Non-invasive ventilation in patients with an altered level of consciousness. A clinical review and practical insights

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

Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study

Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p  < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population

Wentylacja nieinwazyjna u pacjentów w zmienionym stanie świadomości. Przegląd kliniczny i uwagi praktyczne

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

Non-invasive ventilation in patients with an altered level of consciousness. A clinical review and practical insights

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respiratory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preservation of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation

Noninvasive ventilation: education and training. A narrative analysis and an international consensus document

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the timeand if properly applied, it can save patients’ lives and improve long-term prognosis. However, both knowledge and skills of itsproper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training.Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviewswith the results analyzed by a team of experts across the world through e-mail based communications.Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies withindirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implementedonly in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIVeducation and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated.Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care usingNIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developingcountries