Noninvasive positive pressure ventilation (NPPV) has become an integral part of ventilator support in patients with either acute or chronic respiratory failure. NPPV has been shown to avoid the need for invasive mechanical ventilation, it’s associated complications and facilitate successful extubation in patients with chronic obstructive pulmonary disease (COPD) who have marginal weaning parameters. In addition, some studies 1–3 have shown that NPPV improves survival compared with invasive mechanical ventilation in patients with acute respiratory failure. Moreover, NPPV has been shown to be an effective modality for the treatment of chronic respiratory failure in patients with restrictive ventilatory disorders 4–6 and in selected patients with COPD 7, 8. Compared with invasive ventilation, NPPV decreased the risk of ventilatorassociated pneumonia and optimized comfort. Because of its design, success depends largely on patient cooperation and acceptance. Some factors that may limit the use of NPPV are mask (or interface) related problems such as air leaks, mask intolerance due to claustrophobia and anxiety, and poorly fitting mask. Approximately 10–15% of patients fail to tolerate NPPV due to problems associated with the mask interface despite adjustments in strap tension, repositioning, and trial of different types of masks. Other maskrelated problems include facial skin breakdown, aerophagia, inability to handle copious secretions, and mask placement instability. The most commonly used interfaces in both acute and longterm settings are nasal and nasaloral (NO) masks. The following reviews the applications of fullface mask in patients who are unable to tolerate a conventional mask during NPPV.
Noninvasive Mechanical Ventilation Antonio M Esquinas (Editor) Noninvasive Mechanical Ventilation Theory, Equipment, and Clinical Applications Antonio M Esquinas Avenida del Parque, 2, 3B 30500 Murcia Molina Segura Spain e-mail: esquinas@ono.com ISBN: 978-3-642-11364-2 e-ISBN: 978-3-642-11365-9 DOI: 10.1007/978-3-642-11365-9 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010925792 © Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer Violations are liable to prosecution under the German Copyright Law The use of general descriptive names, registered names, trademarks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book In every individual case the user must check such information by consulting the relevant literature Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Contents Section I Interface Technology in Critical Care Settings 1 Full Mask Ventilation Francis Cordova and Manuel Jimenez 2 Helmet Continuous Positive Airway Pressure: Theory and Technology Giacomo Bellani, Stefano Isgrò, and Roberto Fumagalli 3 Helmet Continuous Positive Airway Pressure: Clinical Applications 13 Alberto Zanella, Alessandro Terrani, and Nicolò Patroniti Section II Ventilatory Modes and Ventilators: Theory, Technology, and Equipment 4 Pressure Support Ventilation 21 Enrica Bertella and Michele Vitacca 5 Ventilators for Noninvasive Mechanical Ventilation 27 Raffaele Scala 6 Noninvasive Positive Pressure Ventilation Using Continuous Positive Airway Pressure 39 Pedro Caruso 7 Home Mechanical Ventilators 45 Frédéric Lofaso, Brigitte Fauroux, and Hélène Prigent 8 Maintenance Protocol for Home Ventilation Circuits 51 Michel Toussaint and Gregory Reychler 9 Nocturnal Noninvasive Mechanical Ventilation 59 David Orlikowski, Hassan Skafi, and Djillali Annane v vi Contents Section III Patient–Ventilator Interactions 10 Patient–Ventilator Interaction During Noninvasive Pressure-Supported Spontaneous Respiration in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease 67 Wulf Pankow, Achim Lies, and Heinrich Becker 11 Asynchrony and Cyclic Variability in Pressure Support Ventilation 73 Antoine Cuvelier and Jean-François Muir 12 Carbon Dioxide Rebreathing During Noninvasive Mechanical Ventilation 77 Francesco Mojoli and Antonio Braschi 13 Carbon Dioxide Rebreathing During Pressure Support Ventilation with Airway Management System (BiPAP) Devices 83 Frédéric Lofaso and Hélène Prigent 14 Carbon Dioxide Rebreathing in Noninvasive Ventilation 87 Daniel Samolski and Antonio Antón 15 New Adaptive Servo-Ventilation Device for Cheyne–Stokes Respiration 93 Ken-ichi Maeno and Takatoshi Kasai Section IV Monitoring and Complications 16 Nocturnal Monitoring in the Evaluation of Continuous Positive Airway Pressure 101 Oreste Marrone, Adriana Salvaggio, Anna Lo Bue, and Giuseppe Insalaco 17 Complications During Noninvasive Pressure Support Ventilation 107 Michele Carron, Ulderico Freo, and Carlo Ori Section V Chronic Applications of Noninvasive Mechanical Ventilation and Related Issues 18 Efficacy of Continuous Positive Airway Pressure in Cardiovascular Complications of Obstructive Sleep Apnea 121 Ahmed S BaHammam and Mohammed K.A Chaudhry 19 Obstructive Sleep Apnea and Atherosclerosis 131 R Schulz, F Reichenberger, and K Mayer 20 Transnasal Insufflation — A New Approach in the Treatment of OSAs 135 Georg Nilius, Brian McGinley, and Hartmut Schneider Contents vii 21 Cardiopulmonary Interventions to Prolong Survival in Patients with Duchenne Muscular Dystrophy 143 Yuka Ishikawa 22 Noninvasive Ventilation Pressure Adjustments in Patients with Amyotrophic Lateral Sclerosis 149 Kirsten L Gruis 23 Noninvasive Positive Pressure Ventilation in Amyotrophic Lateral Sclerosis 153 Daniele Lo Coco, Santino Marchese, and Albino Lo Coco 24 Noninvasive Mechanical Ventilation as an Alternative to Endotracheal Intubation During Tracheotomy in Advanced Neuromuscular Disease 161 David Orlikowski, Hélène Prigent, and Jésus Gonzalez-Bermejo 25 Noninvasive Mechanical Ventilation in Patients with Myasthenic Crisis 167 Cristiane Brenner Eilert Trevisan, Silvia Regina Rios Vieira, and Renata Plestch 26 Predictors of Survival in COPD Patients with Chronic Hypercapnic Respiratory Failure Receiving Noninvasive Home Ventilation 171 Stephan Budweiser, Rudolf A Jörres, and Michael Pfeifer 27 Withdrawal of Noninvasive Mechanical Ventilation in COPD Patients with Hypercapnic Respiratory Failure 179 Jacobo Sellares, Miquel Ferrer, and Antoni Torres 28 Noninvasive Ventilation in Patients with Acute Exacerbations of Asthma 185 Sean P Keenan 29 Noninvasive Positive Pressure Ventilation During Acute Asthmatic Attack 191 Arie Soroksky, Isaac Shpirer, and Yuval Leonov 30 Noninvasive Positive Pressure Ventilation for Long-Term Ventilatory Management 199 Akiko Toki and Mikio Sumida 31 Home Ventilation for Chronic Obstructive Pulmonary Disease 205 Georg-Christian Funk viii Contents Section VI Critical Care Applications of Noninvasive Mechanical Ventilation and Related Issues 32 Current Strategies and Equipment for Noninvasive Ventilation in Emergency Medicine 217 Keisuke Tomii 33 Noninvasive Ventilation Outside of Intensive Care Units 223 Davide Chiumello, Gaetano Iapichino, and Virna Berto 34 Noninvasive Positive Airway Pressure and Risk of Myocardial Infarction in Acute Cardiogenic Pulmonary Edema 231 Giovanni Ferrari, Alberto Milan, and Franco Aprà 35 The Role of Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema with Preserved Left Ventricular Systolic Function: A Preliminary Study 237 Andrea Bellone 36 Noninvasive Ventilation in Acute Lung Injury/ Acute Respiratory Distress Syndrome 241 Ritesh Agarwal 37 Noninvasive Positive Pressure Ventilation in Acute Hypoxemic Respiratory Failure and in Cancer Patients 249 S Egbert Pravinkumar 38 Noninvasive Ventilation as a Preoxygenation Method 257 Christophe Baillard 39 Influence of Staff Training on the Outcome of Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure 263 José Luis López-Campos and Emilia Barrot Section VII The Role of Sedation 40 Sedation for Noninvasive Ventilation in Intensive Care 269 Jean-Michel Constantin, Renau Guerin, and Emmanuel Futier 41 Use of Dexmedetomidine in Patients with Noninvasive Ventilation 273 Shinhiro Takeda, Shinji Akada, and Keiko Nakazato Section VIII Weaning from Conventional Mechanical Ventilation and Postextubation Failure 42 Extubation and Decannulation of Unweanable Patients with Neuromuscular Weakness 279 John Robert Bach Contents ix 43 Mechanically Assisted Coughing and Noninvasive Ventilation for Extubation of Unweanable Patients with Neuromuscular Disease or Weakness 287 John Robert Bach 44 Noninvasive Positive Pressure Ventilation in the Postextubation Period 295 Hasan M Al-Dorzi and Yaseen M Arabi 45 Noninvasive Ventilation in Postextubation Respiratory Failure 305 Ritesh Agarwal Section IX Intraoperative and Postoperative Indications for Noninvasive Mechanical Ventilation 46 Intraoperative Use of Noninvasive Ventilation 317 Fabio Guarracino and Rubia Baldassarri 47 Noninvasive Ventilation in Adult Liver Transplantation 321 Paolo Feltracco, Stefania Barbieri, and Carlo Ori 48 Noninvasive Positive Pressure Ventilation in Patients Undergoing Lung Resection Surgery 327 Christophe Perrin, Valérie Jullien, Yannick Duval, and Fabien Rolland Section X Noninvasive Mechanical Ventilation in Neonates and Children 49 Equipment and Technology for Continuous Positive Airway Pressure During Neonatal Resuscitation 335 Georg M Schmölzer and Colin J Morley 50 Air Leakage During Continuous Positive Airway Pressure in Neonates 343 Gerd Schmalisch 51 The Use of Noninvasive Ventilation in the Newborn 357 Debbie Fraser Askin 52 Nasal High-Frequency Ventilation: Clinical Studies and Their Implications 363 Katarzyna Dabrowska and Waldemar A Carlo 53 Bubble Continuous Positive Airway Pressure 369 J Jane Pillow x Contents 54 Noninvasive Mechanical Ventilation with Positive Airway Pressure in Pediatric Intensive Care 377 Giancarlo Ottonello, Andrea Wolfler, and Pietro Tuo 55 Home Mechanical Ventilation in Children with Chronic Respiratory Failure 387 Sedat Oktem, Refika Ersu, and Elif Dagli Index 397 388 S Oktem et al 55.2.2 Positive Ventilation via Mask NIV is based on the cyclical application of a positive pressure (or volume) to the airways Volume-targeted ventilators deliver a set flow to the users’ airways for a timed interval and at a specified frequency or in response to an inspiratory effort This terminates when a preset volume has been delivered Using a pressure-targeted respiratory assist device, the ventilation achieved from a preset airway pressure varies with user effort and the mechanical characteristics of the respiratory system, such as compliance, resistance, autopositive end-expiratory pressure, the ventilatory frequency, and potential leakage When applying respiratory assist, the trigger function, usually sensed as either pressure or flow changes in the system, is of fundamental importance In the case of a small or weak child, inspiratory flows generated by the child may be insufficient to activate the trigger This is further complicated by the volume added by the humidifier, which in children is often interposed For this reason, some authors have chosen protocols by which the setting of the rate of the ventilator is slightly higher than the child’s spontaneous rate, thus effectively instituting a controlled mode of ventilation 55.3 Clinical Scenarios for Home Noninvasive Ventilation with Positive Pressure Long-term NIV at home has been used in a wide range of paediatric conditions (Table 55.1) 55.3.1 Obstructive Sleep Apnea Syndrome Obstructive sleep apnea syndrome (OSAS) is not a single entity but is a spectrum of disorders ranging from primary snoring without impairment of gas exchange to chronic respiratory failure with nocturnal hypoxaemia and hypoventilation Enlargement of the adenoids and tonsils is at least one important mechanism of OSAS in children, but it is not unusual for children with OSAS to have nocturnal derangements in respiratory gas exchange following adenotonsillectomy It has been shown that treatment of these children with supplemental oxygen alone is safe but does not prevent hypoventilation associated with upper airway narrowing Nasal continuous positive airway pressure (nCPAP) has been found to be highly effective in school-age children and even some toddlers with OSAS complicated by hypoxaemia but with normal CO2 elimination Noninvasive positive pressure ventilation (NPPV) is indicated for the older child with OSAS complicated by both hypoventilation and hypoxaemia The sleep laboratory is an ideal site to initiate NPPV or CPAP as a means both to initiate the appropriate pressure settings and to assess the benefit or lack thereof of adenotonsillectomy in the child with complicated OSAS [3] The American Academy of Pediatrics published guidelines on the diagnosis and management of childhood OSAS, recommending the following: All children should be screened for snoring, complex cases 55 Home Mechanical Ventilation in Children with Chronic Respiratory Failure 389 Table 55.1 Clinical conditions associated with the use of long-term noninvasive ventilation at home Common indications Obstructive sleep apnea or hypopnoea Craniofacial syndromes Obesity hypoventilation disorders Metabolic disorders Cerebral palsy Neuromuscular disorders Kyphoscoliosis Possible indications Cystic fibrosis Bridge to transplantation Tracheobronchomalacia Central hypoventilation Congenital central hypoventilation syndrome Down syndrome Myelomeningocoele Chronic lung disease of infancy should be referred to a specialist, polysomnography (PSG) is the diagnostic gold standard, and adenotonsillectomy is the first-line treatment NPPV is an option for those who are not candidates for surgery or who not respond to surgery [4] 55.3.2 Neuromuscular Diseases The most common indication for long-term NIV in children is respiratory failure due to neuromuscular disorders [5] Most children with neuromuscular disease (NMD) eventually require assistance with airway clearance and breathing, especially during sleep The onset of pulmonary symptoms in children with NMDs depends in large part on the type of underlying disease Children with Duchenne muscular dystrophy may not experience any respiratory problems until midadolescence, whereas an infant with spinal muscular atrophy type I is likely to develop respiratory compromise within the first year of life In either case, there is a typical sequence of events that leads to respiratory insufficiency and ultimately to respiratory failure Firstly, respiratory muscle weakness leads to impaired airway clearance and cough, so these patients are prone to recurrent atelectasis and chest infections Secondly, progressive inspiratory muscle weakness causes nocturnal respiratory 390 S Oktem et al dysfunction, which is manifested by frequent arousals, sleep fragmentation, and sleeprelated hypoventilation Finally, hypercapnia extends into the daytime, and frank respiratory failure ensues The duration of this timeline can be expanded by interventions such as assistance with clearance of respiratory secretions and nocturnal mechanical ventilation The criteria for home mechanical ventilation (HMV) of children with neuromuscular weakness have evolved since PSG became available Before this, patients who were candidates for HMV were generally those with frequent, prolonged, or severe episodes of lower respiratory tract infection or those who had complications secondary to chronic hypoxaemia or hypoventilation PSG allows for the early detection of patients who have hypoxaemia or hypoventilation during sleep and provides opportunities to initiate HMV before serious complications The appropriate time to introduce NIV depends on what one is attempting to achieve For example, there are a number of potential pathophysiological problems in NMD one might wish to tackle These possibilities include • Prevention of respiratory decompensation • Reduction in frequency of chest infection, physiotherapy use • Facilitation of pulmonary rehabilitation and exercise programs • Control of nocturnal hypoventilation, symptoms • Alteration of chest wall and lung characteristics • Treatment of established hypercapnic ventilatory failure [6] NIV, applied intermittently and preferably during sleep, relieves respiratory muscles from the work of breathing and augments alveolar ventilation However, NIV therapy is problematic in patients with severe bulbar weakness leading to aspiration, if arterial blood gas tensions can no longer be controlled, if there are insuperable interface difficulties, or if there is failure to thrive In these situations, a transfer to ventilation via tracheotomy is a next step However, some individuals with progressive conditions elect to continue with NIV therapy and cough assistance and forgo invasive ventilation 55.3.3 Central Hypoventilation Congenital central hypoventilation syndrome (CCHS) is a failure of automatic control of breathing Patients have absent or negligible ventilatory sensitivity to hypercapnia and hypoxaemia during sleep and wakefulness Management consists of ventilatory support whilst asleep to overcome the lack of central drive Traditionally, this has been supplied via a tracheostomy and positive pressure ventilation, especially for infants and younger children As tracheostomy is viewed unfavourably by many family members of children with CCHS, there is a trend towards utilization of NPPV as an alternate means of nocturnal ventilatory assistance [7] There is growing interest in the possibility of using noninvasive means to deliver this nighttime support and free the child of a tracheostomy during the day 55 Home Mechanical Ventilation in Children with Chronic Respiratory Failure 391 when the respiratory drive is voluntary Some centers in the United States also offer supplemental diaphragmatic pacing to be applied during the day as an adjunct to mechanical ventilation at night There are some instances when NPPV alone is used as the primary treatment of CCHS as a means of avoiding tracheostomy The success of this approach must be checked by careful observation and sleep studies along with regular assessments of the child’s developmental progress and echocardiography of the status of the pulmonary hypertension The role of NPPV in other disorders characterized by central mechanisms of hypoventilation is also evolving NPPV has been useful in mild hypoventilation associated with the Arnold–Chiari malformation, such as in children with myelomeningocele The important principle in the use of NPPV in these disorders is to be sure that the device used can function in a timed mode to deliver backup machine-delivered inflations in the event of a prolonged central respiratory pause Anecdotal reports of the successful introduction of mask support from diagnosis in infancy are emerging, although they are not universally encouraging More encouraging is increasing experience in the successful transfer of older children or adolescents from an invasive to a noninvasive interface Some studies demonstrated beneficial effects from the long-term use of NIV in CCHS, including children from the age of weeks to teenagers, who in the latter case were converted from invasive ventilation In general, NIV is best started after 5–6 years of age, when the clinical course of CCHS is usually more stable [8] (Fig. 55.1) 55.3.4 Cystic Fibrosis Several short-term physiologic studies found that NPPV improves gas exchange in child ren, both awake and asleep, with cystic fibrosis (CF) [9] Treatment of nocturnal hypoxaemia in CF with supplemental oxygen alone may aggravate hypoventilation, a complication Fig. 55.1 Child with congenital central hypoventilation syndrome receiving noninvasive ventilation (NIV) with a nasal mask 392 S Oktem et al prevented by NIV NIV efficiently unloads the respiratory muscles in CF patients with a comparable level of lung function Lung transplantation is an effective treatment option for selected CF patients with end-stage respiratory failure In advanced CF, NPPV has been successfully used as a “bridge” treatment to facilitate survival before lung transplantation or at least helped these individuals to be discharged from the hospital in countries where lung transplantation is not an option [10] The indication for long-term NIV is diurnal hypercapnia or sleep disturbance Data from the French national CF Observatory were the first to indicate that NIV is associated with stabilization of lung function decline in patients with severe CF lung disease [11] 55.4 Relative Contraindications Contraindications have not been defined However, there are a number of clinical situations in which NIV may not be suitable Severe craniofacial malformations, severe laryngomalacia or tracheomalacia, inadequate nasal passages, ventilatory support for 24 h a day, severe learning disabilities, marked bulbar impairment, profuse secretions, inability to ventilate sufficiently, and the child’s or parents’ inability to cooperate would seem to be possible contraindications [2] 55.5 The Interface in NIV 55.5.1 Nasal Versus Full-Face Mask Full-face masks minimize leakage; however, they also have significant drawbacks, including increased risk of gastric distension with air, difficulties in feeding, worsening gastroaesophageal reflux, and even aspiration Nonetheless, some children prefer the full-face masks, and they can be used safely provided there can be a reasonable level of monitoring In the acute setting, full-face masks have clear advantages over nasal masks in reducing oral leaks 55.5.2 New Masks The desirable characteristics of an interface should include low amount of dead space, adequate transparency, easy adaptability, good seal with low pressure on skin, and low cost The correct size should be chosen considering a balance among patient’s physiognomy, the least dead space possible, and the possibility of avoiding leaks Newer interfaces designed to provide NPPV to children include the helmet device, nasal pillows or plugs, and modified wide-bore soft nasal tubing systems Whereas these newer interfaces show promise in the paediatric population, experience with them is preliminary 55 Home Mechanical Ventilation in Children with Chronic Respiratory Failure 393 55.6 Complications of NIV via Mask Two important factors in patient adherence with NIV are the fit and comfort of the interface Complications are poor mask fit, skin irritation, mucosal drying, airflow-induced arousals, dyssynchrony, carbon dioxide retention associated with large dead space, aspiration, abdominal distention, and midfacial deformity 55.6.1 Poor Mask Fit and Skin Irritation The interface is a crucial determinant of the success of NIV because the patient cannot tolerate and accept NIV in the case of facial discomfort, skin injury, or significant air leak Often, because of poor-fitting interfaces or inadequate headgear, nasal masks are placed firmly on a child’s face, and injury to the underlying skin occurs Some headgear systems have been adapted for smaller children so the systems can fit adequately into systems designed for adults The prophylactic use of tape or hydrocolloid dressing to protect the skin and changing of mask design may relieve the affected area and aid recovery 55.6.2 Midfacial Deformity There is evidence that the chronic use of tight-fitting masks may affect facial growth, resulting in midfacial hypoplasia in some children [1] This seems more likely if the child starts NIV before the age of years and has weakness of the facial muscles Regular evaluation of facial development is advisable Alternation among face masks, nasal masks, and nasal plugs, together with the use of customized masks, may distribute pressure more widely over the facial skeleton in the long term, thereby reducing this problem 55.7 Initiation of Home Ventilation The primary indication for the use of NIV is chronic alveolar hypoventilation with associated respiratory failure as indicated by hypoxaemia and hypercapnia Hypoxaemia is defined as one of the following: • Hypoxemia three standard deviations below normal whilst breathing room air and adjusted for age in a steady state in an infant or young child • Nocturnal hypoxia, defined as Spo2 below 90% for more than 5% of night • The presence of pulmonary hypertension or right ventricular hypertrophy or polycythemia due to chronic hypoxaemia as cited 394 S Oktem et al Hypercapnia is defined as Paco2 above 45 mmHg Indications for elective NIV include symptoms of nocturnal hypoventilation (such as sleep disruption, night sweats, fatigue, morning headaches, and daytime sleepiness) in patients with OSAS, CF, and NMD Other symptoms such as severe dyspnoea, right heart failure, and arterial pulmonary hypertension or other conditions such as transition from a tracheostomy to NIV could also justify NIV in patients with restrictive disorders [5, 10, 12] 55.7.1 Initial NIV Adjustments in Children NPPV should be based on specific goals, such as to assist the respiratory muscles, decrease nocturnal hypercarbia, improve daytime respiratory gas exchange, prevent atelectasis, and improve upper airway patency The peak inspiratory pressure (PIP) should be set at a level sufficient to unload the respiratory muscles, increase tidal volume, and restore alveolar ventilation [3] Children may get uncomfortable at PIP settings above 20 cmH2O, although this may vary A reasonable starting PIP in the clinical setting is cmH2O, with the expectation to raise this in increments as necessary to reduce the work of breathing PIP levels of 8–18 cmH2O suffice for most children The positive end-expiratory pressure (PEEP) setting generally adjusts in the range of 4–10 cmH2O with NIV, dependent on the specific process involved [3] 55.8 Discharging the Pediatric Patient on NIV Several important aspects of successful application of long-term NIV in children include careful preparation of the patient and family, comfortable interface selection, and a strong commitment by both the physician and family towards the success of the intervention A child may be considered suitable for discharge on long-term NIV at home if The medical condition is stable; this would be a clinical decision and would generally imply • The presence of a stable airway • Stable O requirements (if required), usually less than 40% • Pco levels that can be maintained within safe limits on ventilatory equipment that is 2 operable by the family in their home • Nutritional intake adequate to maintain expected growth and development • All other medical conditions well controlled Parents understand the long-term prognosis and are willing and capable of meeting the special needs of their child in the home setting It is practical to provide the level of support and intervention that the child requires at home [13, 14] 55 Home Mechanical Ventilation in Children with Chronic Respiratory Failure 395 55.9 Follow-Up Children treated with NIV on a long-term basis should be followed by a team of clinicians experienced in the assessment and management of paediatric respiratory diseases Respiratory gas exchange, pulmonary function, state of mask, lateral projection of the skull, blood pressure, developmental milestones, growth, and patient satisfaction should be monitored carefully Echocardiography for pulmonary hypertension should be performed annually Each patient should have an annual sleep study that includes a brief period of unassisted breathing and titration of relevant ventilator pressures and oxygen Depending on the condition, follow-up could take place typically every 3–6 months Generally, at the beginning of the NIV at home, the younger or the more unstable the child is, the shorter the intervals should be between hospital visits [10] Key Recommendations ›› The major advantages of NIV, compared to invasive ventilation with ›› ›› ›› ›› tracheostomy, include greater patient comfort; simpler application, use, and care; and reduced incidence of complications, hospital cost, and sedation requirement Common indications for the use of NIV in children include OSAS, NMDs, CF, and central hypoventilation There are no contraindications for NIV However, there are a number of clinical situations for which NIV may not be suitable Severe craniofacial malformations, severe laryngomalacia or tracheomalacia, inadequate nasal passages, ventilatory support for 24 h a day, severe learning disabilities, marked bulbar impairment, profuse secretions, inability to ventilate sufficiently, and child’s or parents’ inability to cooperate would seem to be possible contraindications The interface is a crucial determinant of the success of NIV because the patient cannot tolerate and accept NIV in the case of facial discomfort, skin injury, or significant air leak Common complications are poor mask fit, skin irritation, mucosal drying, dyssynchrony, aspiration, and midfacial deformity References Fauroux B, Lavis JF, Nicot F et al (2005) Facial side effects during non-invasive positive pressure ventilation in children Intensive Care Med 31:965–969 Wallis C (2000) Non-invasive home ventilation Paediatr Respir Rev 1:165–171 396 S Oktem et al Teague WG (2005) Non-invasive positive pressure ventilation: current status in paediatric patients Paediatr Respir Rev 6:52–60 American Adademy of Pediatrics (2002) Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome Pediatrics 109:704–712 Fauroux B, Boffa C, Desguerre I, Estournet B, Trang H (2003) Long-term noninvasive mechanical ventilation for children at home: a national survey Pediatr Pulmonol 35:119–125 Simonds AK, Ward S, Heather S, Bush A, Muntoni F (2000) Outcome of paediatric domiciliary mask ventilation in neuromuscular and skeletal disease Eur Respir J 16(3):476–481 Teague WG, Vanderlaan M, Kirkby S, Hayes R, Washington G, Roberts N (2002) Transition to NPPV in children with congenital central hypoventilation syndrome (CCHS): caregiver perceptions Proceedings of the Fifth International Congress on Pediatric Pulmonology Editions E.D.K, Paris, p 270 Villa MP, Dotta A, Castello D et al (1997) Bilevel positive airway pressure (BiPAP) in an infant with central hypoventilation syndrome Pediatr Pulmonol 24:66–69 Milross MA, Piper AJ, Norman M et al (2001) Low-flow oxygen and bilevel ventilatory support Effects on ventilation during sleep in cystic fibrosis Am J Respir Crit Care Med 163(1):129–134 10 Oktem S, Ersu R, Uyan ZS et al (2008) Home ventilation for children with chronic respiratory failure in İstanbul Respiration 76:76–81 11 Fauroux B, Le Roux E, Ravilly S, Bellis G, Clément A (2008) Long-term noninvasive ventilation in patients with cystic fibrosis Respiration 76(2):168–174 12 Uyan ZS, Ozdemir N, Ersu R et al (2007) Factors that correlate with sleep oxygenation in children with cystic fibrosis Pediatr Pulmonol 42:716–722 13 American Thoracic Society (1990) Home mechanical ventilation of pediatric patients Am Rev Respir Dis 141:258–259 14 Jardine E, Wallis C (1998 Sept) Core guidelines for the discharge home of the child on longterm assisted ventilation in the United Kingdom UK Working Party on Paediatric Long Term Ventilation Thorax 53(9):762–767 Index A Acute, 3, 13, 21, 27, 41, 67, 73, 83, 87, 123, 131, 138, 145, 169, 174, 179, 185, 191–197, 199, 205, 217, 223, 231–235, 237–247, 249–254, 259, 263–265, 269, 273, 280, 288, 295, 305, 317, 321, 327, 366, 373, 377, 392 Acute cardiogenic pulmonary edema (ACPE), 13, 14, 16, 17, 41, 192, 224, 226, 231–235, 237–240, 250 Acute respiratory distress syndrome (ARDS), 73, 217, 224, 241–247, 250, 253, 308, 310, 381–383 Acute respiratory failure, 3–5, 13, 27, 69, 70, 107, 145, 169, 218, 223, 224, 226, 232, 235, 241, 249, 253, 259, 260, 269, 274, 280–281, 288, 289, 295, 297, 298, 308, 310, 317, 325, 327–330, 377 Adaptive servo-ventilation (ASV), 93–98 Adult, 8, 60, 94, 121, 136, 139–141, 257, 292, 297, 321–326, 343–345, 352, 353, 374, 378–380, 383, 384, 393 Air leakage, 5, 33, 85, 282, 290, 318, 327, 343–354 Airway pressure, 9, 10, 22–24, 39, 41, 46, 48, 74, 75, 114, 150, 220, 232, 358, 365, 370, 371, 388 Airways, 52–54, 56, 73, 77, 158, 167, 169, 195, 232, 279, 280, 288, 310, 322–327, 336, 343, 358, 363, 366, 381, 382, 388 Amyotrophic lateral sclerosis (ALS), 149–150, 153–159, 162, 280, 282, 285, 290, 291 Anesthesiology, ARDS See Acute respiratory distress syndrome Assisted coughing, 144–147, 158, 202, 289 Asthma, 185–189, 191–197, 217, 218, 274, 308, 381, 382 Asthmatic attack, 191–197 ASV See Adaptive servo-ventilation Asynchrony, 23, 24, 28, 68, 70, 73–75, 90, 116, 150, 191, 196, 220, 378 Atherosclerosis, 131–133 Average volume-assured pressure support (AVAPS) mode, 207 B Bi-level, 25, 28–30, 32–37, 46, 61, 62, 70, 83, 85, 94, 96, 115, 143, 149, 155, 193, 195, 219, 260, 281, 289, 297, 299, 353, 378, 383 Bilevel positive airway pressure (BiPAP), 30, 34, 35, 41, 83–86, 97, 155, 193, 195, 196, 220, 260, 281, 284, 289, 378, 383 Breathing, 9, 13, 22, 28, 39, 60, 68, 74, 78, 84, 90, 93, 101, 107, 121, 132, 136, 144, 149, 154, 162, 167, 174, 182, 186, 195, 200, 205, 232, 241, 251, 258, 263, 280, 287, 298, 306, 318, 322, 327, 335, 346, 358, 369, 378, 389 Bubble CPAP, 41, 42, 353, 358, 359, 369–374 C Cancer, 249–254, 330 Carbon dioxide (CO2), 9–10, 21, 59, 77–91, 109, 146, 171, 175, 176, 218, 225, 359, 364, 373, 381, 393 397 398 Cardiogenic pulmonary edema (CPE), 39, 189, 217, 218, 220, 223, 224, 235, 250, 295, 305 Cardiovascular, 101, 121–128, 135, 173, 185, 246, 275, 311 Cheyne–Stokes respiration, 93–98, 125, 210 Children, 8, 60, 135, 136, 138–141, 144, 145, 147, 162, 187, 188, 282, 291, 292, 377–383, 387–395 Chronic heart failure, 33, 239, 310, 311 Chronic hypercapnic respiratory, 171–176, 209, 210 Chronic obstructive hypercapnic, 67–70 Chronic obstructive pulmonary disease (COPD), 3, 5, 16, 22–24, 33, 37, 54, 56, 67–70, 74, 135, 137, 138, 171–176, 179–185, 189, 192, 205–210, 217, 218, 223–226, 239, 249, 295–300, 302, 305, 307–311, 317, 329 Chronic respiratory failure (CRF), 3–5, 21, 27, 28, 59, 83, 87, 88, 143, 182, 205, 206, 208–210, 295, 297, 308, 310, 321, 327, 330, 381, 387–395 Circuits, 7, 8, 13, 24, 25, 28, 30, 32, 35, 37, 39–41, 46, 49, 51–57, 77–79, 81, 83–85, 87–90, 109–112, 193, 195, 196, 265, 366, 369, 370, 379, 383 Colonization, 52–56, 324, 326 Complications, 3–5, 93, 107–116, 121–128, 143, 147, 162–167, 169, 180, 184, 199, 200, 202, 218, 223, 231, 232, 241, 247, 249, 251, 252, 254, 258, 260–261, 263, 265, 266, 273, 281, 287, 292, 295, 299, 305, 317–322, 324–329, 331, 360, 380–383, 387, 390, 391, 393, 395 Contamination, 52–56, 113 Continuous positive airway pressure (CPAP), 7, 13, 28, 39, 45, 69, 80, 83, 90, 93, 101–104, 110, 121–128, 133, 135, 188, 193, 217, 226, 237–241, 252, 258, 281, 289, 323, 328, 335, 343, 357, 364, 369, 378, 388 Conventional mechanical ventilation, 169, 185, 186 COPD See Chronic obstructive pulmonary disease CPAP See Continuous positive airway pressure Index CPE See Cardiogenic pulmonary edema CRF See Chronic respiratory failure Critical care, 40, 45, 246, 258, 281, 282, 289, 290 Critically, 23, 30, 56, 74, 111, 257–261, 269 Cyclic-variability, 73–74 D Decannulation, 163, 165, 279–285, 290 Device, 5, 8, 10, 13, 16, 22, 23, 28, 36, 37, 39, 41, 42, 46, 47, 56, 70, 80, 81, 83–86, 88–89, 93–98, 102, 103, 109, 110, 112, 113, 157–159, 219, 220, 244, 258, 259, 279, 288, 336, 337, 339, 340, 344, 346, 349, 350, 352–354, 357, 358, 371, 372, 377–379, 383, 384, 387, 388, 391, 392 Disease, 3, 16, 21, 27, 39, 51, 59, 67–70, 74, 102, 115, 121, 131, 135, 150, 153, 161–167, 171, 180, 185, 191, 199, 205–210, 217, 223, 239, 242, 249, 258, 263, 280, 287–293, 295, 305, 317, 321, 329, 343, 357, 365, 371, 377, 389 Disinfection, 52–54, 56, 57 Duchenne, 60, 143–147, 162, 164, 281, 283, 292, 389 Dystrophy, 60, 143–147, 162, 164, 165, 283, 292, 389 E Efficacy, 4, 5, 8, 15, 17, 22, 39, 41, 56, 63, 74, 77, 96, 103, 104, 121–128, 138, 139, 141, 147, 156, 169, 192, 224, 225, 227, 233, 235, 274, 275, 323, 343 Emergency department (ED), 217–220, 223–226 Emergency medicine, 217–220 Endotracheal intubation, 15, 161–166, 185, 186, 192–194, 197, 218, 223, 225, 226, 231, 240–242, 244, 246, 257, 300, 305, 307, 325, 366, 367, 382 Equipment, 30, 37, 39–42, 45–49, 51–54, 61–63, 111, 199–200, 217–220, 265, 284, 287, 335–340, 354, 357, 360, 370, 374, 377–379, 384, 387, 394 399 Index Equipment and supplies, 40, 41, 358 Evidence, 35, 49, 52, 53, 55, 56, 61, 89, 98, 121–123, 132, 137, 156, 159, 171, 174–176, 185, 189, 192–195, 197, 205–208, 217, 225–227, 234, 235, 238, 241, 249, 250, 258, 269, 275, 295–297, 299–301, 306, 335, 337, 358, 360, 363, 366, 372–374, 393 Exacerbations, 37, 67, 175, 182, 185–189, 192, 194, 217, 223–226, 242, 249, 295, 297, 298, 300, 302, 305, 381, 382 Extubation, 3, 169, 273, 279–285, 287–293, 295–300, 305–307, 309, 311, 322–324, 343, 357, 358, 364, 372–374, 383 F Failure, 3, 13, 21, 27, 48, 51, 59, 67, 73, 83, 87, 93, 107, 121, 135, 143, 149, 153, 163, 167, 171–176, 179–185, 192, 199, 205, 217, 223, 231, 238, 241, 249–254, 258, 263–265, 269, 274, 279, 288, 295, 305–311, 317, 321, 327, 359, 364, 373, 377, 387–395 H Helmet, 7–11, 13–17, 31, 40, 48, 62, 77, 78, 80–82, 85, 107, 109–113, 218–220, 252, 323, 325, 378–379, 384, 392 High-frequency nasal ventilation, 363–367 Home mechanical ventilation, 48, 51–53, 55, 59, 63, 289, 387–395 Home ventilation, 35, 51–57, 61–63, 74, 85, 171–176, 205–210, 393–394 Home ventilator, 28, 34, 36, 37, 63, 383 Hygiene, 54, 56 Hypercapnic, 23, 30, 205, 206, 225, 309–311, 381, 390 Hypercapnic respiratory failure, 21, 83, 171–176, 179–184, 209, 210, 263–266, 296 Hypoxemia, 21, 101, 135, 143, 146, 154, 161, 173, 182, 186, 205, 208, 226, 241, 244, 246, 258, 260, 306–308, 325, 381, 393 Hypoxemic respiratory failure, 21, 192, 223, 242, 249–254, 329 I ICU ventilator, 28–30, 33, 35–37, 40–42, 70, 219, 259 Injuries, 48, 59, 60, 115, 132, 165, 169, 241–247, 249, 300, 308, 310, 322, 360, 366, 380, 393, 395 Inspiratory positive airway pressure (IPAP), 28, 30, 34, 68, 69, 83, 94–97, 145, 149, 150, 183, 188, 195, 196, 241, 246, 260, 308, 310 Instrumentation, 104, 176, 207, 353 Intensive care, 113, 223, 224, 226, 227, 265, 269–272, 377–384 Intensive care unit (ICU), 4, 10, 16, 28–30, 32, 33, 35–37, 39–42, 70, 107, 111, 116, 162, 186, 189, 191, 193, 194, 197, 219, 223–227, 241, 242, 244, 246, 249–254, 258, 259, 261, 270, 271, 274, 275, 296–300, 302, 307, 309, 311, 321, 324, 325, 382, 383 Interactions patient-ventilator, 8, 22–25, 32, 34, 35, 37, 67–70, 74, 75, 77, 112, 116, 195–196, 208 Interface, 3–5, 7, 9, 25, 30, 31, 34, 37, 39, 41, 48–49, 51, 56, 57, 61–63, 73, 77–80, 85, 87, 109, 111, 113, 116, 145, 149, 162, 180, 202, 207–208, 246, 253, 254, 281, 282, 284, 290–292, 336–337, 340, 343–345, 353, 371, 378, 383, 384, 390–395 Intraoperative, 317–320, 322, 323 Intubation, 4, 14–17, 37, 107, 157, 161–166, 169, 180, 185–189, 192–194, 197, 207, 217, 218, 223, 225–227, 231, 240–242, 244–247, 249, 257–261, 264, 269, 280, 288, 292, 295, 298–300, 305, 307, 309–311, 317, 321, 322, 324, 325, 329, 330, 343, 359, 364–367, 377, 381–384 IPAP See Inspiratory positive airway pressure L Left ventricular systolic function, 237–240 Liver transplant, 321–326 Long term noninvasive ventilatory support, 56, 171, 172, 174–176, 388, 389, 391, 392, 394, 395 Lung injury, 115, 241–247, 249, 300, 366 Lung resectional surgery, 300, 327–331 400 M MAC See Mechanically assisted coughing Maintenance, 51–57, 162, 176, 232, 269, 274, 295, 369 Management system, 83–86 Mask, 3–5, 8–10, 13–17, 21, 23–25, 28, 30–34, 40, 41, 46, 48, 51, 53, 56, 62, 69, 70, 77–80, 85, 87–91, 94, 102, 107–114, 116, 140, 149, 155, 158, 162, 188, 193, 194, 196, 201, 202, 208, 218–220, 226, 238, 246, 252, 257, 259–261, 265, 274, 297, 299, 300, 307, 309, 310, 318–320, 323, 327, 330, 336–340, 343–345, 378, 380, 383, 384, 387, 388, 391–393, 395 Measurements, 11, 36, 61, 74, 90, 132, 154, 169, 180, 284, 318, 343–351, 353, 354, 371 Mechanical insufflation–exsufflation, 145, 158 Mechanically assisted coughing (MAC), 145–147, 202, 280–285, 288–292 Mechanical ventilation, 3, 21, 27–37, 45, 51, 59–63, 67, 73, 77–82, 86, 110, 146, 149, 157, 161–169, 176, 179, 185, 191, 200, 205, 223, 241, 249, 261, 264, 289, 296, 305, 317, 322, 327, 343, 357, 363, 372, 377–384, 387–395 Medical devices, 39 Monitoring, 10, 11, 17, 25, 27–31, 35–37, 40–42, 46, 49, 52, 56, 63, 74, 80, 83, 101–104, 110, 115, 169, 172–174, 176, 180, 189, 191, 220, 223, 227, 246, 253, 265, 309, 311, 318, 319, 348, 352–354, 371, 380, 392 Muscular, 60, 143–147, 156, 162, 165, 280–283, 290, 292, 389 Myasthenic crisis, 167–169 Myocardial infarction, 115, 121, 131, 133, 231, 233–235, 239 N Nasal high-frequency ventilation, 363–367 Neonatal, 8, 335–340, 343, 357, 358, 364, 366, 369–371, 373 Neonates, 41, 343–354, 365, 372, 373 Neonatology, Neuromuscular, 13, 21, 28, 33, 37, 51, 59–61, 63, 115, 158, 161–167, 169, 183, Index 191, 242, 279–285, 287–293, 308, 310, 330, 377, 384, 389–390 Neuromuscular disease, 37, 59, 61, 63, 113, 158, 161–166, 183, 281, 287–293, 308, 310, 330, 384, 389–390 Newborn, 336, 352, 357–360, 365, 369 niPSV See Non-invasive pressure support ventilation NIV See Non-invasive ventilation Nocturnal, 28, 51, 59–63, 68, 85, 94, 101–104, 125, 132, 133, 145, 154–156, 159, 174, 182, 206, 208–210, 283, 284, 289, 292, 323, 327, 388–391, 393, 394 Noninvasive mechanical ventilation, 4, 27–37, 47, 49, 59–63, 77–82, 161–169, 179, 181, 322, 377–384 Non-invasive positive pressure ventilation (NPPV), 3, 17, 27, 39–42, 61, 87, 147, 153–159, 191–197, 199–202, 209, 241, 246, 249–254, 260, 274, 287, 295–302, 305, 317, 327–331, 377, 386 Non-invasive pressure support ventilation (niPSV), 67, 74, 107–116, 226, 231–235 Non-invasive ventilation (NIV), 7, 10, 15, 21, 42, 45–49, 51, 61, 73, 78, 80, 83, 85, 87–91, 141, 143, 149–150, 159, 161, 169, 171, 181, 185–189, 192, 196, 205, 217–220, 223–227, 231–235, 241, 257–261, 263–266, 269–275, 287, 305–311, 317–326, 357–360, 364, 374, 377, 387 NPPV See Non-invasive positive pressure ventilation O Obstructive sleep apnea (OSA), 93, 101, 104, 121–128, 131–133, 135, 136, 139–141, 388, 389 Oncology critically, 281, 282 Outcome, 25, 27, 37, 61, 83, 123–125, 171, 172, 187, 193, 194, 240, 242, 244, 247, 250–252, 260–261, 263–265, 269, 273, 280–281, 297, 305, 311, 321, 329, 330, 343, 363, 366, 374, 381, 383, 384 Outside, 9, 13, 80, 187, 223–227, 232, 253, 258, 270, 308, 353, 366 Index P Patient/machine interfaces, 23, 28, 34, 37, 67, 68, 70, 73, 112, 325 Patient–ventilator interaction, 8, 23–25, 32, 35, 67–70, 74, 75, 112,, 116, 195–196, 208 Pediatric, 8, 46, 292, 298, 377–384, 388, 394 Positive airway pressure, 7–11, 13–17, 28, 39–42, 45, 61, 83, 88, 93, 101–104, 110, 121–128, 133, 135, 143, 149, 155, 183, 188, 194, 208, 217, 226, 231–235, 237–241, 258, 281, 289, 299, 323, 335–340, 343–354, 357, 364, 369–374, 377–384, 388 Positive-pressure respiration, 3, 22, 27, 87, 192, 199, 209, 232, 249–254, 295, 306, 308, 318, 321 Positive pressure ventilation, 3, 17, 27, 39–42, 45, 46, 61, 63, 87, 115, 147, 153–159, 191–197, 199–202, 209, 241, 249–254, 260, 279, 287, 288, 295–302, 305, 306, 308, 310, 311, 317, 323, 326–331, 336, 337, 358, 364, 377, 388, 390 Postextubation, 282, 283, 290, 291, 295–302, 305–311, 383 Postoperative, 146, 147, 192, 257, 297, 308, 310, 318, 322–331 Predictors, 139, 154, 169, 171–176, 191, 200, 226, 244, 251, 253, 298, 383 Pre-hospital, 14, 17, 217–220, 233 Premature ventilation, 24, 33, 70, 233, 305, 357 Preoxygenation, 257–261 Pressure-cycled ventilators, 51, 61, 62 Pressure support ventilation (PSV), 8, 10, 13, 21–25, 31, 32, 35, 40, 62, 67, 73–75, 80, 83–86, 107–116, 188, 196, 207, 208, 226, 231, 233, 235, 259, 260, 270, 296, 297 Preterm infants, 8, 335, 338–340, 371, 372 Protocol, 17, 51–57, 149, 179–184, 246, 265, 270–272, 282, 290–293, 311, 366, 388 Pulmonary edema, 13, 14, 39, 41, 115, 189, 192, 217, 223, 224, 226, 231–235, 237–241, 250, 295, 305, 309, 311, 324, 329 Q Quadriplegia, 401 R Rebreathing, 9–11, 25, 27–30, 32, 45, 46, 62, 77–91, 109, 220 Respiratory failure, 3, 13, 21, 27, 51, 59, 69, 73, 83, 87, 107, 141, 143, 149, 153, 161, 167, 171–176, 179–185, 192, 205, 218, 223, 231, 241, 249–254, 259, 263–265, 269, 274, 279, 288, 295, 305–311, 317, 321, 327, 366, 373, 377, 387–395 Respiratory paralysis, 156, 157, 199 Resuscitation, 335–340 Risk, 3, 11, 25, 28, 46, 52, 62, 82, 83, 101, 104, 114, 123, 131, 141, 146, 155, 161, 169, 172, 183, 191, 200, 218, 223, 231–235, 249, 258, 269, 292, 296, 305, 317, 321, 327, 343, 357, 363, 379, 392 S Sedation, 33, 68, 73, 108, 110, 146–147, 161, 162, 166, 191, 223, 249, 269–275, 306, 318, 319, 323, 324, 371, 383, 387, 395 Sleep, 27, 39, 46, 59, 67, 73, 83, 93, 101, 111, 121–128, 131–133, 135, 146, 154, 182, 201, 207, 239, 273, 308, 323, 377, 388–389 Spinal cord, 59, 60, 183, 199, 200, 270, 281, 282, 290, 291 Spontaneous respiration, 67–70 Strategies, 32, 111, 135, 169, 179, 182–184, 208, 217–220, 323, 325, 326, 357, 360, 372, 377 Survival, 3, 51, 60, 61, 126, 143–147, 149, 150, 154–157, 159, 162, 171–176, 181, 199, 205, 206, 218, 225, 227, 237, 244, 246, 251, 252, 281, 284, 297, 311, 330, 358, 363, 377, 392 T Technology, 7–11, 27, 39, 45–49, 61, 62, 74, 93, 147, 199–201, 335–340, 343, 387 Tidal volume (TV), 14, 15, 21, 23, 34, 41, 47, 62, 68, 78, 79, 83, 89, 94, 109, 110, 113, 145, 150, 175, 195, 200, 201, 206, 242, 246, 259, 260, 306, 308, 318, 328, 329, 337–340, 349, 351, 367, 379, 381, 394 Titration CPAP auto-CPAP, 102–104 402 Index Tracheotomy, 157, 161–166, 209, 210, 279, 280, 282–285, 288–290, 292, 293, 297, 390 Training, 37, 104, 146, 201, 220, 263–266, 384 250, 258, 280, 281, 283, 284, 288–292, 298, 299, 317, 318, 390, 392, 395 Volume-cycled ventilators, 30, 61, 62, 143, 145 U Units, 4, 9, 13, 28, 39, 40, 55, 70, 89, 90, 107, 162, 168, 176, 184, 186, 191, 219, 223–227, 233, 241, 249, 253, 258, 264, 266, 270, 274, 284, 296, 298, 307, 308, 321, 328–330, 336, 364, 373, 377, 382 Unweanable, 279–285, 287–293 W Weakness, 21, 62, 143, 149, 150, 153, 156–158, 167, 168, 279–285, 287–293, 298, 324, 377, 389, 390, 393 Weaning, 3, 146, 169, 176, 179, 181, 183, 192, 246, 281, 284, 289, 291, 292, 295–299, 305–307, 310, 311, 318, 322, 325, 326, 360, 383 Work of breathing, 9, 13–16, 22, 23, 25, 32, 69, 84, 107, 138, 146, 149, 156, 168, 188, 195, 197, 205, 241, 242, 251, 263, 298, 306, 307, 322, 325, 327, 336, 358–360, 369, 371, 390, 394 V Ventilatory modes, 23, 87 Ventilatory support, 5, 46, 49, 63, 73, 107, 110, 143, 145, 155, 156, 168, 169, 176, 181, 182, 185, 186, 193, 195–196, 226, 231, 241, 246, [...]... aureus MV mechanical ventilation MWD 6-minute walking distance N Nasal NIMV Noninvasive mechanical ventilation NIPPV noninvasive positive pressure ventilation NIPSV Noninvasive pressure support ventilation NIV noninvasive ventilation NMD neuromuscular weakness NNPV noninvasive positive pressure NO Nasal oral NPPV noninvasive positive pressure ventilation NPSV Noninvasive pressure support ventilation ON Oronasal... (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection Am J Respir Crit Care Med 164:1231–1235 2 Carlucci A, Richard JC, Wysocki M, Lepage E et al (2001) Non invasive versus conventional mechanical ventilation An epidemiologic survey Am J Respir Crit Care Med 163:874–880 3 Bott J, Carroll MP, Conway JH et al (1993) Randomized controlled trial of nasal ventilation. .. support in respiratory failure with nasal positive pressure ventilation Chest 97:150–158 9 Criner GJ, Travaline JM, Brennan KJ et al (1994) Efficacy of a new full face mask for non invasive positive pressure ventilation Chest 106:1109–1115 10 Bruce Roy MD, Cordova F, Travaline J et al (2007) Full face mask for noninvasive positive pressure ventilation in patients with acute respiratory failure J Am... (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure N Engl J Med 344(7):481–487 6 Principi T et al (2004) Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure Intensive Care Med 30(1):147–150, Epub 2003 Oct 31 7 Rocco M et al (2004) Noninvasive... increasing the EELF and preventing alveolar collapse 18 A Zanella et al References 1 Masip J et al (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis JAMA 294(24):3124–3130 2 Tonnelier JM et al (2003) Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study Intensive Care Med 29(11):... Interface Technology in Critical Care Settings Full Mask Ventilation 1 Francis Cordova and Manuel Jimenez 1.1 Introduction Noninvasive positive pressure ventilation (NPPV) has become an integral part of ventilator support in patients with either acute or chronic respiratory failure NPPV has been shown to avoid the need for invasive mechanical ventilation, it’s associated complications and facilitate... hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial JAMA 284(18):2352–2360 Section II Ventilatory Modes and Ventilators: Theory, Technology, and Equipment Pressure Support Ventilation 4 Enrica Bertella and Michele Vitacca 4.1 Introduction Noninvasive ventilation (NIV) refers to the provision of mechanical ventilation. .. nicolo.patroniti@unimib.it A.M Esquinas (ed.), Noninvasive Mechanical Ventilation, DOI: 10.1007/978-3-642-11365-9_3, © Springer-Verlag Berlin Heidelberg 2010 13 14 A Zanella et al face mask is therefore somehow difficult and requires an experienced team and a collaborative patient The head helmet has been introduced with success as a tool to deliver noninvasive CPAP It seems to offer some significant... intolerance, and 3 Helmet Continuous Positive Airway Pressure: Clinical Applications 17 inability to obtain a sufficient seal are the most important causes of failure of noninvasive CPAP as well as of noninvasive positive pressure ventilation (NPPV) By avoiding these two major problems, the use of the helmet may extend the use of CPAP to a much larger patient population Second, to limit patient discomfort... 107(4):148–156 11 Liesching TN, Cromier K, Nelson D et al (2003) Total face mask TM vs standard full face mask for noninvasive therapy of acute respiratory failure Am J Respir Crit Care Med 167:A996 12 Navalesi P, Fanfulla F, Frigeiro P et al (2000) Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure Chest