Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxe... more Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.
Neuropulmonology refers to the complex interconnection between the central nervous system and the... more Neuropulmonology refers to the complex interconnection between the central nervous system and the respiratory system. Neurologic injury includes traumatic brain injury, hemorrhage, stroke, and seizures, and in each there are far-reaching effects that can result in pulmonary dysfunction. Systemic changes can induce impairment of pulmonary function due to changes in the core structure and function of the lung. The conditions and disorders that often occur in these patients include aspiration pneumonia, neurogenic pulmonary edema, and acute respiratory distress syndrome, but also several abnormal respiratory patterns and sleep-disordered breathing. Lung infections, pulmonary edema - neurogenic or cardiogenic - and pulmonary embolus all are a serious barrier to recovery and can have significant effects on outcomes such as hospital course, prognosis, and mortality. This review presents the spectrum of pulmonary abnormalities seen in neurocritical care.
Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care, 2016
The use of noninvasive ventilation (NIV) has gained popularity in a variety of applications, incl... more The use of noninvasive ventilation (NIV) has gained popularity in a variety of applications, including acute respiratory failure, and it has been shown to be beneficial in the reduction of complications and improvement in outcomes [1]. A variety of factors can lead to failure to tolerate NIV, and the use of sedation can be effective in keeping the patient comfortable, yet awake and arousable, so as to prevent distress while providing a suitable level of sedation. A survey of the use of sedation in patients receiving NIV revealed that practices vary widely, likely because of a lack of evidence, and as such its application is underused [2]. There are inconsistencies in how often sedation and analgesia are provided, which agents are used, methods of administration, and determination of patient requirements. This lack of consistency sets up a situation in which the patient is exposed to circumstances that make it more difficult to be successfully weaned from mechanical ventilation.
Wentylacja nieinwazyjna odgrywa coraz większą rolę w leczeniu ostrej hipoksemicznej lub hiperkapn... more Wentylacja nieinwazyjna odgrywa coraz większą rolę w leczeniu ostrej hipoksemicznej lub hiperkapnicznej niewydolności oddychania i ma wiele zalet w porównaniu z inwazyjną wentylacją mechaniczną. Do zalet tych zalicza się zachowanie mechanizmów obronnych dróg oddechowych, zmniejszoną potrzebę sedacji i zmniejszenie ryzyka powikłań związanych z intubacją dotchawiczą. Mimo niewątpliwych walorów wentylacji nieinwazyjnej istnieją również pewne przeciwwskazania do stosowania tej metody, jak na przykład ciężka encefalopatia. W niniejszym artykule przeglądowym przeanalizowano podstawy teoretyczne, dowody naukowe i wady stosowania wentylacji nieinwazyjnej u pacjentów z hiperkapnią lub bez hiperkapni, znajdujących się w stanie zaburzonej świadomości
The use of blood products is common in the period after cardiopulmonary bypass. A rare cause of a... more The use of blood products is common in the period after cardiopulmonary bypass. A rare cause of adult respiratory distress syndrome is a reaction to antileukocyte antibodies. The plasma transfused may contain a potent leukocyte antibody that may cause severe problems in the intensive care unit.
Sultan Qaboos University Medical Journal [SQUMJ], 2018
Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration t... more Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration to the lungs without the need for endotracheal intubation. As NIV has proven beneficial in comparison to invasive mechanical ventilation, it has become the optimal modality for initial respiratory support among children in respiratory distress. High-flow nasal cannulae (HFNC) therapy is a relatively new NIV modality and is used for similar indications. This review discusses the usefulness and applications of conventional NIV in comparison to HFNC.Keywords: Noninvasive Ventilation; Nasal Cannulae; Endotracheal Intubation; Mechanical Ventilation; Children.
Acute respiratory failure (ARF) is a major complication in patients with hematological malignancy... more Acute respiratory failure (ARF) is a major complication in patients with hematological malignancy, with outcome largely depending on the cause. Noninvasive ventilation (NIV) is useful as a form of prophylactic support in early ARF and, by avoiding intubation, may improve outcome in patients with reversible ARF. This chapter summarizes the current evidence regarding outcome, application, and limitations of NIV in these patients.
American Journal of Obstetrics and Gynecology, 1991
A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after ... more A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after surgical resection of a cornual pregnancy at 10 weeks' gestation was treated successfully with positive end-expiratory pressure. The underlying cause, extensive pulmonary embolism, was subsequently revealed. The patient survived without residual brain damage. The possible causes of adult respiratory distress syndrome in pregnancy are discussed.
To evaluate the impact of case mix variation on the performance of the Acute Physiology and Chron... more To evaluate the impact of case mix variation on the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II using measures of calibration and discrimination. APACHE II data were collected prospectively at the surgical intensive care unit of the University of Vermont on all adult admissions over an 8-yr period (excluding cardiac surgical patients, burn patients, and patients < 16 yrs of age). The original case mix was systematically varied to create 2,000 different case mixes ranging in mortality between 5% and 18% using a computer-intensive resampling algorithm. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow C statistic were derived for each of the simulated case mixes with bootstrapping. The surgical intensive care unit at a 450-bed teaching hospital. A group of 6,806 adult surgical patients excluding cardiac surgical patients and burn patients. Simulated data sets were created from a database of patients treated at a single institution to test the hypothesis that the performance of APACHE II is stable across a clinically reasonable range of mortality rates. The discrimination and calibration of APACHE II varied with case mix. The discrimination of APACHE II is not independent of case mix. However, the variability of the Hosmer-Lemeshow statistic as a function of the case mix may simply reflect the limitations of this goodness of fit statistic to assess model calibration. Because the discrimination of APACHE II is a function of case mix, caution should be exercised when using APACHE II-based adjusted mortality rates to compare intensive care units with widely divergent case mixes.
Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxe... more Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.
Neuropulmonology refers to the complex interconnection between the central nervous system and the... more Neuropulmonology refers to the complex interconnection between the central nervous system and the respiratory system. Neurologic injury includes traumatic brain injury, hemorrhage, stroke, and seizures, and in each there are far-reaching effects that can result in pulmonary dysfunction. Systemic changes can induce impairment of pulmonary function due to changes in the core structure and function of the lung. The conditions and disorders that often occur in these patients include aspiration pneumonia, neurogenic pulmonary edema, and acute respiratory distress syndrome, but also several abnormal respiratory patterns and sleep-disordered breathing. Lung infections, pulmonary edema - neurogenic or cardiogenic - and pulmonary embolus all are a serious barrier to recovery and can have significant effects on outcomes such as hospital course, prognosis, and mortality. This review presents the spectrum of pulmonary abnormalities seen in neurocritical care.
Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care, 2016
The use of noninvasive ventilation (NIV) has gained popularity in a variety of applications, incl... more The use of noninvasive ventilation (NIV) has gained popularity in a variety of applications, including acute respiratory failure, and it has been shown to be beneficial in the reduction of complications and improvement in outcomes [1]. A variety of factors can lead to failure to tolerate NIV, and the use of sedation can be effective in keeping the patient comfortable, yet awake and arousable, so as to prevent distress while providing a suitable level of sedation. A survey of the use of sedation in patients receiving NIV revealed that practices vary widely, likely because of a lack of evidence, and as such its application is underused [2]. There are inconsistencies in how often sedation and analgesia are provided, which agents are used, methods of administration, and determination of patient requirements. This lack of consistency sets up a situation in which the patient is exposed to circumstances that make it more difficult to be successfully weaned from mechanical ventilation.
Wentylacja nieinwazyjna odgrywa coraz większą rolę w leczeniu ostrej hipoksemicznej lub hiperkapn... more Wentylacja nieinwazyjna odgrywa coraz większą rolę w leczeniu ostrej hipoksemicznej lub hiperkapnicznej niewydolności oddychania i ma wiele zalet w porównaniu z inwazyjną wentylacją mechaniczną. Do zalet tych zalicza się zachowanie mechanizmów obronnych dróg oddechowych, zmniejszoną potrzebę sedacji i zmniejszenie ryzyka powikłań związanych z intubacją dotchawiczą. Mimo niewątpliwych walorów wentylacji nieinwazyjnej istnieją również pewne przeciwwskazania do stosowania tej metody, jak na przykład ciężka encefalopatia. W niniejszym artykule przeglądowym przeanalizowano podstawy teoretyczne, dowody naukowe i wady stosowania wentylacji nieinwazyjnej u pacjentów z hiperkapnią lub bez hiperkapni, znajdujących się w stanie zaburzonej świadomości
The use of blood products is common in the period after cardiopulmonary bypass. A rare cause of a... more The use of blood products is common in the period after cardiopulmonary bypass. A rare cause of adult respiratory distress syndrome is a reaction to antileukocyte antibodies. The plasma transfused may contain a potent leukocyte antibody that may cause severe problems in the intensive care unit.
Sultan Qaboos University Medical Journal [SQUMJ], 2018
Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration t... more Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration to the lungs without the need for endotracheal intubation. As NIV has proven beneficial in comparison to invasive mechanical ventilation, it has become the optimal modality for initial respiratory support among children in respiratory distress. High-flow nasal cannulae (HFNC) therapy is a relatively new NIV modality and is used for similar indications. This review discusses the usefulness and applications of conventional NIV in comparison to HFNC.Keywords: Noninvasive Ventilation; Nasal Cannulae; Endotracheal Intubation; Mechanical Ventilation; Children.
Acute respiratory failure (ARF) is a major complication in patients with hematological malignancy... more Acute respiratory failure (ARF) is a major complication in patients with hematological malignancy, with outcome largely depending on the cause. Noninvasive ventilation (NIV) is useful as a form of prophylactic support in early ARF and, by avoiding intubation, may improve outcome in patients with reversible ARF. This chapter summarizes the current evidence regarding outcome, application, and limitations of NIV in these patients.
American Journal of Obstetrics and Gynecology, 1991
A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after ... more A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after surgical resection of a cornual pregnancy at 10 weeks' gestation was treated successfully with positive end-expiratory pressure. The underlying cause, extensive pulmonary embolism, was subsequently revealed. The patient survived without residual brain damage. The possible causes of adult respiratory distress syndrome in pregnancy are discussed.
To evaluate the impact of case mix variation on the performance of the Acute Physiology and Chron... more To evaluate the impact of case mix variation on the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II using measures of calibration and discrimination. APACHE II data were collected prospectively at the surgical intensive care unit of the University of Vermont on all adult admissions over an 8-yr period (excluding cardiac surgical patients, burn patients, and patients < 16 yrs of age). The original case mix was systematically varied to create 2,000 different case mixes ranging in mortality between 5% and 18% using a computer-intensive resampling algorithm. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow C statistic were derived for each of the simulated case mixes with bootstrapping. The surgical intensive care unit at a 450-bed teaching hospital. A group of 6,806 adult surgical patients excluding cardiac surgical patients and burn patients. Simulated data sets were created from a database of patients treated at a single institution to test the hypothesis that the performance of APACHE II is stable across a clinically reasonable range of mortality rates. The discrimination and calibration of APACHE II varied with case mix. The discrimination of APACHE II is not independent of case mix. However, the variability of the Hosmer-Lemeshow statistic as a function of the case mix may simply reflect the limitations of this goodness of fit statistic to assess model calibration. Because the discrimination of APACHE II is a function of case mix, caution should be exercised when using APACHE II-based adjusted mortality rates to compare intensive care units with widely divergent case mixes.
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