Med Klin
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Randomized Controlled Trial Comparative Study Clinical Trial
[Epidemiology and diagnosis of intermittent self-ventilation].
The purpose of the lung is intrapulmonary gas exchange. The circulatory system delivers the respiratory gases to the tissue. The ventilatory pump however is responsible for the circulation of air between the lungs and the ambient atmosphere. ⋯ Chronic ventilatory failure as a result of neuromuscular disease or scoliosis of the thoracic spine are the classical indications. COPD and myasthenia gravis are under discussion as indications for intermittent mechanical ventilation with an increasing tendency to ventilate. Epidemiological data however can only be roughly estimated due to the heterogeneity of indication and selection of the patients.
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Noninvasive ventilation as well established in treatment of chronic respiratory failure. Many announcements and our own experience give evidence that this method of treatment is useful for patients with acute respiratory failure too. Also the actual situation of our health system requires increasing attention to financial points of view. ⋯ So noninvasive ventilation is a cost reducing and gentle alternative compared to conventional invasive mechanical ventilation for many patients with acute respiratory failure. It is also practicable in regional hospitals. Further investigation is needed to specify those groups of patients who receive the most benefit from noninvasive ventilation.
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Patients who develop acute exacerbation of a chronic pulmonary disease (COPD), neuromuscular dysfunction and/or disorders of the ventilator control often require assistance of ventilation. transtracheal intubation presents risks of nosocomial pneumonia and injuries. There is general agreement that in patients with chronic alveolar hypoventilation noninvasive positive pressure ventilatory assistance improves ventilation, quality of life, and prolongs survival. Recently, some studies also demonstrate that noninvasive positive pressure ventilation may offer an alternative to intubation in some patients with COPD and lung edema. ⋯ These safeguards include extensive institutional experiences for noninvasive positive pressure ventilations, adequate physicians and respiratory care technicians to provide bedside skilled care and preparedness of emergent intubation, and the patient's mental alertness to tolerate noninvasive ventilatory techniques. The most pronounced benefits of noninvasive positive pressure ventilation was absence of side effects, shortening of time spent in ICU. The present clinical data support the hypothesis that noninvasive positive pressure ventilation may be an alternative for intubation in patient with acute respiratory failure and suggest further clinical investigative support.
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The aim of the present study was to evaluate if Proportional Assist Ventilation (PAV), when applied noninvasively via face mask, can reduce ventilatory effort in patients with respiratory failure. We present preliminary results of an ongoing study. ⋯ Four patients showed reduction of PTdi to various extend. One patient who presented low diaphragmal activity at baseline due to diaphragmal paralysis showed a slight increase in PTdi during ventilation. Mean PTdi decreased by 26.7%. PaCO2 in the 5 patients showed no significant change after 15 minutes of ventilation, thus indicating that with noninvasive PAV patients can maintain constant ventilation with reduced effort.