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J-F Muir

Publications and source records attributed to J-F Muir.

10 recordsLinked to original sources
PubMed2005

[Domiciliary ventilation in patients with COPD].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has become one of the main indications for domiciliary ventilation, which is usually non-invasive (NIV). This review focuses on the pathophysiology processes and clinical trial data that underlie current guidelines from international societies. STATE OF THE ART: To date most published studies about domiciliary ventilation in COPD have been short-term and their message is complicated by the presence of significant methodological problems. The two controlled studies of > or =12 months-duration both found that survival was not improved by long-term NIV. Domiciliary ventilation may be considered when long-term oxygen therapy is unsuccessful and when failed with a progressive deterioration in clinical respiratory status with recurrent episodes of acute hypercapnic respiratory failure. A diurnal PaCO(2) > or =55 mmHg (7.3 kPa) is a necessary but not sufficient condition to consider domiciliary ventilation. CONCLUSION: Domiciliary ventilation should only be initiated in selected patients on the basis of clinical symptoms and exacerbation frequency. Until further characterization of patients who are likely to respond, the response to treatment should be assessed regularly.

Clinical Trials as Topic↗
PubMed2005

Dependency on mask ventilation after acute respiratory failure in the intermediate care unit.

The predictive factors for long-term dependency (LTD) on noninvasive ventilation (NIV) immediately after acute hypercapnic respiratory failure (AHRF) have not been identified. The present authors studied 42 patients with chronic obstructive pulmonary disease (COPD) and 58 non-COPD patients successfully treated by NIV for an AHRF episode. Parameters at stable state, at admission for AHRF and during a 1-yr follow-up were compared in patients with or without LTD-NIV at discharge. The incidence of LTD-NIV was 39% in non-COPD patients and 19% in COPD patients. Based on multivariate analysis with stepwise logistic regression, lower baseline pH values and noninfectious causes of AHRF were independently associated with LTD-NIV. Mutually adjusted odds ratios were found to be 1.316 (95% confidence interval (CI) = 1.127-1.536) for a 0.01 decrease of baseline pH value and 5.1 (95% CI = 1.8-14.0) for a noninfectious cause of AHRF. Outcome after 1 yr was poor in COPD patients. Long-term dependency on noninvasive ventilation is not an uncommon situation after resolution of an acute hypercapnic respiratory failure episode, especially in patients with non-chronic obstructive pulmonary disease causes of respiratory failure. The present study raises the need for prospective validation of a weaning protocol in patients managed by noninvasive ventilation for an acute hypercapnic respiratory failure episode.

Acute Disease↗
PubMed2003

[Instrumental treatment of chronic obstructive bronchopneumonia. The place of non-invasive ventilation].

OF DEBATABLE INTEREST: Although the place of non-invasive ventilation (NIV) is indisputable in the management of acute respiratory failure during chronic obstructive pulmonary disease (COPD), where it significantly reduces the rate of intubation and complications and the number of days spent in intensive care, its interest is debated in the long term management of chronic obstructive respiratory failure (CORF). EFFICACY TO BE DEMONSTRATED: Although several short term studies confirm the efficacy of NIV on some physiological parameters and on the quality of sleep and quality of life in some patients, long term prospective studies are still too few and do not confirm these data on small series of patients and limited time. FOR CERTAIN CATEGORIES OF PATIENTS: It is legitimous to consider that sub-groups of patients respond to NIV, notably in cases of instable CORF non-controlled by medical treatments or by well-conducted kinesitherapy and oxygentherapy.

Bronchopneumonia↗
PubMed2003

[Non-invasive ventilation of elderly patients in the intensive care unit].

INTRODUCTION: An increasing number of elderly patients, with acute respiratory failure (ARF) due to e.g. COPD exacerbation or cardiac failure, are being referred to intensive care units for mechanical ventilation. STATE OF ART: NIV can be an effective ventilatory technique in ARF due to a variety of aetiologies. NIV has been shown to decrease endotracheal intubation rates, complication rates and median hospital length of stay. When managing acute-on-chronic respiratory failure, NIV is a first-line ventilatory technique, in the absence of criteria for immediate endotracheal intubation. The efficacy of NIV depends on the expertise of the medical and nursing staff (including physiotherapists) and should always be performed in an appropriate setting. There are very few data about NIV in the elderly but studies, which included patients over 75 years, did not identify different outcomes for this age group. PERSPECTIVES: Future clinical studies on NIV should allow us to better understand which patients will benefit the most from the technique. Certain specific settings in elderly populations, such as in palliative care or when an "non intubation order" has been given by the patient, his family or the medical/nursing staff, are under evaluation. CONCLUSIONS: NIV is effective and well tolerated and it has become a key ventilatory technique in the management of ARF, particularly for elderly patients.

Acute Disease↗