Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders.
BACKGROUND: Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to...
| Publicado en: | Respiratory Care Vol. 60; no. 4; pp. 477 - 484 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Apr2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103789596&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103789596 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Apr2015 vid: 60 iid: 4 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 103789596 102204365 10.4187/respcare.03584 NLM25841044 103789596 ppf: 477 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders. aug: au: Bach, John R Sinquee, Diane M Saporito, Louis R Botticello, Amanda L affil: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, University Hospital, Newark, New Jersey sug: subj: Lung Diseases Insufflation Respiration, Artificial Methods Noninvasive Procedures Utilization Critically Ill Patients Statistics and Numerical Data Human Retrospective Design Record Review New Jersey T-Tests Post Hoc Analysis Male Female Adult Middle Age Child Adolescence Aged Aged, 80 and Over Descriptive Statistics Data Analysis Software Adult: 19-44 years Middle Aged: 45-64 years Child: 6-12 years Adolescent: 13-18 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for consecutive unweanable subjects. METHODS: A retrospective chart review was performed for consecutively referred intubated subjects with single-organ (respiratory muscle) failure. At presentation, CO2 was normalized by adjusting ventilator settings and VC was measured (point 1). Then, MIE was used via the tube up to every h until oximetry remained ≥ 95% on ambient air and VC was remeasured (point 2) immediately before extubation. Subjects who could not meet ventilator weaning criteria and had no ventilator-free breathing ability upon extubation to CNVS were enrolled. Post-extubation, the MIE was used to maintain oximetry ≥ 95% in room air. VC and breathing tolerance were remeasured within 3 weeks (point 3). RESULTS: Ninety-seven of 98 subjects were successfully extubated despite 45 having been CNVS-dependent for 4 months to 18 y before being intubated. Sixty-nine of the 98 were intubated for 24.9 ± 22 (range 1-158) d and failed 0-6 (mean 1.7) extubation attempts before being transferred and successfully extubated in 2.24 ± 1.78 (range < 1-8) d to CNVS. VC increased by 270% (P < .001) from points 1 to 3. Weaning from CNVS to part-time NVS was achieved by all 52 subjects who had not been CNVS-dependent before intubation. One subject underwent tracheotomy. CONCLUSIONS: Many unweanable subjects can be extubated to CNVS and MIE. The latter can normalize O2 saturation, increase VC, and facilitate extubation. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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