Non-invasive Mechanical Ventilation in Critical Care, Anesthesiology and Palliative Care

This book provides an easy, modern and practical way for physicians to approach the world of noninvasive mechanical ventilation (NIMV). Noninvasive ventilation is well-established and increasingly used in routine clinical practice. However, some concepts and techniques of NIMV may be difficult to grasp for students or for healthcare professionals with less experience. The book is subdivided into 7 sections covering different aspects of clinical applications of NIMV. From modes of ventilation to the proper moment to start noninvasive ventilation; from critical care applications of NIVM (pre-, intra- and post-hospitalization as well as in emergency medicine), to the use outside of ICUs. Its purpose is also considered in several different diseases and settings, including the experience during Covid-19 pandemic and at the end of life. The book addresses anesthesiologists, critical care, emergency care, palliative care, primary care physicians using noninvasive ventilation and will represent an invaluable tool for a better understanding of this technique. Contents List of Contributors Abbreviations Part I: Ventilatory Modes, Ventilators and Interfaces 1: Non-invasive Ventilation: Modes of Delivery and Interfaces 1.1 Modes of Delivery 1.2 Types of Interfaces 1.3 Choosing the Right Non-invasive Ventilation (NIV) Interfaces References 2: Continuous Positive Airway Pressure: High Flow CPAP 2.1 Continuous Positive Airway Pressure 2.1.1 Indications 2.2 High Flow CPAP 2.2.1 Indications 2.2.2 How to Start 2.3 Conclusions References 3: High-Flow Nasal Cannula 3.1 Introduction 3.2 Mechanism of Action and Clinical Benefits 3.3 Researches 3.4 Clinical Indications 3.5 Contraindications 3.6 Complications 3.7 HFNC in the COVID-19 Pandemic References 4: Humidification, Airway Secretions Management, and Aerosol Therapy 4.1 Introduction 4.1.1 Concept Humidity and Physiology and Role of the Upper Airway 4.2 Humidification Devices 4.3 Active Humidifiers 4.4 Assembly 4.5 Precautions and Monitoring for Active Humidifiers 4.6 Passive Humidifiers 4.7 Dead Space 4.8 Resistance 4.9 Active or Passive Humidification 4.10 Background Aerosol Therapy 4.11 Fundamentals of Aerosol Therapy 4.12 Device Effects 4.13 The Heliox Effect 4.14 Type of Aerosol Generator in the Circuit 4.15 Features of Breath 4.16 Dose Effect and the Time 4.17 High Flow Nasal Cannula Effect 4.18 Contemporary Applications of Aerosol Therapy in Critical Care: Focus on Antibiotics 4.19 Limits of Aerosol Therapy in Intensive Care 4.20 Conclusion References Part II: Methodology 5: Why and When to Start Non-invasive Ventilation 5.1 Introduction 5.2 General Criteria for Starting NIV 5.2.1 Indications and Contraindications of NIV 5.2.2 Selection of Patients Who Can Benefit from NIV 5.2.3 Selection of the NIV Interface 5.2.4 Selection of the Most Appropriate NIV Modality 5.3 Clinical Indications for Starting NIV in the Acute Setting 5.3.1 Acute Exacerbation of COPD 5.3.2 Acute Cardiogenic Pulmonary Edema 5.3.3 Acute Exacerbation of Asthma 5.3.4 De Novo Acute Respiratory Failure 5.3.5 Coronavirus Disease-2019 5.3.6 Weaning from Invasive Mechanical Ventilation 5.3.7 NIV in the Prevention and Treatment of ARF after Extubation 5.3.8 NIV in Palliative Care 5.4 NIV in the Chronic Setting 5.4.1 Long-Term NIV in COPD 5.4.2 Obstructive Sleep Apnea Syndrome and Obesity Hypoventilation Syndrome 5.4.3 NIV in Thoracic Restrictive Disorders and Neuromuscular Disease 5.5 Conclusions References Part III: Critical Care Applications of NIMV and Related Issues: Pre-hospital and Emergency Medicine 6: Non-invasive Mechanical Ventilation in Prehospital Medicine 6.1 Introduction 6.2 Indications, Contraindications, and Patient Selection 6.2.1 Indications 6.2.2 Contraindications 6.3 Safety: NIV Vs. Orotracheal Intubation 6.4 Time Issue 6.5 Modalities of NIV 6.5.1 CPAP 6.5.1.1 Venturi-Type Flow Generator System 6.5.1.2 Boussignac System 6.5.2 CPAP-ASB and BIPAP 6.5.2.1 Transport Ventilators 6.6 NIV Interfaces 6.6.1 Helmet Vs. Masks 6.6.2 High Flow Nasal Cannula (HFNC) 6.7 Cost-Effectiveness 6.8 Conclusions References 7: Current Strategies and Equipment for Non-invasive Ventilation in Emergency Medicine 7.1 Introduction 7.2 State of Art 7.3 Discussion 7.4 Conclusion References Part IV: Critical Care Applications of NIMV and Related Issues: Critical Care 8: Non-invasive Positive Airway Pressure and Non-invasive Ventilation in Acute Cardiogenic Pulmonary Edema 8.1 Acute Cardiogenic Pulmonary Edema 8.2 NIV and CPAP in ACPE: Pathophysiology and Benefit of Positive Airway Pressure 8.3 NIV vs CPAP in ACPE: Evidence-Based Results 8.4 NIV and CPAP: Modes and Devices 8.5 Clinical Management 8.6 Modalities Selection and Settings 8.7 Monitoring and Follow-Up 8.8 Conclusions References 9: Non-invasive Ventilation in Severe Pneumonia 9.1 Introduction 9.2 NIV in Severe Pneumonia 9.3 Conclusions References 10: Non-invasive Ventilation in Acute and Chronic Obstructive Pulmonary Disease 10.1 Respiratory System Mechanics and Gas Exchange 10.2 Heart–Lung Interactions 10.3 NIV in COPD 10.4 NIV in Asthma References 11: NIV and ARDS References 12: Non-invasive Ventilation in Covid-19 12.1 Introduction 12.2 NIV Indications and Modifications in Covid-19: Benefits and Advantages 12.3 Ventilation-Related Risks and Contraindications 12.4 Contamination-Related Hazard and Practical Recommendations for Hospital Management References 13: Non-invasive Mechanical Ventilation in Trauma 13.1 Introduction 13.2 Acute Respiratory Failure in Trauma 13.3 Pathophysiology of Acute Respiratory Failure in Trauma 13.4 Direct Chest Trauma 13.4.1 Blunt Thoracic Trauma 13.4.2 Penetrating Chest Trauma 13.4.3 Pneumothorax 13.5 Indirect Chest Trauma 13.6 Ventilatory Management 13.7 Definitive Airway 13.8 Non-invasive Ventilation 13.9 Conclusion References 14: Non-invasive Ventilation in Post-extubation Failure 14.1 The Importance of Extubation and Its Relevance in ICU Patients 14.1.1 Extubation Failure, an Underestimated Problem 14.2 Physiology of Extubation Failure and Its Prevention 14.3 Niv in Prevention of Post-extubation Respiratory Failure 14.4 Niv in Treatment of Post-extubation Respiratory Failure 14.5 Niv in Weaning Patients 14.6 Niv and High-Flow Nasal Oxygen 14.7 Conclusions References Part V: Critical Care Applications of NIMV and Related Issues: Intra- and Postoperative Indications for Non-invasive Mechanical Ventilation 15: Use of Non-invasive Ventilation in Postoperative Patients in Cardiac and Thoracic Surgeries 15.1 Postoperative Pulmonary Complications in Cardiac and Thoracic Surgeries 15.2 Niv and Cardiothoracic Surgery 15.3 NIV and Thoracic Surgery 15.4 Conclusion References 16: Use of Non-invasive Ventilation in Postoperative Patients in Abdominal Surgery 16.1 Introduction 16.2 Risk Factors and Mechanisms of Abdominal Surgery-Induced Postoperative Pulmonary Complications 16.3 Role of Non-invasive Ventilation in Abdominal Surgery 16.3.1 Prevention of Postoperative Pulmonary Complications 16.3.2 Treatment of Postoperative Pulmonary Complications 16.3.3 Complications of NIV in Abdominal Surgery 16.4 Definitions and Principles of the Two Main NIV Techniques 16.5 How to Set NIV and Duration of Trial 16.6 Problems Related to NIV in Postoperative Patients in Abdominal Surgery 16.7 Contraindication 16.8 Conclusion References 17: Non-invasive Ventilation in Solid Transplantation 17.1 Kidney and Pancreas 17.2 Liver 17.3 Lung 17.4 Heart References 18: Non-invasive Positive Pressure Ventilation in Patients Undergoing Lung Resection Surgery 18.1 Introduction 18.2 Epidemiology of Postoperative Pulmonary Complications After Lung Resection Surgery 18.3 Pathophysiology of Postoperative Pulmonary Complications After Lung Resection Surgery 18.4 Role of Non-invasive Respiratory Support Strategies After Lung Resection Surgery 18.4.1 High Flow Nasal Cannula Oxygen Therapy 18.4.2 Non-invasive Positive Pressure Ventilation and Continuous Positive Airway Pressure 18.4.3 High Flow Nasal Cannula Oxygen Therapy Vs Non-invasive Positive Pressure Ventilation 18.5 Conclusions References Part VI: Non-invasive Ventilation Analgesia and Sedation 19: Sedation and Analgesia During Non-invasive Ventilation in Intensive Care References Part VII: Non-invasive Mechanical Ventilation in Do Not Endotracheal Intubation Order and Palliative Care 20: Palliative Use of Non-invasive Ventilation 20.1 Introduction 20.2 End-Stage Chronic Respiratory Disease 20.3 Neoplastic Disease References 21: Use of Non-invasive Mechanical Ventilation in Older Patients 21.1 Introduction 21.2 Structural and Functional Changes with Ageing 21.3 Frailty 21.4 Very Old Patients and Do Not Intubate (DNI) Order 21.5 Conclusion References Untitled 22: Use of Non-invasive Ventilation at the End of Life 22.1 Introduction 22.2 Patients Suitable of NIV at the End of Life 22.3 Medical Decision Making and Withdrawing of NIV 22.4 Planning the Process of Withdrawal 22.5 Symptoms of Respiratory Distress At the End of Life and Their Relief 22.6 Ethical Issues References