Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to inve...Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.展开更多
AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric i...AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.展开更多
Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that b...Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.展开更多
目的:探讨无创正压通气(Non-invasive positive pressure ventilation,NIPPV)与经鼻高流量湿化氧疗(High-flow nasal cannula,HFNC)交替疗法在急重症呼吸衰竭患者急救中的应用。方法:选取2023年9月~2024年8月鄱阳县人民医院重症监护室...目的:探讨无创正压通气(Non-invasive positive pressure ventilation,NIPPV)与经鼻高流量湿化氧疗(High-flow nasal cannula,HFNC)交替疗法在急重症呼吸衰竭患者急救中的应用。方法:选取2023年9月~2024年8月鄱阳县人民医院重症监护室收治的60例急重症呼吸衰竭患者作为研究对象,采用简单数字表法分为HFNC组和NIPPV组,各30例,HFNC组采用HFNC呼吸支持治疗,NIPPV组予以NIPPV与HFNC交替疗法,对比治疗前、治疗3 d后两组血气指标、肺功能、呼吸动力学指标、血清指标,并统计不良事件发生情况、机械通气时间、ICU入住时间。结果:治疗3 d后,NIPPV组血二氧化碳分压(Partial pressure of carbon dioxide,PaCO_(2))、气道峰压(Peak inspiratory pressure,PIP)、气道阻力(Airway resistance,Raw)、呼吸做功(Work of breathing,WOB)、单核细胞分布宽度(Monocyte distribution width,MDW)、中性粒细胞与淋巴细胞比例(Neutrophil to lymphocyte ratio,NLR)、降钙素原(Procalcitonin,PCT)、脑钠肽(Brain natriuretic peptide,BNP)、不良反应发生率均明显低于HFNC组(P<0.05),机械通气时间、住院时间短于HFNC组(P<0.05);NIPPV组血氧饱和度(Oxygen saturation,SaO_(2))、血氧分压(Partial pressure of oxygen,PaO_(2))、氧合指数(Oxygenation index,OI)、用力肺活量(Forced vital capacity,FVC)、最大呼气流速(Peak expiratory flow rate,PEF)、第1秒最大呼气量(Forced expiratory volume in one second,FEV1)、FEV1占预计值的百分比(Forced expiratory volume in the first second predicted,FEV1%pred)均明显高于HFNC组(P<0.05)。结论:相较于HFNC治疗,NIPPV与HFNC交替疗法应用于急重症呼吸衰竭患者急救中可显著改善血气指标与呼吸动力学指标,有助于肺功能恢复,同时减轻机体炎症与心肌损伤,降低不良事件发生,促进预后恢复。展开更多
文摘Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
基金supported by NIH National Center for Advancing Translational Science,No.UL1TR001881
文摘AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.
文摘Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.
文摘目的:探讨无创正压通气(Non-invasive positive pressure ventilation,NIPPV)与经鼻高流量湿化氧疗(High-flow nasal cannula,HFNC)交替疗法在急重症呼吸衰竭患者急救中的应用。方法:选取2023年9月~2024年8月鄱阳县人民医院重症监护室收治的60例急重症呼吸衰竭患者作为研究对象,采用简单数字表法分为HFNC组和NIPPV组,各30例,HFNC组采用HFNC呼吸支持治疗,NIPPV组予以NIPPV与HFNC交替疗法,对比治疗前、治疗3 d后两组血气指标、肺功能、呼吸动力学指标、血清指标,并统计不良事件发生情况、机械通气时间、ICU入住时间。结果:治疗3 d后,NIPPV组血二氧化碳分压(Partial pressure of carbon dioxide,PaCO_(2))、气道峰压(Peak inspiratory pressure,PIP)、气道阻力(Airway resistance,Raw)、呼吸做功(Work of breathing,WOB)、单核细胞分布宽度(Monocyte distribution width,MDW)、中性粒细胞与淋巴细胞比例(Neutrophil to lymphocyte ratio,NLR)、降钙素原(Procalcitonin,PCT)、脑钠肽(Brain natriuretic peptide,BNP)、不良反应发生率均明显低于HFNC组(P<0.05),机械通气时间、住院时间短于HFNC组(P<0.05);NIPPV组血氧饱和度(Oxygen saturation,SaO_(2))、血氧分压(Partial pressure of oxygen,PaO_(2))、氧合指数(Oxygenation index,OI)、用力肺活量(Forced vital capacity,FVC)、最大呼气流速(Peak expiratory flow rate,PEF)、第1秒最大呼气量(Forced expiratory volume in one second,FEV1)、FEV1占预计值的百分比(Forced expiratory volume in the first second predicted,FEV1%pred)均明显高于HFNC组(P<0.05)。结论:相较于HFNC治疗,NIPPV与HFNC交替疗法应用于急重症呼吸衰竭患者急救中可显著改善血气指标与呼吸动力学指标,有助于肺功能恢复,同时减轻机体炎症与心肌损伤,降低不良事件发生,促进预后恢复。
