Starting experience with non-invasive ventilation in paediatric intensive care unit

Non-invasive ventilation in pressure support (NIV) is well described in the adult and child over 5 years. However, its use in children less than 1 year of age remains anecdotal. We report our preliminary experience with the use of NIV in six children aged from 5 days to 10 months. NIV was delivered with a flow generator (VPAP IIST, Resmed Ltd, North Ryde, NSW, Australia) in association with specific tubings and a nasal mask. The use of NIV resulted in a significant decrease of both the respiratory rate (from 53 to 39 breaths per min, p < 0.01) and the PvCO(2) (from 9.33 to 6.28 kPa, p < 0.01). These results show that NIV can be used in children under 1 year of age with improvement of physiological parameters.     

Clinical applications of mechanical ventilation

This paper reviews recent applications of mechanical ventilation such as controlled hypoventilation in acute asthma, domiciliary nocturnal ventilation in chronic respiratory failure due to neuromuscular disease and improvement of left ventricular performance by raised intrathoracic pressure. Established uses of mechanical ventilation include control of respiratory failure, intracranial pressure and pulmonary hypertension while other uses such as internal splinting of flail chest, simultaneous ventilation-compression cardiopulmonary resuscitation and prophylactic postoperative ventilation are more controversial.     

Our experience of non-invasive lung ventilation in surgical intensive care unit

Non-invasive lung ventilation (NILV) is one of the most up-to-date methods of respiratory support at acute respiratory failure (ASF). The study is devoted to evaluation of efficacy, safety and tolerance (comfort) of this treatment mode for the patient. NIVL was carried out in 483 patients divided into 5 groups against the leading etiopathogenetic development mechanism of ASF. The greatest success of NIVL was achieved in the groups of patients with acute left ventricle failure and respiratory failure with restrictive-like ventilation disturbances. The greatest frequency of complications was noted in groups of patients with acute parenchymatous lung damage and chronic obstructive lung disease. Use of NILV allows to improve gas exchange indices and mechanical property of lungs noticeably. This treatment mode is an efficacious and safe enough alternative to intubation of trachea in patients with ASF in resuscitation units of multiply-discipline surgical hospitals.     

Clinical application of postoperative non-invasive positive pressure ventilation after lung cancer surgery

Objective

The purpose of this study was to clarify the clinical efficacy of postoperative non-invasive positive pressure ventilation (PONIV) after pulmonary lobectomy in patients with lung cancer.

Methods

From August 2010 and July 2015, 143 patients with lung cancer who underwent pulmonary lobectomy were retrospectively reviewed. PONIV was used immediately after surgery until the morning of postoperative day (POD) 1. Arterial blood gas was analyzed before and just after surgery (POD0) and on POD1. Oxygenation ability was perioperatively assessed by PaO₂/FiO₂ ratio, alveolar–arterial oxygen difference (A-aDO₂), and respiratory index (A-aDO₂/PaO₂).

Results

112 patients received PONIV. From POD0 to POD1, the PaO₂/FiO₂ ratio significantly improved in all patients who received PONIV (333?±?83 to 359?±?47 mmHg, p?=?0.004). Moreover, A-aDO₂ and respiratory index significantly decreased following PONIV. PONIV significantly improved the PaO₂/FiO₂ ratio in patients with PaO₂/FiO₂ ratio of ≤?300 on POD0, older age (≥?70 years), higher body mass index (≥?25 kg/m²), and longer one-lung ventilation time (≥?180 min). There was no respiratory failure requiring mechanical ventilation and no mortality.

Conclusions

PONIV effectively improved oxygenation in patients undergoing pulmonary lobectomy in patients with poor status, especially in patients with PaO₂/FiO₂ ratio of ≤?300 on POD0. PONIV could be an option of perioperative management for major thoracic surgery.