5±13.2cm H2O; p=0.011). Two patients in the ice slush group had left diaphragmatic dysfunction with none in the control group.. The use of topical ice slush is associated with freezing injury of the phrenic nerves. This will adversely affect the inspiratory muscle force which may lead to respiratory complications after surgery.

Topics: Administration, Topical; Adult; Coronary Artery Bypass; Coronary Artery Disease; Diaphragm; Humans; Hypothermia, Induced; Ice; Inspiratory Capacity; Male; Middle Aged; Nose; Phrenic Nerve; Postoperative Period; Respiratory Insufficiency; Respiratory Paralysis

Nasal cannula can achieve apneic oxygenation during emergency intubation. However, pre-procedure nasal cannula placement may be difficult in patients undergoing non-invasive positive pressure ventilation (NPPV) prior to intubation. Our objective was to compare mask leak during NPPV with versus without simultaneous application of nasal cannula. We hypothesized mask leak would be no worse with concomitant use of nasal cannula (non-inferiority design).. We enrolled 64 subjects. Mean time-averaged mask leak was 2.2L/min for NPPV-a versus 4.0L/min for NPPV-nc for a difference of 1.7L/min (one-sided 95% CI -∞ to 3.2L/min). NPPV-a resulted in higher mean minute volume received (13.5 versus 12.2L) and higher mean respiratory rates (14.8 versus 13.5 breaths per minute).. The addition of nasal cannula during NPPV does not significantly increase mask leak. The simultaneous application of nasal cannula with NPPV may be a useful strategy to streamline airway management among patients undergoing NPPV prior to intubation.

Topics: Adult; Cannula; Cross-Over Studies; Equipment Failure; Female; Healthy Volunteers; Humans; Male; Noninvasive Ventilation; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Treatment Outcome

A good mask fit, avoiding air leaks and pressure effects on the skin are key elements for a successful noninvasive ventilation (NIV). However, delivering practical training for NIV is challenging, and it takes time to build experience and competency. This study investigated whether a pressure sensing system with real-time visual feedback improved mask fitting.. During an NIV training session, 30 healthcare professionals (14 trained in mask fitting and 16 untrained) performed two mask fittings on the same healthy volunteer in a randomized order: one using standard mask-fitting procedures and one with additional visual feedback on mask pressure on the nasal bridge. Participants were required to achieve a mask fit with low mask pressure and minimal air leak (<10 L/min). Pressure exerted on the nasal bridge, perceived comfort of mask fit and staff- confidence were measured.. Compared with standard mask fitting, a lower pressure was exerted on the nasal bridge using the feedback system (71.1 ± 17.6 mm Hg vs 63.2 ± 14.6 mm Hg, P < 0.001). Both untrained and trained healthcare professionals were able to reduce the pressure on the nasal bridge (74.5 ± 21.2 mm Hg vs 66.1 ± 17.4 mm Hg, P = 0.023 and 67 ± 12.1 mm Hg vs 60 ± 10.6 mm Hg, P = 0.002, respectively) using the feedback system and self-rated confidence increased in the untrained group.. Real-time visual feedback using pressure sensing technology supported healthcare professionals during mask-fitting training, resulted in a lower pressure on the skin and better mask fit for the volunteer, with increased staff confidence.

Topics: Adult; Cross-Over Studies; Feedback, Sensory; Female; Humans; Male; Masks; Middle Aged; Noninvasive Ventilation; Nose; Pressure; Prospective Studies; Respiratory Insufficiency

The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06.. HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

Topics: Airway Extubation; Bandages; Catheters; Continuous Positive Airway Pressure; Epistaxis; Equipment Design; Erythema; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nose; Respiratory Insufficiency; Trauma Severity Indices; Ulcer

In acute respiratory failure, non-invasive ventilation (NIV) treatment is used to prevent the need for intubation. NIV applied through a face mask may contribute to the development of facial skin lesions. This study was conducted to compare the efficacy of protective dressings and of using no materials for pressure ulcer prevention.. There were 90 participants in this study. The participants were assigned into three groups: control group, tegasorb group, and tegaderm group.. The tegasorb group and tegaderm group, in contrast to the control group, had fewer pressure ulcers based on our statistics and occurrence duration time (p<.01). However, there were no significant difference in occurrence duration time between the tegasorb group and tegaderm group.. This result revealed that tegasorb and tegaderm could be used on the face of NIV patients to prevent pressure ulcers.

Topics: Acute Disease; Aged; Analysis of Variance; Bandages, Hydrocolloid; Clinical Nursing Research; Critical Care; Female; Humans; Incidence; Male; Masks; Nose; Pressure Ulcer; Respiration, Artificial; Respiratory Insufficiency; Risk Factors; Skin Care; Taiwan; Time Factors; Treatment Outcome

Noninvasive positive pressure techniques such as continuous and bilevel positive airway pressure avoid intubation and its attendant complications in selected patients with acute respiratory failure. However, mask intolerance remains a common cause for failure of noninvasive ventilatory techniques. The aim of our study was to assess patient tolerance of oronasal vs. nasal mask ventilation in acute respiratory failure.. Randomized, controlled trial.. Emergency department or intensive care units at a university hospital.. Seventy patients with acute respiratory failure as evidenced by clinical or blood gas criteria.. Patients randomly received either a disposable nasal or an oronasal mask (Respironics, Pittsburgh, PA) when they met study criteria.. Thirty-five patients were randomized into each arm of the study; most of the patients had acute cardiogenic pulmonary edema (48.6% of the nasal mask group and 42.8% of the facial mask group) or chronic obstructive airway disease (34.3% of the nasal mask group and 31.4% of the facial mask group). Baseline clinical characteristics of the two groups of patients were similar. Heart and respiratory rates and blood gases improved similarly for patients in both mask groups. Rates of intubation were also similar (eight in each group). However, mask intolerance was significantly higher in the nasal than the oronasal mask group (12 vs. 4, respectively, p=.023). Four patients in the nasal (11.4%) and two in the oronasal mask group (5.7%) died later during the hospitalization. The overall success rate tended to be greater in the oronasal (65.7%) than the nasal group (48.6%), but the difference was not statistically significant.. Although both masks performed similarly with regard to improving vital signs and gas exchange and avoiding intubation, the nasal mask was less well tolerated than the oronasal mask in patients with acute respiratory failure.

Topics: Acute Disease; Aged; Equipment Design; Female; Humans; Male; Masks; Mouth; Nose; Respiration, Artificial; Respiratory Insufficiency

To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants.. Thirty-two premature infants receiving nasal CPAP for apnea or mild respiratory distress were enrolled. Birth weight was (mean +/- standard deviation) 1081 +/- 316 g, gestational age 29 +/- 2 weeks, age at study 13 +/- 12 days, and fraction of inspired oxygen (FIO(2)) at study.29 +/-.1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (DeltaV(L)) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H(2)O using calibrated direct current-coupled respiratory inductance plethysmography.. DeltaV(L) was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, DeltaV(L) was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and FIO(2) were greater with the modified cannula than for either of the other 2 devices.. Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased respiratory effort and FIO(2).

Topics: Apnea; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lung Compliance; Nose; Positive-Pressure Respiration; Respiration; Respiratory Insufficiency; Total Lung Capacity

Respiratory failure is the commonest cause of death in patients with Duchenne muscular dystrophy (DMD). Life expectancy is less than one year once diurnal hypercapnia develops. This study examines the effects of nasal intermittent positive pressure ventilation (NIPPV) on survival in symptomatic Duchenne patients with established ventilatory failure.. Nocturnal NIPPV was applied in 23 consecutive patients with DMD of mean (SD) age 20.3 (3.4) years who presented with diurnal and nocturnal hypercapnia.. One year and five year survival rates were 85% (95% CI 69 to 100) and 73% (95% CI 53 to 94), respectively. Early changes in arterial blood gas tensions following NIPPV occurred with mean (SD) PO2 increasing from 7.6 (2.1) kPa to 10.8 (1.3) kPa and mean (SD) PCO2 falling from 10.3 (4.5) kPa to 6.1 (1.0) kPa. Improvements in arterial blood gas tensions were maintained over five years. Health perception and social aspects of SF-36 health related quality of life index were reported as equivalent to other groups with nonprogressive disorders using NIPPV.. Nasal ventilation is likely to increase survival in hypercapnic patients with Duchenne muscular dystrophy and should be considered as a treatment option when ventilatory failure develops.

Topics: Adolescent; Adult; Carbon Dioxide; Follow-Up Studies; Home Care Services; Humans; Hypercapnia; Intermittent Positive-Pressure Ventilation; Male; Muscular Dystrophies; Nose; Oxygen; Partial Pressure; Quality of Life; Respiratory Insufficiency

Non-invasive ventilation has been used in chronic respiratory failure due to chronic obstructive pulmonary disease (COPD), but the effect of the addition of nasal positive-pressure ventilation to long-term oxygen therapy (LTOT) has not been determined. We report a randomized crossover study of the effect of the combination of nasal pressure support ventilation (NPSV) and domiciliary LTOT as compared with LTOT alone in stable hypercapnic COPD. Fourteen patients were studied, with values (mean +/- SD) of Pao2 of 45.3 +/- 5.7 mm Hg, PaCO2 of 55.8 +/- 3.6 mm Hg, and FEV1 of 0.86 +/- 0.32 L. A 4 wk run-in period (on usual therapy) was followed by consecutive 3-mo periods of: (1) oxygen therapy alone, and (2) oxygen plus NPSV in randomized order. Assessments were made during run-in and at the end of each study period. There were significant improvements in daytime arterial PaO2 and PaCO2, total sleep time, sleep efficiency, and overnight PaCO2 following 3 mo of oxygen plus NPSV as compared with run-in and oxygen alone. Quality of life with oxygen plus NPSV was significantly better than with oxygen alone. The degree of improvement in daytime PaCO2 was correlated with the improvement in mean overnight PaCO2. Nasal positive-pressure ventilation may be a useful addition to LTOT in stable hypercapnic COPD.

Topics: Aged; Carbon Dioxide; Cross-Over Studies; Exercise Test; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Hypercapnia; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Quality of Life; Respiratory Insufficiency; Sleep; Vital Capacity

Evaluation of the effectiveness of chronic nightly mechanical ventilation through a nasal mask system in patients with neuromuscular diseases or patients with thorax malformations or COPD.. Centre for Home Mechanical Ventilation, University Hospital Utrecht.. Retrospective study.. During the period June 1988-May 1993, 64 patients (11-69 years old) were treated with nasal mask ventilation during the night: 37 men (most of whom had Duchenne's disease (18) and 27 women (most of whom had (post-polio) kyphoscoliosis (n = 13). The effects on arterial blood gases were analysed. Complications during use of the nasal mask systems were recorded.. The duration of the nasal mask ventilation was 2 to 56 months. Arterial PCO2 and PO2 improved during the night as well as by day during spontaneous respiration. The most common problems were necrosis of the skin of the bridge of the nose, leakage of air through the mouth or insufflation of air into the stomach. After the start of the mechanical ventilation quality of life improved considerably.. Nasal ventilation at night is sufficient and simple. The installation of a tracheostoma can be postponed or avoided with this non-invasive kind of ventilation.

Topics: Adolescent; Adult; Aged; Child; Female; Home Care Services; Humans; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Neuromuscular Diseases; Nose; Positive-Pressure Respiration; Postpoliomyelitis Syndrome; Respiratory Insufficiency; Retrospective Studies

Acute exacerbations of chronic obstructive airways disease (COAD) are a common cause of admission to hospital, and have a high mortality. Nasal intermittent positive pressure ventilation (NIPPV) has been used successfully in patients with respiratory failure due to neuromuscular and skeletal disorders, but the outcome of treatment in patients with COAD is less well known. We carried out a prospective randomised controlled trial of conventional treatment versus conventional treatment plus NIPPV, in 60 patients with acute ventilatory failure due to exacerbations of COAD. For the NIPPV group there was a rise in pH, compared with a fall in the controls (mean difference of change between the groups 0.046 [95% CI 0.06-0.02, p < 0.001]), and a larger fall in PaCO2 (mean difference in change between the groups 1.2 kPa [95% CI 0.45 to 2.03, p < 0.01]). Median visual analogue scores over the first 3 days of admission showed less breathlessness in the NIPPV group (2.3 cm [range 0.1-5.5]) than in the control group (4.5 cm [range 0.9-8.8]) (p < 0.025). Survival rates at 30 days were compared for intention-to-treat and efficacy populations. In the efficacy mortality comparison, mortality in the NIPPV group was reduced: 1/26 vs 9/30 (relative risk = 0.13, CI = 0.02-0.95, p = 0.014). This effect was less in the intention-to-treat analysis: 3/30 vs 9/30 (relative risk = 0.33, CI = 0.10-1.11, p = 0.106). In patients with acute ventilatory failure due to COAD who received NIPPV there was a significant rise in pH, a reduction in PaCO2 and breathlessness, and reduced mortality.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Blood; Bronchodilator Agents; Carbon Dioxide; Doxapram; Humans; Hydrogen-Ion Concentration; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Oxygen; Prospective Studies; Respiratory Insufficiency; Risk; Survival Rate

Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting.. Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives.. Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.

Topics: Adult; Blood Gas Analysis; Clinical Nursing Research; Clinical Protocols; Critical Care; Fatigue; Fees and Charges; Humans; Length of Stay; Lung Volume Measurements; Masks; Middle Aged; Neuromuscular Diseases; Nose; Patient Care Planning; Patient Compliance; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Wake Disorders; Treatment Outcome

Topics: Cannula; Humans; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency

Noninvasive ventilation (NIV) has become the preferable modality of respiratory support for spontaneously breathing premature infants in the neonatal ICU (NICU). Whereas NIV support contributes to the prevention of long-term respiratory sequelae from mechanical ventilation, the nasal interfaces used are well known for placing patients at risk for development of NIV device-related pressure injuries (PIs). After implementing clinical practice guidelines promoting the use of sealing NIV interfaces for respiratory support in a level IV NICU, an increase in the frequency of stage 2 or worse and deep tissue injury (DTI) PI was observed. We hypothesized that the implementation of a multifaceted skin care bundle (SCB) would reduce the incidence of NIV device-related PI.. Quality improvement methodology was used to evaluate the impact of implementing an SCB for patients supported with NIV via a nasal interface. Incidence rate of stage 2 or worse and DTI PI was reported per 100 NIV days over 4 distinct time periods: (1) pre-NIV guideline, (2) post-NIV guideline, (3) post SCB, and (4) sustainability phase. Incidence comparisons were made using one-sided. The NICU experienced a notable rise in NIV device-related PI after implementation of NIV guidelines (0.01 vs 0.34 per 100 NIV days;. A collaborative and multidisciplinary team approach was used to promote engagement with clinical staff to address a preventable harm. The implementation of a multifaceted PI prevention bundle contributed to reducing harm while permitting the continued use of appropriate respiratory support to a highly vulnerable patient population in the NICU.

Topics: Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Noninvasive Ventilation; Nose; Pressure Ulcer; Respiration, Artificial; Respiratory Insufficiency

Topics: Humans; Masks; Nose; Positive-Pressure Respiration; Respiratory Insufficiency

Topics: Humans; Hypercapnia; Noninvasive Ventilation; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency

Topics: Humans; Hypercapnia; Noninvasive Ventilation; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency

Topics: Humans; Noninvasive Ventilation; Nose; Pressure Ulcer; Respiration, Artificial; Respiratory Insufficiency

Topics: Adult; Humans; Hypoxia; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency

Topics: Aged, 80 and over; Cannula; Conscious Sedation; Echocardiography, Transesophageal; Humans; Male; Noninvasive Ventilation; Nose; Oxygen Inhalation Therapy; Respiratory Insufficiency

Topics: Critical Care; Humans; Immunocompromised Host; Nose; Oxygen; Respiratory Insufficiency

Topics: Cleft Lip; Cleft Palate; Continuous Positive Airway Pressure; Craniofacial Abnormalities; Head Protective Devices; Humans; Infant, Newborn; Male; Nose; Respiratory Insufficiency

Topics: Humans; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency; Risk Factors

Topics: Asthma; Cannula; Humans; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency

The purpose of the study is to describe early predictors and to develop a prediction tool that accurately identifies the need for mechanical ventilation (MV) in pneumonia patients with hypoxemic acute respiratory failure (ARF) treated with high-flow nasal cannula (HFNC).. This is a 4-year prospective observational 2-center cohort study including patients with severe pneumonia treated with HFNC. High-flow nasal cannula failure was defined as need for MV. ROX index was defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate.. One hundred fifty-seven patients were included, of whom 44 (28.0%) eventually required MV (HFNC failure). After 12 hours of HFNC treatment, the ROX index demonstrated the best prediction accuracy (area under the receiver operating characteristic curve 0.74 [95% confidence interval, 0.64-0.84]; P<.002). The best cutoff point for the ROX index was estimated to be 4.88. In the Cox proportional hazards model, a ROX index greater than or equal to 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk for MV (hazard ratio, 0.273 [95% confidence interval, 0.121-0.618]; P=.002), even after adjusting for potential confounding.. In patients with ARF and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours.

Topics: Adult; Aged; Catheterization; Female; Humans; Male; Middle Aged; Nose; Oximetry; Oxygen; Oxygen Inhalation Therapy; Pneumonia; Proportional Hazards Models; Prospective Studies; Respiration, Artificial; Respiratory Insufficiency; Respiratory Rate; Severity of Illness Index; Treatment Failure

The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).. We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2 /FIO2 of ≤300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy.. Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2 significantly increased from 83 (68-97) mm Hg to 108 (83-140) mm Hg using HFNC and to 125 (97-200) mm Hg using NIV (P<.01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27-127) h and NIV for 23 (8-31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥30 breaths/min was an early factor associated with intubation.. HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation.

Topics: Acute Disease; Aged; Catheters; Female; Humans; Hypoxia; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Patient Satisfaction; Pilot Projects; Prospective Studies; Respiratory Distress Syndrome; Respiratory Insufficiency; Respiratory Rate; Severity of Illness Index; Treatment Failure

Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS.. This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared.. Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (PaO2 /FIO2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P=.001), occurrence of additional organ failure (76% vs 26%, P=.002), mainly hemodynamic (50% vs 7%, P=.001) or neurological (22% vs 0, P=.01), and trends toward lower PaO2 /FIO2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis.. In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

Topics: Acute Disease; Adult; Aged; Catheters; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Respiratory Distress Syndrome; Respiratory Insufficiency; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Failure

Device-related pressure ulcers from noninvasive ventilation masks alter skin integrity and cause patients discomfort.. To examine the incidence, location, and stage of pressure ulcers and patients' comfort with a nasal-oral mask compared with a full-face mask.. A before-after study of a convenience sample of patients with noninvasive ventilation orders in 5 intensive care units was conducted. Two groups of 100 patients each received either the nasal-oral mask or the full-face mask. Skin was assessed before the mask was applied and every 12 hours after that or upon mask removal. Comfort levels were assessed every 12 hours on a Likert scale of 1 to 5 (1, most comfortable).. A pressure ulcer developed in 20% of patients in the nasal-oral mask group and 2% of patients in the full-face mask group (P < .001). Comfort scores were significantly lower (more comfortable) with the full-face mask (mean [SD], 1.9 [1.1]) than with the nasal-oral mask (mean [SD], 2.7 [1.2], P < .001). Neither mean hours worn nor percentage adherence differed significantly: 28.9 (SD, 27.2) hours and 92% for full-face mask and 25 (SD, 20.7) and 92% for nasal-oral mask. No patients who had a pressure ulcer develop with the nasal-oral mask had a pressure ulcer develop with the full-face mask.. The full-face mask resulted in significantly fewer pressure ulcers and was more comfortable for patients. The full-face mask is a reasonable alternative to traditional nasal-oral masks for patients receiving noninvasive ventilation.

Topics: Causality; Female; Humans; Incidence; Male; Masks; Middle Aged; Noninvasive Ventilation; Nose; Patient Satisfaction; Pressure Ulcer; Respiratory Insufficiency; Time Factors

High flow nasal cannulas (HFNCs) provide humidified oxygen at higher flow rates and higher FiO2s than conventional delivery devices and are typically used in special care units. There is limited information on their use in general hospital settings.. The medical records of all patients who were treated with HFNC during the calendar year 2014 were retrospectively reviewed to collect information on age, sex, indications, arterial blood gases when available, O2 saturations and outcomes.. One hundred six patients received oxygen supplementation by HFNC in their hospital in 2014. The average age was 61.6 ± 16.2 years; 62 patients were men. The indications for HFNC included dyspnea (1 patient), hypoxemic respiratory failure (101 patients) and hypercapneic respiratory failure (4 patients). The PaO2 increased from 68.2 ± 16.3 mm Hg to 83.1 ± 32.2 mm Hg (N = 32, P = 0.02) with the change to HFNC. The O2 saturation increased from 93.1 ± 4.5% to 95.1 ± 3.0% (N = 106, P = 0.00015). The mean duration of use was 4.3 ± 3.7 days. Sixty-five patients did not require intubation or noninvasive ventilation (NIV). Sixteen required NIV, 16 required intubation and 9 required both. The overall mortality was 15%.. HFNC oxygen therapy is used relatively frequently in their hospital on surgical and medical services. PaO2s and O2 saturations improved when patients were switched to this mode of oxygenation, but some patients subsequently required NIV and/or intubation. Patients on HFNC need careful monitoring for deterioration in their respiratory status.

Topics: Adult; Aged; Aged, 80 and over; Catheters; Female; Humans; Hypercapnia; Male; Middle Aged; Noninvasive Ventilation; Nose; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Insufficiency; Retrospective Studies; Tertiary Healthcare

Anesthesiologists have the privilege and challenge of providing care for an extremely diverse population of patients, at times in urgent or emergent situations. We present a case of a 31-year-old woman with Pierre Robin sequence, severe juvenile scoliosis, and respiratory failure who underwent successful awake nasal fiberoptic intubation for tracheostomy at an adult tertiary care medical center. Familiarity with patient conditions infrequently encountered within our practice, as well as adherence to practice guidelines, proved essential to providing our patient with the safest care possible.

Topics: Adult; Anesthesia, General; Anesthetics; Female; Fiber Optic Technology; Humans; Intubation, Intratracheal; Nose; Pierre Robin Syndrome; Respiratory Insufficiency; Scoliosis; Tracheostomy

High-flow nasal cannula (HFNC) creates positive oropharyngeal airway pressure and improves oxygenation. It remains unclear, however, whether HFNC improves thoraco-abdominal synchrony in patients with mild to moderate respiratory failure. Using respiratory inductive plethysmography, we investigated the effects of HFNC on thoraco-abdominal synchrony.. We studied 40 adult subjects requiring oxygen therapy in the ICU. Low-flow oxygen (up to 8 L/min) was administered via oronasal mask for 30 min, followed by HFNC at 30-50 L/min. Respiratory inductive plethysmography transducer bands were circumferentially placed: one around the rib cage, and one around the abdomen. We measured the movement of the rib-cage and abdomen, and used the sum signal to represent tidal volume (V(T)) during mask breathing, and at 30 min during HFNC. We calculated the ratio of maximum compartmental amplitude (MCA) to V(T), and the phase angle. We assessed arterial blood gas and vital signs at each period, and mouth status during HFNC. We used multiple regression analysis to identify factors associated with improvement in thoraco-abdominal synchrony.. During HFNC, breathing frequency significantly decreased from 25 breaths/min (IQR 22-27 breaths/min) to 21 breaths/min (IQR 18-24 breaths/min) (P < .001), and MCA/VT (P < .001) and phase angle (P = .047) significantly improved.. HFNC improved thoraco-abdominal synchrony in adult subjects with mild to moderate respiratory failure.

Topics: Abdomen; Aged; Catheters; Critical Illness; Female; Humans; Male; Middle Aged; Movement; Noninvasive Ventilation; Nose; Oxygen Inhalation Therapy; Prospective Studies; Respiratory Insufficiency; Respiratory Mechanics; Thorax

In patients with neuromuscular disorders, no randomized studies have been performed whether nasal or oronasal masks should be preferred. Oronasal masks are often used in acute respiratory failure, while nasal masks are preferred in patients with chronic respiratory failure. However, the use of nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks have been applied during home noninvasive ventilation (NIV). Until now, upper airway obstruction during NIV has been thought to be induced by nasal obstruction, pharyngeal collapse, and/or glottis closure. We report a case indicating another cause of upper airway obstruction: use of an oronasal mask can induce obstructive events in the upper airways, possibly resulting in sleep fragmentation and decreased efficiency of NIV.

Topics: Airway Obstruction; Amyotrophic Lateral Sclerosis; Equipment Design; Humans; Male; Masks; Middle Aged; Mouth; Noninvasive Ventilation; Nose; Polysomnography; Respiratory Insufficiency

In recent clinical practice, high-flow nasal cannula (HFNC) therapy has been used to improve oxygenation in adults with acute respiratory failure (ARF). However, bronchoscopy using HFNC in ARF has not yet been reported. Herein, we describe 5 cases of ARF where bronchoalveolar lavage (BAL) was employed successfully using an HFNC. We were able to discontinue or reduce the HFNC fraction of inspired oxygen (FiO2) 30 min after completion of the bronchoscopy. Only 1 patient needed non-invasive positive pressure ventilation for 16 h after bronchoscopy. The HFNC may be a useful tool for ARF patients who require bronchoscopy.

Topics: Acute Disease; Aged; Bronchoalveolar Lavage; Bronchoscopy; Catheters; Female; Humans; Male; Middle Aged; Nose; Respiratory Insufficiency; Treatment Outcome

Topics: Acute Disease; Adolescent; Humans; Male; Nose; Polychondritis, Relapsing; Radiography; Respiratory Insufficiency; Trachea

Use of high-flow humidified nasal cannulas to deliver continuous positive airway pressure in children is increasing. Data on the relationship between the flow values and the corresponding pressures are limited. The purpose of this experiment was to evaluate the relationship between the device, intraprong, and proximal airway pressures and the flow values in a neonatal/pediatric test lung model, using the Vapotherm 2000i and Fisher-Paykel humidified nasal cannulas devices.. Using a pediatric size cannula (2-mm inner diameter), we measured the device, intraprong, and proximal airway pressures at random flow values between 0 L/min and 12 L/min with an FIO2 of 0.21 at a temperature of 37°C and 100% humidity. Measurements were repeated for both devices under simulated minimal and moderate nares-prong leak (leak). Effects of varying mouth leak were also studied.. All three pressures generally increased with increasing flows with both devices, irrespective of leak. In case of minimal leak, the Fisher-Paykel device generated larger pressures than the Vapotherm device for flows of < 8 L/min, whereas this trend was reversed at higher flows due principally to the pressure release feature of the Fisher-Paykel system. Under minimal leak, the intraprong pressure values varied between 22% and 27% and 20% and 32% of the corresponding device pressure value for Fisher-Paykel and Vapotherm, respectively. The proximal airway pressure was further reduced by about 20% to 30% relative to the intrapong pressure values with the two devices. The device pressure was essentially unaffected by nares-prong leaks or mouth leak. The intraprong pressure and particularly the proximal airway pressure were reduced substantially, as either nares or mouth leak increased.. High flow humidified nasal cannulas systems may deliver uncontrolled continuous positive airway pressure to infants. This, along with the potentially large nares and mouth leak effects on any form of continuous positive airway pressure, renders the effective humidified nasal cannulas delivered continuous positive airway pressure particularly unpredictable.

Topics: Continuous Positive Airway Pressure; Humans; Humidity; Infant; Models, Biological; Mouth; Nose; Reproducibility of Results; Respiratory Insufficiency; Transducers

The aim of this study was to assess the heat and moisture exchange (HME) capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate in patients with head and neck cancer.. We plotted the subglottic temperature and humidity measurements in 10 patients with head and neck cancer with a temporary precautionary tracheotomy during successive 10-minute periods of nose, mouth, and tracheotomy breathing in a randomized sequence.. End-inspiratory temperatures of nose, mouth, and tracheotomy breathing were 31.1, 31.3, and 28.3°C, respectively. End-inspiratory humidity measurements of nose, mouth, and tracheotomy breathing were 29.3, 28.6, and 21.1 mgH₂O/L, respectively. There was a trend toward lower end-inspiratory humidity in patients with radiotherapy or with large surgery-induced oropharyngeal mucosal defects, whereas temperatures were similar.. This study gives objective information about the HME capacity of the upper respiratory tract in patients with head and neck cancer with precautionary tracheotomy, and thus provides target values for HMEs for laryngectomized and tracheotomized patients.

Topics: Adult; Aged; Blood Gas Analysis; Body Temperature Regulation; Cohort Studies; Female; Follow-Up Studies; Head and Neck Neoplasms; Hot Temperature; Humans; Humidity; Intubation, Intratracheal; Linear Models; Male; Maximal Voluntary Ventilation; Middle Aged; Mouth; Mouth Breathing; Neck Dissection; Nose; Oxygen Consumption; Postoperative Care; Respiratory Insufficiency; Risk Assessment; Trachea; Tracheotomy; Young Adult

To evaluate the efficiency, safety and outcome of high flow nasal cannula oxygen (HFNC) in ICU patients with acute respiratory failure.. Pilot prospective monocentric study. Thirty-eight patients were included. Baseline demographic and clinical data, as well as respiratory variables at baseline and various times after HFNC initiation during 48 h, were recorded. Arterial blood gases were measured before and after the use of HFNC. Noise and discomfort were monitored along with outcome and need for invasive mechanical ventilation.. HFNC significantly reduced the respiratory rate, heart rate, dyspnea score, supraclavicular retraction and thoracoabdominal asynchrony, and increased pulse oxymetry. These improvements were observed as early as 15 min after the beginning of HFNC for respiratory rate and pulse oxymetry. PaO(2) and PaO(2)/FiO(2) increased significantly after 1 h HFNC in comparison with baseline (141 ± 106 vs. 95 ± 40 mmHg, p = 0.009 and 169 ± 108 vs. 102 ± 23, p = 0.036; respectively). These improvements lasted throughout the study period. HFNC was used for a mean duration of 2.8 days and a maximum of 7 days. It was never interrupted for intolerance. No nosocomial pneumonia occurred during HFNC. Nine patients required secondary invasive mechanical ventilation. Absence of a significant decrease in the respiratory rate, lower oxygenation and persistence of thoracoabdominal asynchrony after HFNC initiation were early indicators of HFNC failure.. HFNC has a beneficial effect on clinical signs and oxygenation in ICU patients with acute respiratory failure. These favorable results constitute a prerequisite to launching a randomized controlled study to investigate whether HFNC reduces intubation in these patients.

Topics: Adult; Aged; Critical Care; Female; France; Humans; Humidity; Intensive Care Units; Male; Middle Aged; Nose; Outcome Assessment, Health Care; Oxygen; Oxygen Inhalation Therapy; Pilot Projects; Positive-Pressure Respiration; Prospective Studies; Respiratory Insufficiency; Safety

Noninvasive ventilation by facemask is commonly used for patients with respiratory failure. We evaluated the pressure exerted by two types of facemask on the faces of 12 healthy volunteers while they were being given different levels of continuous or bi-level positive airway pressure ventilation. The mean (SD) pressure recorded on the bridge of the nose was much higher than that on the cheek (nose: 65.8 (21.2) vs cheek 15.4 (7.2) mmHg, p < 0.0001). Progressive tightening of the harness and increasing of the volume of air in the facemask cushions increased the pressure on the bridge of the nose, and the effect of these two factors was additive. Some commercially available facemasks can produce substantial pressure on the bridge of the nose and this explains why pressure complications on the bridge of the nose are common during noninvasive ventilation.

Topics: Adolescent; Adult; Aged; Cheek; Humans; Masks; Middle Aged; Nose; Positive-Pressure Respiration; Pressure; Respiratory Insufficiency; Stress, Mechanical; Transducers, Pressure

Topics: Chronic Disease; Face; Humans; Masks; Nose; Respiration, Artificial; Respiratory Insufficiency

To investigate the value of portable fibrobronchoscope in the management of respiratory failure by endotracheal intubation through the nose.. Fifty-eight patients with acute or chronic respiratory failure received mechanical ventilation by endotracheal intubation through the nose under the guidance of portable fibrobronchoscope.. Intubation was successfully performed in all the patients in a single attempt (which took 30 min to 5 min) without interruption of autonomous breathing or incurring laryngospasm or cardiac arrest. After mechanical ventilation for 30 min, conspicuous improvement of respiratory failure was observed in all the cases.. With convenient and easy manipulation, portable fibrobronchoscope provides quick and accurate guidance for endotracheal intubation through the nose in the emergency management of respiratory failure.

Topics: Adult; Bronchoscopes; Emergency Medical Services; Female; Humans; Intubation, Intratracheal; Male; Nose; Respiration, Artificial; Respiratory Insufficiency; Treatment Outcome

Increased resistance in the upper airway is known to be a contributing factor to deviant facial growth patterns. These patterns are the result of a prolonged presence of unbalanced oropharyngeal muscle activity. We hypothesized that mechanically increasing airway resistance would enhance the activity of the muscles facilitating respiration, and we attempted to demonstrate that the increased muscle activity is modulated by mechanoreceptors in the pharyngeal airway. The response of oropharyngeal muscles to increased airway resistance during spontaneous breathing was observed in 11 rabbits. Electromyographic signals from the ala nasi, orbicularis oris superior, genioglossus, mylohyoid muscles, and the diaphragm were recorded by fine-wire electrodes. Pressure changes were monitored by pressure transducers at the side branch of the cannule close to openings for the nose and the trachea. The study consisted of 2 experimental sessions. First, to evoke the response of muscles to the inspiratory resistance, increasing stepwise polyethylene tubes of various diameters were attached to the nasal and tracheal opening and the diameter of the tubes was gradually reduced. Muscle activity changes in response to the increased resistance were recorded during spontaneous nasal or tracheal breathing. Second, to examine muscle responses to negative pressure to the pharyngeal airway, irrespective of breathing activity, the pharynx was isolated as a closed circuit by a stoma constructed at a more caudal side in the trachea. Muscle responses to the negative pressure generated by a syringe in the pharyngeal segment were measured. Nasal breathing induced a greater muscle activity than did tracheal breathing, in general, at P <.05. When resistance was gradually increased, nasal breathing resulted in a greater increase in muscle activity than did tracheal breathing (P <.05), except in the diaphragm. Application of negative pressure to the isolated pharyngeal airway segment increased the muscle activity significantly (P <.05). We conclude that an increased airway resistance may facilitate oropharyngeal muscle activity through mechanoreceptors in the oropharyngeal airway.

Topics: Airway Obstruction; Airway Resistance; Animals; Diaphragm; Electrodes, Implanted; Electromyography; Facial Muscles; Inhalation; Intubation; Intubation, Intratracheal; Mechanoreceptors; Mouth; Muscle Contraction; Neck Muscles; Nose; Oropharynx; Pharyngeal Muscles; Pressure; Rabbits; Respiratory Insufficiency; Respiratory Physiological Phenomena; Trachea; Transducers, Pressure

To study whether nasal continuous positive airway pressure (nCPAP) improves pulmonary oxygen transfer and avoids reintubation in patients with severe nonhypercapnic oxygenation failure after major cardiac, vascular, or abdominal surgery.. Prospective interventional study.. Surgical ICU of a university hospital.. Twenty consecutive patients after thoracic, abdominal, or combined thoracoabdominal operations, in whom pulmonary oxygen transfer deteriorated continuously following elective extubation after initial mechanical ventilation. Respiratory failure was due to atelectasis and/or left heart failure, and all patients met predefined criteria for reintubation.. nCPAP therapy (8 to 10 cm H(2)O) was initiated if PaO(2) had decreased to < 80 mm Hg despite application of 100% oxygen (flow, 25 L/min), intermittent mask continuous positive airway pressure, and maximum conventional therapy.. nCPAP treatment was started 24.1 +/- 3.4 h after elective extubation. PaO(2) was < 80 mm Hg in all patients, in 13 patients it was < 60 mm Hg, and in 3 patients it was < 50 mm Hg. Mean PaO(2)/fraction of inspired oxygen (FIO(2)) ratio had decreased to 60 +/- 2.6, and increased within the first hour of nCPAP to 136 +/- 12 (p < 0.001). The clinical condition in all patients improved further, and after 35.2 +/- 6.3 h, all patients were well oxygenated by face mask at ambient pressure (PaO(2)/FIO(2) ratio, 146 +/- 14). Two patients were reintubated for reasons unrelated to oxygenation or ventilation (data are presented as mean +/- SEM).. nCPAP is safe, easy to apply, and effective to improve arterial blood oxygenation in < 1 h in postoperative patients with severe nonhypercapnic oxygenation failure. In these patients, who otherwise would have been reintubated, nCPAP can avoid endotracheal reintubation and mechanical ventilation.

Topics: Blood Gas Analysis; Female; Heart Failure; Hospitals, University; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Postoperative Care; Prospective Studies; Pulmonary Atelectasis; Pulmonary Diffusing Capacity; Respiratory Care Units; Respiratory Insufficiency; Treatment Failure

Nasal mechanical ventilation is not only applicable to adults but also in childhood when necessary.. Thirty-six children suffering from various neuromuscular diseases were brought up by their parents to learn nasal mechanical ventilation. Thirty children had to be ventilated, because of symptomatic ventilatory failure, reduced ventilatory muscle capacity or hypercapnia.. Thirty-five children could be adapted to nasal mechanical ventilation, 1 girl needed a naso-oral mask. All children wanted to continue with ventilation because they realized the benefit. Their symptoms disappeared.. The management of ventilatory failure should be the same in adults and children. Nasal mechanical ventilation is indeed a good possibility for children even in early childhood. Children should be introduced to mechanical ventilation at the beginning of the symptoms of ventilatory failure.

Topics: Adolescent; Animals; Child; Female; Humans; Male; Nose; Respiration, Artificial; Respiratory Insufficiency

In this report we present two infants with congenital myotonic dystrophy (CMD) who were successfully weaned from prolonged ventilatory support using nasal continuous positive airway pressure (N-CPAP). The first infant received 127 days of endotracheal mechanical ventilation as part of 141 days of total ventilatory support, including N-CPAP; the second infant received 27 days of endotracheal mechanical ventilation as part of 84 days of total ventilatory support. Noninvasive N-CPAP facilitated weaning these two infants from ventilatory support, thereby minimizing the morbidity associated with prolonged intubation. The developmental outcomes of our two infants were comparable to infants not requiring prolonged endotracheal mechanical ventilation. We suggest that this noninvasive modality of ventilatory support may be advantageous in the management and beneficial to the outcome of infants with CMD who are respirator-dependent >30 days.

Topics: Adult; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Male; Myotonic Dystrophy; Nose; Positive-Pressure Respiration; Pregnancy; Respiratory Insufficiency; Ventilator Weaning

Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.

Topics: Acidosis, Respiratory; Adult; Age Factors; Aged; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Obesity; Oxygen; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Polysomnography; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes

Topics: Female; Humans; Middle Aged; Monitoring, Physiologic; Nose; Oximetry; Respiratory Insufficiency

Problems related with nasal intermittent positive pressure ventilation (NIPPV) are nasal and mouth dryness, soreness on the bridge of the nose, eye irritation and epistaxis. Gastrointestinal distention due to air swallowing has been reported in half of the patients. Acceleration of digestive function with drugs or reduction of the volume delivered to alleviate gastric distension are considered as the conventional treatment. It is also possible that the problem disappears spontaneously after a few weeks of NIPPV. We present a patient in whom conventional treatment was unsuccessful. When we changed to a different ventilator, symptoms disappeared, and the new one was very well tolerated. In our experience, changing ventilators should be included in the management of gastrointestinal distension due to NIPPV, especially if conventional procedures, such as drugs or gas flow modifications, fail.

Topics: Adolescent; Aerophagy; Humans; Intermittent Positive-Pressure Ventilation; Male; Muscular Dystrophies; Nose; Respiratory Insufficiency; Vomiting

A 68 yr old woman presented with acute respiratory failure. She was suspected of having a phrenic-diaphragmatic impairment, without evidence of an intrinsic lung disease or generalized neuromuscular disorder, after 3 weeks of prolonged mechanical ventilation. A series of studies, including fluoroscopy, phrenic nerve stimulation test and diaphragmatic electromyography, was performed before the diagnosis of bilateral diaphragmatic paralysis (BDP) was confirmed. The patient was successfully weaned from the conventional mechanical ventilator, and was placed on nasal mask bi-level positive airway pressure (BiPAP) ventilation. A high degree of clinical suspicion of bilateral diaphragmatic paralysis should always be raised in patients suffering respiratory failure without definite predisposing factors. Weaning with noninvasive nasal mask ventilation should be tried first instead of direct tracheostomy.

Topics: Acute Disease; Aged; Female; Humans; Masks; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Respiratory Paralysis

The aim of this study is to show our experience in the surveillance of home mechanical ventilation in pediatric patients.. Between July 1992 and September 1996, 14 patients (20 months to 18 years of age) received home ventilation on 16 occasions. There were 10 boys and 4 girls. Home ventilation lasted from 7 days to 28 months. All patients had chronic respiratory failure secondary to neuromuscular disease, cystic fibrosis or sleep apnea syndrome.. Tolerance was good in 11 patients and bad in 3, 2 of which suffered from cystic fibrosis and died in terminal respiratory failure. The patients who benefited most were those with neuromuscular disease, cyphoscoliosis and sleep apnea syndrome. The technique also has been used for ventilator weaning and as a bridge to lung transplantation.. Home nasal mechanical ventilation is a useful technique for the treatment of chronic respiratory failure in adults and children.

Topics: Adolescent; Adult; Child; Child, Preschool; Chronic Disease; Cystic Fibrosis; Equipment Design; Female; Home Care Services; Humans; Infant; Male; Nose; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Ventilators, Mechanical

We report our experience with nasal mask ventilation in children and adolescents with type II respiratory failure admitted to the paediatric intensive care unit (PICU) over an 18-month period. Seven patients were treated with nasal mask ventilation during part of their PICU stay. All showed significant improvement in arterial pH, PaCO2, and PaO2/FiO2 from presentation to discharge, although at discharge PaCO2 and PaO2/FiO2 fell outside of the normal range. Complications occurred in four patients. When compared to 11 patients with type II respiratory failure not treated with nasal mask ventilation, the nasal mask ventilation group had a similar PICU length of stay and incidence of complications. We conclude that nasal mask ventilation may be useful in maintaining near normal alveolar ventilation in selected children with type II respiratory failure and that a prospective study of this technique is indicated.

Topics: Adolescent; Adult; Carbon Dioxide; Child; Child, Preschool; Critical Care; Humans; Hydrogen-Ion Concentration; Incidence; Intubation, Intratracheal; Length of Stay; Masks; Nose; Oxygen; Patient Discharge; Positive-Pressure Respiration; Prospective Studies; Pulmonary Alveoli; Respiratory Insufficiency; Treatment Outcome

This is a retrospective review of children 15 years of age or younger, who underwent overnight sleep studies between 1980 and 1993. All were diagnosed and treated for obstructive sleep apnea (OSA). Overnight studies were performed for OSA in 413 children. One hundred seventy-five (42.4%) children were treated with adenotonsillectomy and 80 (19.4%) with nasal mask continuous positive airway pressure (nCPAP). The proportion of male children was greater than expected in both the entire study group (69%, p < 0.001) and in those treated with nCPAP for OSA (71% p < 0.001). There was no significant difference between the mean age of the children treated with nCPAP (5.7 +/- 0.5 yr) and the entire group studied (5.04 +/- 0.21 yr). A greater proportion of the children who received nCPAP therapy had a congenital syndrome or malformation than in the group with OSA as a whole; 27.7% of children assessed for OSA were affected, and 53% of those children with OSA who received treatment with nCPAP (p < 0.001). Therapy with nCPAP (mean duration 15 +/- 3 mo, mean pressure 7.9 cm H2O) eliminated the signs of OSA in 72 children (90%). Respiratory disturbance index fell from a mean of 27.3 +/- 20.2 to 2.55 +/- 2.74 (p < 0.001). Eight of 32 children who underwent pressure determination studies could not tolerate nCPAP above an upper limit because of hypoventilation or frequent central apneas. Nevertheless, we conclude that nCPAP is an effective and generally well-tolerated therapy for treatment of OSA in infants and children.

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Infant; Male; Masks; Nose; Polysomnography; Positive-Pressure Respiration; Pulmonary Ventilation; Respiratory Insufficiency; Retrospective Studies; Sleep Apnea Syndromes; Sleep Stages; Tonsillectomy; Treatment Outcome

Nasal continuous positive airways pressure (nCPAP) is recommended in children for the treatment of obstructive sleep apnoea which persists following adenotonsillectomy. Nasal CPAP was successfully used in the palliative care of two severely disabled children with upper airway obstruction as an alternative to tracheostomy. Nasal CPAP resulted in the correction of obstructive apnoea in sleep, with the added benefit of sleep consolidation and fewer nocturnal arousals requiring parental attendance. There was also an unexpected benefit of reduced airway problems in the awake state in these children. Nasal CPAP is an effective form of treating upper airway obstruction for palliative care in association with other major disabilities.

Topics: Airway Obstruction; Child, Preschool; Female; Humans; Infant; Nose; Palliative Care; Positive-Pressure Respiration; Respiratory Insufficiency; Tracheostomy

To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation.. Prospective case series.. Medical intensive care unit in Veterans Administration Medical Center.. Twelve chronic obstructive pulmonary disease patients treated during 14 episodes of hypercapnic respiratory failure.. Nasal mechanical ventilation in addition to conventional therapy to treat hypercapnic respiratory failure. Patients underwent nasal mechanical ventilation for at least 30 mins, or longer if the therapy was tolerated. Responses to therapy and arterial blood gases were monitored.. Half of the episodes were successfully treated with nasal mechanical ventilation. There were no differences in age, prior pulmonary function, baseline arterial blood gases, admission arterial blood gases, or respiratory rate between those patients successfully treated and those patients who failed nasal mechanical ventilation. Unsuccessfully treated patients appeared to have a greater severity of illness than successfully treated patients, as indicated by a higher Acute Physiology and Chronic Health Evaluation II score (mean 21 +/- 4 [SD] vs. 15 +/- 4; p = .02). Unsuccessfully treated patients were edentulous, had pneumonia or excess secretions, and had pursed-lip breathing, factors that prevented adequate mouth seal and contributed to greater mouth leaks than in successfully treated patients (the mean volume of the mouth leak was 314 +/- 107 vs. 100 +/- 70 mL; p < .01). Successfully treated patients were able to adapt more rapidly to the nasal mask and ventilator, with greater and more rapid reduction in PaCO2, correction of pH, and reduction in respiratory rate.. Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation.

Topics: Acute Disease; Aged; Blood Gas Analysis; Female; Forced Expiratory Volume; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Masks; Nose; Positive-Pressure Respiration; Prospective Studies; Respiration; Respiratory Insufficiency; Severity of Illness Index; Survival Rate; Tidal Volume; Treatment Outcome; Vital Capacity

Chronic respiratory failure is a major factor contributing to mortality in progressive neuromuscular disorders. Among the muscular dystrophies, respiratory failure most commonly occurs with Duchenne dystrophy, while in Becker, limb-girdle, and facioscapulo-humeral dystrophies, respiratory failure is infrequent and generally occurs in the more severe cases that have progressed to a nonambulatory, advanced functional stage. We report two brothers with a myopathic disease in which the distribution of weakness, initial clinical course, heredity, and muscle pathology most closely resembled a limb-girdle type of dystrophy. Both brothers, however, presented with chronic alveolar hypoventilation and respiratory failure when their locomotor disabilities were still mild. Respiratory failure was reversed, and satisfactory ventilation has been maintained for more than a year using a type of non-invasive intermittent positive pressure ventilation, with a bilevel positive airway pressure device (Bi-PAP), administered through a nasal mask during sleeping hours. These cases demonstrate an unusual presentation of limb-girdle dystrophy, and document that nocturnal, nasal administration of continuous airway pressure using the Bi-PAP device may be sufficient to maintain adequate long-term ventilation in some patients with neuromuscular causes of respiratory failure, and thus significantly improve quality of life and delay the need for more complex or invasive forms of assisted ventilation.

Topics: Adolescent; Adult; Equipment Design; Humans; Intermittent Positive-Pressure Breathing; Male; Masks; Muscular Dystrophies; Nose; Quality of Life; Respiratory Function Tests; Respiratory Insufficiency; Sleep

In patients who underwent lung transplantation one of the primary determinants of patient survival is infection. Contributing factors in the development of pneumonia include immunosuppression and alterations in the natural lung defense mechanism induced by transplantation. We describe a case of a Pneumocystis carinii pneumonia occurring in the recipient of single lung transplantation for interstitial lung disease four months after surgery. The patient developed severe acute respiratory failure (ARF) requiring mechanical ventilation. Because of the increased infectious risk, tracheal intubation was avoided and pressure support ventilation was performed by the nasal route (NPSV) with PEEP (PS: 16 cm H2O PEEP: 8 cm H2O). NPSV and PEEP were applied 20-22 hours/day in the first 4 days, thereafter 2 to 6 hours 3 times a day, together with medical therapy. This treatment was performed for 15 days. This mode of ventilation was well tolerated and was successful. We conclude that NPSV may be useful in the treatment of ARF in patients with lung transplantation, particularly to avoid invasive mechanical ventilation related infectious complications.

Topics: Humans; Lung Transplantation; Male; Middle Aged; Nose; Pneumonia, Pneumocystis; Respiration, Artificial; Respiratory Insufficiency

Topics: Humans; Hydrogen-Ion Concentration; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Prognosis; Respiratory Insufficiency; Treatment Failure

Topics: Acute Disease; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Respiratory Insufficiency

Topics: Humans; Intermittent Positive-Pressure Ventilation; Neuromuscular Diseases; Nose; Respiratory Insufficiency; Tracheostomy

In order to investigate respiratory failure during sleep in patients with Duchenne muscular dystrophy (DMD), overnight arterial oxygen saturation (SaO2) and end-tidal CO2 (EtCO2) monitoring by capnographoximeter was performed. We supposed that average of EtCO2 over 60 mmHg documented by continuous overnight capnograph study indicated the need for introducing nocturnal respiratory assistance. Accordingly, four patients who showed EtCO2 over 60 mmHg were initiated to treat with nocturnal nasal intermittent positive pressure ventilation (NIPPV). The first ventilator settings were adjusted for patient comfort and to attain near normal arterial blood gas values while the patients were awake on NIPPV. After the patients were able to tolerate NIPPV for the whole night, overnight recording of SaO2 and EtCO2 on nocturnal NIPPV were made to assure the adequacy of ventilation and to provide basis for adjusting ventilator settings. Subsequently, appropriate nocturnal NIPPV could normalize overnight SaO2 and EtCO2, improve daytime arterial PO2 and PCO2, and reverse symptoms of chronic alveolar hypoventilation in these patients. According to further decline in pulmonary function, efficacy of NIPPV must be checked periodically by overnight monitoring, and ventilator resettings should be done if necessary. We believe that early awareness and appropriate management of respiratory failure during sleep by NIPPV are important to postpone tracheostomy for patients with DMD.

Topics: Adolescent; Adult; Humans; Intermittent Positive-Pressure Ventilation; Muscular Dystrophies; Nose; Respiratory Insufficiency; Sleep Apnea Syndromes

This paper describes the use of a nasal mask to deliver intermittent positive pressure ventilation to treat chronic respiratory failure in one patient with severe kyphoscoliosis. After two months of overnight nasal ventilation at home the patient achieved normal blood gases, showed improved inspiratory muscle strength, effort tolerance and was able to return to work. Intermittent nasal ventilation is a safe and effective ventilatory support modality for some patients with hypercapnic respiratory failure.

Topics: Adult; Chronic Disease; Follow-Up Studies; Humans; Hypercapnia; Inspiratory Capacity; Lung; Male; Masks; Nose; Positive-Pressure Respiration; Pressure; Respiratory Insufficiency; Respiratory Mechanics; Tidal Volume

Topics: Aged; Carcinoma, Basal Cell; Female; Home Nursing; Humans; Male; Middle Aged; Nose; Respiratory Insufficiency; Respiratory Protective Devices; Skin Neoplasms; Sleep Apnea Syndromes

We report the results of a retrospective study of a group of 27 patients with a myopathy who were ventilated at home using a nasal mask over a period of 5 years. Twelve patients were ventilated in a preventive fashion before any orthopaedic surgical intervention and 15 out of necessity because of respiratory failure and/or hypercapnia. There was a statistically significant improvement in the PaO2 while the PaCO2 remained stable. The vital capacity (CV) was unaltered. Side effects were relatively frequent but did not lead to this method of ventilation being stopped. One patient died from a very advanced cardio-myopathy after having stopped his own assisted ventilation. Another patient died at home of bronchial congestion. One patient had a tracheotomy after 3 years of ventilation. The treatment was judged overall as positive amongst the 19 patients who responded to a questionnaire anonymously. We are able to confirm the efficacy of this mode of ventilation by the nasal route as much therapeutically as prophylactically, which is against the recently reported results in a multi-centre study.

Topics: Adolescent; Adult; Carbon Dioxide; Child; Female; Humans; Male; Masks; Middle Aged; Muscular Dystrophies; Nose; Oxygen; Patient Satisfaction; Positive-Pressure Respiration; Preoperative Care; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Vital Capacity

A 57 year old man with chronic bronchitis sought a consultation for dyspnoea at rest associated with an absolute inability to lie flat. Examination revealed paradoxical respiration and respiratory function testing revealed a mixed ventilation disturbance, which was predominantly obstructive and was aggravated in the dorsal decubitus position. Radiology revealed bilateral diaphragmatic paralysis, which was confirmed on measurement of transdiaphragmatic pressure. The patient benefited from assisted ventilation by the nasal route with an excellent result in both the short and the medium term. Investigation into the cause was negative, in particular there was no evidence of any neuromuscular abnormality. This case recalls the role of the diaphragm in acute respiratory failure and shows the value of mechanical ventilation by the nasal route in the treatment of certain types of diaphragmatic paralysis.

Topics: Bronchitis; Chronic Disease; Humans; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Nose; Respiration, Artificial; Respiratory Insufficiency; Respiratory Mechanics; Respiratory Paralysis

We reviewed the Mayo Clinic experience with nocturnal nasal ventilation (NNV) and retrospectively assessed the clinical benefits, patient compliance, and complications. NNV had been instituted in 26 patients with daytime hypercapnia and nocturnal hypoventilation due to neuromuscular diseases or chronic obstructive pulmonary disease. After initiation of NNV, 21 of 26 patients continued to use this treatment regularly (81% compliance rate) and considered their life-style improved. In this subset of patients, the arterial partial pressure of carbon dioxide during unassisted breathing decreased from 64 +/- 13 to 51 +/- 7 mm Hg, and the arterial partial pressure of oxygen increased from 58 +/- 12 to 68 +/- 8 mm Hg. No significant change was noted in the forced vital capacity or maximal respiratory pressures. Four of the five patients in whom NNV had been discontinued cited discomfort related to the mask or severity and poor prognosis of the underlying illness as reasons for cessation of treatment. We conclude that NNV is well tolerated by most patients and may improve alveolar ventilation and arterial oxygenation in patients with chronic respiratory failure.

Topics: Adolescent; Adult; Aged; Carbon Dioxide; Chronic Disease; Female; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Patient Compliance; Positive-Pressure Respiration; Pulmonary Gas Exchange; Respiratory Insufficiency; Respiratory Muscles; Retrospective Studies

Topics: Equipment Design; Humans; Hypercapnia; Nose; Respiration, Artificial; Respiratory Insufficiency; Ventilators, Mechanical

A 49 yr old poliomyelitic patient had been under cuirass-type nocturnal negative pressure ventilation for more than 20 yrs. He had a severe restrictive ventilatory impairment, and normal awake blood gases at rest and during light exercise. He was offered a trial of intermittent positive pressure ventilation applied through the nose (nIPPV). Two daytime studies and one night study were carried out under nIPPV, and one night study was performed under negative pressure ventilation. Tidal volume, respiratory frequency (Respitrace), blood gases and electromyogram (EMG) of the diaphragm (DEMG, oesophageal electrode) and/or sternocleidomastoid (ScEMG, surface electrodes) were measured. During daytime studies under nIPPV, the DEMG (and/or the ScEMG) did not decrease by more than 25% (p less than 0.005). However, when the patient was encouraged to relax, the DEMG decreased by 62% (p less than 0.001). Tidal volume and ventilation significantly increased during daytime nIPPV (p less than 0.025), whereas blood gases were kept at physiological levels. At night, the ScEMG was present and prominent until sleep onset. Thereafter it disappeared and remained silent, including periods of wakefulness during sleep time, until final awakening in the morning. This was true for both negative pressure ventilation and nIPPV. Snoring was present throughout sleep under negative pressure ventilation but not under nIPPV. We conclude that the behavioural response of the subject may determine the electrical activity of respiratory muscles during assisted ventilation.

Topics: Adaptation, Physiological; Adult; Electromyography; Humans; Intermittent Positive-Pressure Breathing; Intermittent Positive-Pressure Ventilation; Male; Nose; Poliomyelitis; Positive-Pressure Respiration; Respiratory Insufficiency; Respiratory Muscles; Sleep; Wakefulness

These are preliminary observations of the introduction of a new technique of noninvasive positive pressure respiratory support for patients with subacute or chronic respiratory failure. Clinical situations where intubation or tracheostomy may have been performed were managed by intermittent positive pressure ventilation via nasal access (NIPPV) with a CPAP mask, or a custom constructed Vel-Foam nose piece. Four patients were managed at home with the use of portable volume ventilators. One patient employed the technique while hospitalized with subacute respiratory failure. Two patients, otherwise dependent on mouth intermittent positive pressure ventilation (MIPPV) 24 hours a day, received necessary dental care with NIPPV support. In a large population with a decade or more follow-up, MIPPV was shown to be an effective noninvasive technique to support respiration in patients with the most severe paralytic respiratory failure. Preliminary observations suggest that NIPPV may compare favorably with MIPPV and deserves more widespread study and application.

Topics: Adult; Female; Humans; Intermittent Positive-Pressure Breathing; Male; Multiple Sclerosis; Muscular Dystrophies; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Respiratory Paralysis; Scoliosis; Time Factors

Severe nocturnal hypoxemia may occur in patients with respiratory muscle weakness caused by neuromuscular disorders. Negative pressure ventilators may be partially effective in these patients but can cause upper airway obstructive apneas. We examined the effectiveness of positive pressure ventilation through a nose mask in preventing nocturnal hypoxemia and compared it with negative pressure systems. We reasoned that nasal positive pressure would provide stability for the upper airway. Five patients with neuromuscular disorders underwent a series of all-night sleep studies under control conditions, negative pressure ventilation, and positive pressure ventilation through a comfortable nose mask. Sleep staging and respiratory variables were monitored during all studies. Daytime awake lung function, respiratory muscle strength, and arterial blood gases were also measured. The severe hypoxemia and hypercapnia that occurred under control conditions were prevented by positive pressure ventilation through a nose mask. Negative pressure ventilation improved NREM ventilation in all patients, but did not prevent severe oxyhemoglobin desaturation, which occurred during REM sleep. Negative pressure ventilation appears to contribute to upper airways obstruction during REM sleep as evidenced by cessation of air flow, reduced chest wall movements, falls in arterial oxyhemoglobin saturation, and hypercapnia. With treatment, daytime PaO2 improved from a mean of 70 to 83 mm Hg, and PaCO2 decreased from a mean of 61 to 46 mm Hg. We conclude that nasally applied positive pressure ventilation is a highly effective method of providing nocturnal assisted ventilation because it stabilizes the oropharyngeal airway.

Topics: Evaluation Studies as Topic; Humans; Hypercapnia; Hypoxia; Masks; Neuromuscular Diseases; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes; Sleep, REM

Topics: Acute Disease; Female; Humans; Infant; Intubation, Intratracheal; Nasal Mucosa; Nose; Respiration; Respiratory Insufficiency; Sodium Chloride

Lack of the upper airway function after laryngectomy creates unfavorable effects on the lower respiratory tract. The purpose of this study is to re-evaluate this relationship objectively. Respiratory function tests were performed on 13 laryngectomized patients. Pulmonary volumetry and ventilometry revealed increased RV and FRC, and decreased FEV1.0%, indicating evidence of obstructive changes in the lung, MEFV-recordings showed greater downward convexity than those of the normal at the lower volume level. The value of MEF50/body-height was definitely smaller than normal average in the same age group. Pulmonary resistance was in wide variety but definitely lower than normal because of lack of the upper airway resistance. If this component is added to the value, the total will be in normal range or even higher. Dynamic compliance remained mostly in the normal range when measured using a mask at the tracheostoma. The value was lower than normal when measured through a cuff-canula. The difference in static and dynamic compliances was greater than that in normal cases, which may indicate evidence of uneven distribution of air in the lung. Regular check-up and suitable respiratory care are recommended on the laryngectomized.

Topics: Airway Obstruction; Humans; Laryngectomy; Lung; Mouth Breathing; Nose; Respiration; Respiratory Function Tests; Respiratory Insufficiency; Trachea

Topics: Airway Obstruction; Animals; Bronchi; Cardiovascular Diseases; Cilia; Dogs; Humans; Immunoglobulins; Lung; Nasal Mucosa; Nose; Paranasal Sinuses; Pharyngeal Diseases; Reflex; Respiration; Respiratory Insufficiency; Respiratory Physiological Phenomena

The philtrum point VG 26 (Jen Chung) was needled in 69 cases of respiratory depression or apnoea in dogs and cats during induction or maintenance of general anaesthesia. Respiration was restored to normal or near normal rates within 10 to 30 seconds of insertion of the needle in all the cases. In seven cases of anaesthetic apnoea with concurrent cardiac arrest and absence of vital signs, the revival rate was 43 per cent. Those which recovered required four to 10 minutes of acupuncture stimulation. In eight cases of collapse due to other causes, the revival rate was 25 per cent. The cases included five sheep in shock following liver biopsy, two cases of haemorrhagic shock (dog, cat) and one terminal collapse in chronic congestive heart failure (dog).

Topics: Acupuncture Therapy; Anesthesia, General; Animals; Apnea; Cat Diseases; Cats; Dog Diseases; Dogs; Heart Arrest; Nose; Respiratory Insufficiency; Sheep; Sheep Diseases

A nasal CPAP system consisting of a jet device (weight 5 g) connected with a binasal nose-piece is described. A positive airway pressure is obtained with the system applied to newborn infants provided a certain magnitude of air is brought to the jet device, and a resistance, presented by the airways, exists against the flow of air. As the system requires neither a manometer nor an excess pressure safety valve, pressures in the nasopharynx were recorded at various jet flows to illustrate the flow/pressure relationship. The CPAP can easily be etablished at definite pressures by simple adjustment of the jet flow, using this flow/pressure curve. The system appeared efficient for the treatment of apnoea, apparently due to a special attribute of the jet device. Oesophageal pressures were measured at various gas flows and at various stages of RDS, and in children with healthy lungs. The pressure appeared high with increased density of the lungs, but constant in healthy lungs despite various gas flows. Extreme pressure excursion were recorded during crying and increased muscular tone. This may explain the high frequency of pneumothorax in RDS.

Topics: Child; Humans; Infant, Newborn; Nose; Positive-Pressure Respiration; Pressure; Respiration; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency

A girl with the characteristic abnormalities of Larsen's syndrome is presented. A soft flabby consistence of the cartilaginous skeleton of the larynx and trachea was thought to be the cause of attacks of respiratory failure which suddenly caused her death at the age of 9 months. Microscopy revealed a considerably reduced number of elastic fibres in the larynx, trachea and bronchi. Closed reduction of the knee dislocation by skin traction seemed to be successful.

Topics: Abnormalities, Multiple; Epiglottis; Face; Female; Humans; Infant; Joint Dislocations; Knee; Nose; Respiratory Insufficiency; Sudden Infant Death; Tibia; Toes

The excessive accumulation of gas in the gastrointestinal tracts was invariably induced on experimental animals (mice, rats, guinea pigs, hamsters and rabbits) by simply obstructing nasal passages. The analysis of the gas showed the almost identical composition to the ambient air or flutus which was largely due to swallowed air. Also the numerous small foams were found on and underneath the epithelial lining of small intestine. The pathological evaluation was done both macroscopically and microscopically. Dying animals after nasal obstruction showed hemorrhagic and necrotic changes in the jejunum and ileum. This observation may cast some light to the pathogenesis of necrotizing enterocolitis in human neonatal.

Topics: Aerophagy; Air; Animals; Cricetinae; Digestive System; Disease Models, Animal; Enterocolitis, Pseudomembranous; Female; Guinea Pigs; Humans; Male; Mice; Mouth Breathing; Nose; Rabbits; Rats; Respiratory Insufficiency

Topics: Humans; Manometry; Mouth Breathing; Nose; Orthodontics; Respiratory Insufficiency; Rheology

Topics: Adolescent; Adult; Aged; Anesthesia, Local; Anesthetics, Local; Child; Female; Humans; Male; Middle Aged; Muscle Cramp; Nose; Paranasal Sinuses; Pulmonary Edema; Respiratory Insufficiency; Tachycardia

Topics: Deglutition Disorders; Enteral Nutrition; Humans; Male; Methods; Middle Aged; Nose; Postoperative Complications; Respiratory Insufficiency; Unconsciousness

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Nose; Pediatric Nursing; Respiratory Insufficiency

Topics: Age Factors; Anti-Bacterial Agents; Blood Pressure; Brain Diseases; Brain Edema; Central Venous Pressure; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Craniofacial Dysostosis; Emphysema; Face; Humans; Infant; Infant, Newborn; Intracranial Pressure; Nose; Orbit; Osteotomy; Postoperative Complications; Respiratory Insufficiency; Skin Transplantation; Skull; Surgery, Plastic; Transplantation, Autologous; Urinary Catheterization

Topics: Animals; Catheterization; Chronic Disease; England; France; Hemodynamics; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lung Diseases, Obstructive; Masks; Nose; Oxygen; Oxygen Inhalation Therapy; Physical Exertion; Respiratory Insufficiency; United States

Topics: Asthma; Cartilage; Child; Child, Preschool; Chronic Disease; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Otitis Media; Postoperative Complications; Pulmonary Ventilation; Respiratory Insufficiency; Rhinitis, Allergic, Seasonal; Rhinoplasty; Speech Disorders; Time Factors; Tonsillitis

Topics: Acute Disease; Adult; Child, Preschool; Epiglottis; Female; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Nose; Polyvinyls; Postoperative Complications; Respiratory Insufficiency; Time Factors; Tracheotomy

Topics: Electrocardiography; Humans; Intubation, Intratracheal; Monitoring, Physiologic; Nose; Oxygen Inhalation Therapy; Respiratory Insufficiency; Time Factors

Topics: Atrophy; Dilatation; Female; Humans; Male; Methods; Nose; Nose Deformities, Acquired; Respiratory Insufficiency; Rhinoplasty

Topics: Biomedical Engineering; Epinephrine; Humans; Manometry; Nasal Decongestants; Nose; Nose Diseases; Pressure; Respiration; Respiratory Insufficiency

Topics: Adolescent; Adult; Aged; Cardiac Surgical Procedures; Catheterization; Child; Child, Preschool; Female; Humans; Infant; Intubation; Intubation, Intratracheal; Male; Middle Aged; Nose; Postoperative Care; Postoperative Complications; Respiratory Insufficiency

Topics: Atmospheric Pressure; Elasticity; Epinephrine; Facial Muscles; Humans; Models, Theoretical; Nasopharynx; Nose; Nose Diseases; Respiration; Respiratory Insufficiency; Rhinoplasty

Topics: Cyanosis; Fetus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Nose; Posture; Respiratory Insufficiency; Sucking Behavior

Topics: Accidents, Traffic; Facial Bones; Fracture Fixation; Fractures, Bone; Humans; Immobilization; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Pneumonia, Aspiration; Radiography; Respiratory Insufficiency; Transportation of Patients

Topics: Bites and Stings; Bronchi; Burns; Foreign Bodies; Humans; Inflammation; Laryngeal Diseases; Laryngeal Neoplasms; Larynx; Nose; Otorhinolaryngologic Diseases; Pharyngeal Neoplasms; Respiratory Insufficiency

Topics: Child; Child, Preschool; Epiglottis; Humans; Infant; Intubation, Intratracheal; Laryngitis; Male; Nose; Polyvinyls; Respiratory Insufficiency

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Respiratory Insufficiency

Topics: Adolescent; Child; Female; Humans; Jaw Abnormalities; Male; Malocclusion; Maxilla; Nose; Orthodontic Appliances; Respiratory Function Tests; Respiratory Insufficiency

Topics: Humans; Nose; Respiratory Function Tests; Respiratory Insufficiency

Topics: Apnea; Asphyxia; Death, Sudden; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Nose; Respiration; Respiratory Insufficiency; Seasons

Topics: Abnormalities, Multiple; Catheterization; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Male; Nose; Radiography, Thoracic; Respiratory Insufficiency; Surgical Procedures, Operative

Topics: Child; Female; Humans; Manometry; Methods; Nose; Respiration; Respiratory Insufficiency; Surgery, Plastic

Topics: Age Factors; Aged; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Respiratory Insufficiency

Topics: Humans; Nose; Nose Deformities, Acquired; Respiration; Respiratory Insufficiency; Rhinoplasty

Topics: Cephalometry; Humans; Nose; Nose Diseases; Respiratory Insufficiency; Rhinitis, Atrophic; Rhinoplasty

Topics: Adenoids; Child; Diagnosis, Differential; Endoscopy; Humans; Hyperplasia; Hypertrophy; Infant; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms; Respiratory Insufficiency; Rhinitis; Rhinitis, Atrophic

Topics: Cartilage; Cervical Vertebrae; Cornea; Dermatology; Ear, External; Embolism; Embolism, Air; Head; Hemorrhage; Humans; Lymphedema; Neck; Neck Dissection; Nose; Otitis Media; Paralysis; Parotid Gland; Postoperative Complications; Respiratory Insufficiency; Salivary Gland Fistula; Spinal Injuries; Surgical Procedures, Operative; Thoracic Duct; Tooth

Topics: Child; Congenital Abnormalities; Family Practice; Flatulence; General Practice; Humans; Infant; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Nose; Otitis Media; Pediatrics; Respiratory Insufficiency; Skull; Spasm; Stomatitis; Tongue; Tooth, Deciduous

Topics: Airway Obstruction; Humans; Nasal Septum; Nose; Nose Deformities, Acquired; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Tract Diseases

Topics: Congenital Abnormalities; Humans; Malocclusion; Maxilla; Nose; Nose Deformities, Acquired; Orthodontics; Palate; Respiratory Insufficiency; Surgery, Oral