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PubMed1993

[Home intermittent negative pressure ventilation in a case of chronic respiratory failure due to old tuberculous pleuritis].

A 64-year-old male with a history of tuberculous pleuritis at age 29 had received home oxygen therapy since age 58 because of chronic respiratory failure. He was admitted with symptoms of dyspnea at rest and myoclonus at age 62. Because CO2 narcosis occurred twice, we performed intermittent negative pressure ventilation (INPV) after short-term positive pressure ventilation with transnasal intubation. He has received INPV for 7 hours every day at his home for 20 months without acute exacerbation of respiratory failure, and his activity of daily life subsequently improved. In conclusion, INPV seems to be useful for patients with chronic hypercapnic respiratory failure due to lung disease.

Chronic Disease↗
PubMed1993

Intermittent negative pressure ventilation in patients with restrictive respiratory failure.

Thirty one patients in stable respiratory failure (arterial oxygen tension (PaO2) 67 +/- 20 mmHg (8.9 +/- 2.7 kPa) and arterial carbon dioxide tension (PaCO2) 59 +/- 10 mmHg 7.9 +/- 1.3 kPa)), secondary to non-obstructive ventilatory impairment, were treated by intermittent negative pressure ventilation (INPV), using a pneumowrap or poncho during the night. Daytime arterial blood gas measurements, taken before and after the ventilation, revealed a substantial improvement in PaO2, PaCO2 and maximal inspiratory pressure (Pimax). This improvement persisted during the six month follow-up of home nocturnal ventilation. The polysomnographic, recording during mechanical ventilation by poncho, in five patients, showed a general improvement in the quality and structure of sleep. All patients returned to normal arterial oxygen saturation (SaO2) values (> 90%), except for one. In three patients, the appearance of obstructive events was noted but the desaturation that they caused was, remarkably, lower than that caused by central events in baseline recording. We conclude that non-invasive treatment by INPV, in patients with neuromuscular and chest wall disease, is the method of choice as an alternative to intermittent positive pressure ventilation and to tracheostomy.

Adult↗
PubMed1995

Effects of the iron lung on respiratory function in chronic hypercapnic COPD patients.

Whether or not short-term negative pressure ventilation (NPV) improves respiratory function by decreasing the drive to the respiratory muscles in hypercapnic chronic obstructive pulmonary disease (COPD) patients remains to be defined. In six severely obstructed hypercapnic COPD patients (Group A) with grade IV dyspnoea (modified Medical Research Council (MRC) dyspnoea scale), we evaluated pulmonary volumes, arterial blood gases, the pattern of breathing (tidal volume (VT) and respiratory frequency (Rf)) and the neuromuscular respiratory drive (NMRD), before and immediately after a 7 day period with the iron lung (IL). NMRD was assessed by expressing mouth occlusion pressure (P0.1) recorded during quiet breathing as a percentage of maximal P0.1 recorded during exogenous CO2 stimulation (P0.1 max,CO2). A group of six hypercapnic, less dyspnoeic (grade II to III) COPD patients (Group B), with similar mechanical characteristics, and another less obstructed historically normocapnic control group (Group C) were also considered. Before IL, in Group A VT was lower than in C, and P0.1 (%P0.1 max,CO2) was greater than in Group B and C. After a 7 day period with IL, VT increased, Rf decreased, and arterial blood gases and dyspnoea grade improved; P0.1 (%P0.1 max,CO2) significantly decreased remaining, however, greater than in Group C. In Group A the time course of arterial carbon dioxide tension (Pa,CO2) and P0.1 (%P0.1 max,CO2) were significantly related to each other. These data seem to indicate that IL is effective in improving respiratory function and symptoms in chronic hypercapnic severely dyspnoeic COPD patients. The observation that these effects were associated with a decrease in NMRD reflects an improved efficiency of the respiratory system. After IL, respiratory function in Group A was similar or even better than that in Group B. This study also considers the possibility of putting severely dyspnoeic hypercapnic COPD patients into an IL trial before starting a traditional rehabilitation programme.

Aged↗
PubMed1996

Central alveolar hypoventilation (Ondine's curse) treated with negative pressure ventilation.

A 22 year old woman with central alveolar hypoventilation (CAH) underwent repeated nocturnal polysomnographic recordings to assess the efficacy of negative pressure ventilation (NPV) administered by pneumowrap. The NPV successfully prevented hypoxia during most of the recording time; however, a sudden severe hypoxic episode not related to an apnoea occurred during a recording night with NPV. This made home use advisable together with an ear oximeter fitted with an alarm.

Adult↗
PubMed1996

Continuous negative extrathoracic pressure in neonatal respiratory failure.

OBJECTIVE: In uncontrolled clinical trials, negative extrathoracic pressure has been shown to be an effective respiratory support. We aimed to assess its role in the context of current neonatal intensive care. DESIGN: A randomized controlled trial, with sequential analysis of matched pairs of infants. Matching was undertaken by stratified randomization from 15 groups divided according to gestational age, oxygen requirement, and whether patients were intubated at 4 hours of age. SETTING: Two neonatal intensive care units. PATIENTS: Two hundred forty-four patients (birth weight 1.53 +/- 0.69 kg (mean +/- SD); gestational age 30.4 +/- 3.5 weeks) with respiratory failure. INTERVENTIONS: Patients were randomized at 4 hours of age to receive either standard neonatal intensive care, or standard care plus continuous negative extrathoracic pressure (CNEP, -4 to -6 cmH2O) applied within a purpose-designed neonatal incubator. OUTCOME SCORES: Clinical scores were calculated for each infant at 56 days of age, or death if earlier. Scores included measures for mortality, respiratory outcome, the presence of cerebral ultrasound abnormalities, patent arterial duct, necrotizing enterocolitis, and retinopathy. The treatment given for the higher score for each pair was recorded and the cumulative net number of pairs favoring CNEP plotted in the sequential analysis to provide an ethical early termination strategy. Individual components of the outcome score and other secondary measurements were analyzed on completion of the trial. RESULTS: The sequential analysis reached a decision boundary after 122 out of a possible maximum of 124 pairs were completed. The overall outcome score showed an overall significant benefit for CNEP. Secondary analysis showed that the use of CNEP was associated with an increase in mortality, cranial ultrasound abnormalities, and pneumothoraces, which were not statistically significant. However, 5% fewer patients were intubated (95% confidence interval [CI], 0-10), and the total duration of oxygen therapy among surviving infants at 56 days was lower (20.5 days, compared with 38.9 in controls; difference 18.4 days, 95% CI 3.8 to 33.0). Among all infants, the mean total duration of oxygen therapy was 18.3 days among CNEP-treated infants compared with 33.6 days among the controls (difference -15.3 days, 95% CI -0.2 to -30.4). This reduction in mean levels is entirely attributable to substantially fewer patients requiring prolonged oxygen therapy, the median duration of treatment being very similar in the two groups. As a result, commensurately fewer surviving infants showed chronic lung disease of prematurity. CONCLUSIONS: The use of continuous negative pressure improves the respiratory outcome for neonates with respiratory failure.

Female↗
PubMed1996

[Temporary use of chest negative pressure ventilation to facilitate closure of a tracheal stoma before domiciliary nasal intermittent positive pressure ventilation].

A 67-year-old patient with pulmonary tuberculosis sequela had undergone a tracheostomy. The patient was receiving nasal intermittent positive pressure ventilation and the stoma failed to close. Temporary use of chest negative pressure ventilation facilitated closure of the stoma and probably shortened the patient's hospital stay. Nasal intermittent positive pressure ventilation at home was begun safely and effectively.

Aged↗
PubMed1996

[Effects of several methods of thoracic drainage on respiratory function].

UNLABELLED: The object of this study was to verify the influence on the pulmonary function of the pleural space ampliation with pleural drainage tube underwater seal, with several volumes or with variables negative pressures. We performed 42 New Zealand white rabbits of both sexes with an average age of 57 +/- 9.31 days and an average weight of 1720 +/- 181 g. The experimental protocol consisted of study group: P1 (n = 14) was performed a unilateral thoracostomy at the 5th. Intercostal space and P2 (n = 14) with bilateral pleural drainage. The pleural drainage tube (drain trocart ORX Vygon number 8) connected at small bottle (Fp), with 35 ml of extrapleural volume and at big bottle (FG) with 3940 ml of extrapleural volume and vacuum suction of various negative pressures (-5, -10, -15 and -20 cm H2O). CONTROL GROUP: C1 (n = 7) with unilateral pleural drainage clamped and C2 (n = 7) with bilateral pleural drainage clamped. Anesthesia was induced with ketamine hydrochloride (7.5 ml/Kg) and propionilpromazyne (1.5 ml/Kg) intramuscular cocktail and after maintained with bolus injection of 1/4 induction dose. We studied the mortality, the the fluctuations of drain hydrostatic column, heart rate (FC), respiratory rate (FR) and blood gas tensions, after cannulation of right jugular vein and during the different phases of experimental design. Venous blood samples were obtained for pO2, pCO2 and pH measurements were repeated at 5' in both groups. The 50% of animals died in the P2 group during the drainage pleural of FG. The fluctuation of column of Fp was similar in both groups: P1 = 6.39 +/- 1.0, with a decrease of 0.64 +/- 0.23 and P2 = 6.37 +/- 1.29, with a decrease of 0.63 +/- 0.28, respectively. The vacuum suction of pleural cavity may produce a FR fall which recovery fast. The bilateral pleural drainage with negative pressures produced decreases of pCO2 and pO2. There is not modifications of Acid Base Balance in the experimental groups. We concluded that during bilateral pleural underwater seal connected a FG, because the increase of extrapleural space may produce a high mortality and a fall of respiratory rate with fast recovery. Also the pleural suction improved the CO2 diffusion into the alveolus. There is not modifications of pO2 in P1 group or decrease in the P2 group.

Animals↗
PubMed1997

[Noninvasive ventilation in intensive care].

Non-invasive ventilation has been in use for many years to provide long-term home ventilatory support to patients with chronic respiratory failure. In recent years, it has emerged on the intensive care scene as a means of avoiding intubation in acute respiratory failure. The results of several studies indicate that such an approach can lead to a reduction in mortality and duration of hospital stay compared to conventional mechanical ventilation with endotracheal intubation. The purpose of this article is to explore the various ventilatory techniques available, the choice of respirator and ventilatory mode in various clinical conditions, and to discuss some of the logistics involved in the optimal use of this technique.

Acute Disease↗
PubMed1997

Negative pressure ventilation in COPD patients with acute on chronic respiratory failure.

Negative pressure ventilators act by exposing the surface of the chest wall to subatmospheric pressure during inspiration. During negative pressure ventilation (NPV), tidal volume is related to the peak of the inspiratory negative pressure and the pressure waveform generated by the ventilator pump; for the same peak of negative pressure a square wave produces a greater tidal volume than a half sine wave. Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease (COPD), reducing the need for endotracheal intubation. Recently, NPV has been used with a good outcome as a first-line treatment in COPD patients with severe acute respiratory failure and hypoxic hypercapnic coma. The positive results of these reports need to be confirmed by further controlled studies before recommending the generalized use of NPV in COPD patients with acute respiratory failure as standard care.

Acute Disease↗
PubMed1997

Effects of positive and negative pressure breathing on muscle sympathetic nerve activity in humans.

To clarify the dynamic effects of short-term continuous positive-pressure breathing (CPPB) and continuous negative-pressure breathing (CNPB) on sympathetic nerve activity, we measured muscle sympathetic nerve activity (MSNA) in the tibial nerve together with blood pressure, heart rate, and central venous pressure (CVP) during spontaneous breathing: 5, 10, and 15 mm Hg (CPPB), and -5, -10, and -15 mm Hg (CNPB) for 5 min, respectively, in six healthy male volunteers. Increasing levels of CPPB at 5, 10, and 15 mm Hg produced increasing levels of MSNA, however, during CNPB, MSNA was virtually constant. Mean blood pressure decreased and heart rate increased during CNPB, while neither factor changed significantly during CPPB. CVP increased during CPPB and decreased during CNPB. These results suggest that CPPB and CNPB do not have the inverse effects on MSNA.

Adult↗
PubMed1988

Home mechanical ventilation.

Recently, interest in the use of mechanical ventilation outside the hospital setting has been increasing. Patients with various types of chronic respiratory failure may benefit from this approach. Evaluation for long-term mechanical ventilation necessitates assessment of the underlying disease process, the goals of the medical team, and the needs of the patient and family. Externally applied negative-pressure devices can provide adequate ventilation for many patients, particularly those with neuromuscular diseases. Positive-pressure ventilation by means of a tracheostomy provides greater control of the airway, allows adjustment of tidal volume and minute ventilation, and may be delivered by portable equipment. Ongoing care and support services in the home must be provided. A variety of mechanical devices and new techniques of ventilator support have made home mechanical ventilation a realistic option for long-term care.

Adult↗
PubMed1993

Phrenic nerve pacing--an alternative to positive pressure ventilation: the required nursing care.

Phrenic nerve pacing as a method of ventilation was first recognized in 1783. For years, this technique was not used because of the lack of practical technology. Interest in phrenic nerve pacing was renewed in the 1960s with the development of a radio frequency transmission system. Applicable to a limited patient population, phrenic nerve pacing has several benefits over positive-pressure ventilation. Benefits include greater patient mobility, verbal articulation, less mechanical noise, and breathing by natural negative-pressure. This article provides information for nurses who care for patients ventilated by phrenic nerve pacing.

Diaphragm↗