MyMedR

Fulltext Domiciliary non-invasive ventilatory devices--a general hospital experience

Norhaya MR, Wazi RA, Azhar AA

Med J Malaysia, 2009 Mar;64(1):77-9.

PMID: 19852329

Treatment for chronic respiratory failure has advanced since the introduction of domiciliary non-invasive ventilatory devices. This has given a new light of hope for patients with chronic respiratory failure secondary to various causes. We report a series of patients with respiratory failure of different origins and types of management that they received. Four patients received bilevel positive airway pressure (BiPAP) and one patient received continuous positive airway pressure (CPAP).

Matched MeSH terms: Respiratory Insufficiency/therapy*

Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

Manap HH, Abdul Wahab AK

J Artif Organs, 2017 Mar;20(1):8-17.

PMID: 27193131 DOI: 10.1007/s10047-016-0905-x

The implementation of extracorporeal carbon dioxide removal (ECCO2R) as one of the extracorporeal life support system is getting more attention today. Thus, the objectives of this paper are to study the clinical practice of commercial ECCO2R system, current trend of its development and also the perspective on future improvement that can be done to the existing ECCO2R system. The strength of this article lies in its review scope, which focuses on the commercial ECCO2R therapy in the market based on membrane lung and current investigation to improve the efficiency of the ECCO2R system, in terms of surface modification by carbonic anhydrase (CA) immobilization technique and respiratory electrodialysis (R-ED). Our methodology approach involves the identification of relevant published literature from PubMed and Web of Sciences search engine using the terms Extracorporeal Carbon Dioxide Removal (ECCO2R), Extracorporeal life support, by combining terms between ECCO2R and CA and also ECCO2R with R-ED. This identification only limits articles in English language. Overall, several commercial ECCO2R systems are known and proven safe to be used in patients in terms of efficiency, safety and risk of complication. In addition, CA-modified hollow fiber for membrane lung and R-ED are proven to have good potential to be applied in conventional ECCO2R design. The detailed technique and current progress on CA immobilization and R-ED development were also reviewed in this article.

Matched MeSH terms: Respiratory Insufficiency/therapy*

Fulltext Fracture synthetic tracheostomy tube: an ENT emergency

Shashinder S, Tang IP, Kuljit S, Muthu K, Gopala KG, Jalaludin MA

Med J Malaysia, 2008 Aug;63(3):254-5.

PMID: 19248703 MyJurnal

A synthetic tracheostomy tube [non-metallic type] fracturing within three days of insertion is very rare but it could lead to serious complications such as acute asphyxia or sudden death. We report three such cases at our centre. Recommendations are made to closely observe patients on tracheostomy tube in the first seven days post-insertion of the tube.

Matched MeSH terms: Respiratory Insufficiency/therapy

Diaphragmatic hernia: an unusual cause of postpartum collapse

Sharifah H, Naidu A, Vimal K

BJOG, 2003 Jul;110(7):701-3.

PMID: 12842063

Matched MeSH terms: Respiratory Insufficiency/therapy

Fulltext Respiratory failure requiring ventilation in acute bronchiolitis

Chan PWK, Goh AYT, Lum LCS

Med J Malaysia, 1999 Dec;54(4):487-91.

PMID: 11072467

Severe bronchiolitis requiring mechanical ventilation is uncommon and is associated with the risk of barotrauma. We report our experience with 25 (42%) of 60 infants admitted to the Paediatric Intensive Care Unit (PICU) with severe bronchiolitis who required mechanical ventilation. Eighteen patients (72%) had severe hypoxaemia (PaO2/FiO2 < 250). The mean airway pressure required ranged from 5.8 to 15.6 cmH2O with median ventilation duration of 4.0 days (range 2.0-14.0 days). Oxygenation improved significantly within 12 hours of intubation. There was only one death. Mechanical ventilation is required in a subset of patients for severe bronchiolitis and is effective and generally well tolerated.

Matched MeSH terms: Respiratory Insufficiency/therapy*

Acquired tracheo-oesophageal fistula following tracheal intubation in a burned patient

Tan KK, Lee JK, Tan I, Sarvesvaran R

Burns, 1993 Aug;19(4):360-1.

PMID: 8357487

A 27-year old male sustained a 60 per cent TBSA burn with inhalation injury following a road traffic accident. He developed respiratory distress on day 3 postburn, and was intubated and ventilated. He was noted to have greenish aspirate from his trachea on day 17 of ventilation. He succumbed from sepsis and died on day 21 post injury. At post-mortem, a large tracheo-oesophageal fistula (TOF) was found at the level of the cuff of the nasotracheal tube.

Matched MeSH terms: Respiratory Insufficiency/therapy

Fulltext An unsuspected danger in oxygen administration

Kuhan N, Abidin Z, Koh KH

Med J Malaysia, 1981 Mar;36(1):37-8.

PMID: 7321936

Matched MeSH terms: Respiratory Insufficiency/therapy*

Thirteen years of invasive and noninvasive home ventilation for children in a developing country: A retrospective study

Nathan AM, Loo HY, de Bruyne JA, Eg KP, Kee SY, Thavagnanam S, et al.

Pediatr Pulmonol, 2017 04;52(4):500-507.

PMID: 27712049 DOI: 10.1002/ppul.23569

INTRODUCTION: Home ventilation (HV) for children is growing rapidly worldwide. The aim was to describe (1) the sociodemographic characteristics of children on HV and (2) the indications for, means and outcome of initiating HV in children from a developing country.

METHODOLOGY: This retrospective study included patients sent home on noninvasive or invasive ventilation, over 13 years, by the pediatric respiratory unit in a single center. Children who declined treatment were excluded.

RESULTS: Seventy children were initiated on HV: 85.7% on noninvasive ventilation, 14.3% on invasive ventilation. There was about a threefold increase from 2001-2008 (n = 18) to 2009-2014 (n = 52). Median (range) age of initiating HV was 11 (1-169) months and 73% of children were <2 years old. Common indications for HV were respiratory (57.2%), chest/spine anomalies (11.4%), and neuromuscular (10.0%). Fifty-two percent came off their devices with a median (interquartile range) usage duration of 12 (4.8, 21.6) months. Ten children (14.3%) died with one avoidable death. Children with neuromuscular disease were less likely to come off their ventilator (0.0%) compared to children with respiratory disease (62.1%). Forty-one percent of parents bought their equipment, whereas 58.6% borrowed their equipment from the medical social work department and other sources.

CONCLUSION: HV in a resource-limited country is possible. Children with respiratory disease made up a significant proportion of those requiring HV and were more likely to be weaned off. The mortality rate was low. The social work department played an important role in facilitating early discharge. Pediatr Pulmonol. 2017;52:500-507. © 2016 Wiley Periodicals, Inc.

Matched MeSH terms: Respiratory Insufficiency/therapy

Fulltext Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients

Lee JWW, Chiew YS, Wang X, Tan CP, Mat Nor MB, Damanhuri NS, et al.

Ann Biomed Eng, 2021 Dec;49(12):3280-3295.

PMID: 34435276 DOI: 10.1007/s10439-021-02854-4

While lung protective mechanical ventilation (MV) guidelines have been developed to avoid ventilator-induced lung injury (VILI), a one-size-fits-all approach cannot benefit every individual patient. Hence, there is significant need for the ability to provide patient-specific MV settings to ensure safety, and optimise patient care. Model-based approaches enable patient-specific care by identifying time-varying patient-specific parameters, such as respiratory elastance, Ers, to capture inter- and intra-patient variability. However, patient-specific parameters evolve with time, as a function of disease progression and patient condition, making predicting their future values crucial for recommending patient-specific MV settings. This study employs stochastic modelling to predict future Ers values using retrospective patient data to develop and validate a model indicating future intra-patient variability of Ers. Cross validation results show stochastic modelling can predict future elastance ranges with 92.59 and 68.56% of predicted values within the 5-95% and the 25-75% range, respectively. This range can be used to ensure patients receive adequate minute ventilation should elastance rise and minimise the risk of VILI should elastance fall. The results show the potential for model-based protocols using stochastic model prediction of future Ers values to provide safe and patient-specific MV. These results warrant further investigation to validate its clinical utility.

Matched MeSH terms: Respiratory Insufficiency/therapy*

Fulltext The immediate outcome of ventilation for pulmonary diseases

Yaacob I, Mustafa M

Singapore Med J, 1994 Oct;35(5):512-4.

PMID: 7701374

Fifty-eight patients were ventilated for acute respiratory failure complicating respiratory diseases between 1985 to 1990. There were 19 cases of chronic obstructive airway disease (COAD), 17 cases of asthma, 16 cases of pneumonia and 6 cases with other diagnoses. Overall, 40% of patients survived and were discharged from the ward. Patients with pneumonia had the lowest survival rate (25%) whilst the survival rates for asthma and COAD were 47% and 42% respectively. Increasing age had an inverse relationship to survival rate (r = 0.96, p < 0.05) but the duration of ventilation did not correlate with survival. Patients who were electively ventilated before respiratory arrest had a better chance of survival (57%) compared with only 18% survival rate in patients who were ventilated as an emergency (x2 = 4.47, p < 0.05). Patients who developed other organ failure had higher mortality (71%) than those who did not (22%; x2 = 2.14, p < 0.05). We conclude that patients younger than 50 years of age, who were electively ventilated and without other organ failure had a better immediate survival after assisted ventilation.

Matched MeSH terms: Respiratory Insufficiency/therapy*

Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country

Lum LC, Abdel-Latif ME, de Bruyne JA, Nathan AM, Gan CS

Pediatr Crit Care Med, 2011 Jan;12(1):e7-13.

PMID: 20190672 DOI: 10.1097/PCC.0b013e3181d505f4

To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children.

Matched MeSH terms: Respiratory Insufficiency/therapy*

The principles of snakebite treatment

Reid HA

Clin. Toxicol., 1970 Sep;3(3):473-82.

PMID: 5520050

Matched MeSH terms: Respiratory Insufficiency/therapy

Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department

Adi O, Via G, Salleh SH, Chuan TW, Rahman JA, Muhammad NAN, et al.

Am J Emerg Med, 2021 Nov;49:385-392.

PMID: 34271286 DOI: 10.1016/j.ajem.2021.06.031

STUDY OBJECTIVE: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED).

METHODS: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate.

RESULTS: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP.

CONCLUSION: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.

Matched MeSH terms: Respiratory Insufficiency/therapy*

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