Artificial respiration
In medicine and respiratory therapy,, artificial respiration is "Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have respiratory insufficiency to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2)."[1]
Classification
Using intratracheal intubation
Intratracheal intubation involves the insertion of a tube into the trachea to maintain an airway and to prevent obstruction.
- PEEP. A randomized controlled trial has compared titrating PEEP with esophageal pressure and recommendations by the Acute Respiratory Distress Syndrome Network (ARDSNet).[2]
Extraglottic methods
- i-gel[3]
Noninvasive
According to the U.S. National Library of Medicine, the terms for the types of nonvinvasive ventilation, also called noninvasive positive pressure ventilation (NPPV) are:
- Continuous positive airway pressure (CPAP).
- Bilevel positive airway pressure (bilevel PAP).
- Intermittent positive-pressure breathing (IPPB or NIPPB or called pressure support).
Inconsistent terminology of noninvasive modes
The terminology for noninvasive respiratory support is inconsistently used in the medical literature.
- Some authors interchange IPPB with IPPV. B indicates the patient is spontaneously breathing while V indicates ventilation via intratracheal intubation.
- Some authors interchange IPPB and IPPV with bilevel PAP as done in a recent randomized controlled trial.[4]
- Some authors interchange bilevel PAP with BiPAP. The latter is a specific brand of a bilevel PAP ventilator.
Effectiveness
Chronic obstructive pulmonary disease
All types of noninvasive ventilation studied through 2003 may help respiratory insufficiency due to chronic obstructive pulmonary disease according to systematic reviews[5][6] of randomized controlled trials[7][8], especially if the exacerbations are severe[9]. In one trial[7]:
- Patients were included if PaCO2 was greater than 45 mm Hg.
- Bilevel PAP was started at:
- Inspiratory pressure 10 cm H20
- Expiratory pressure 4 cm H20
- Encouraged for up to:
- Day 1: As much as tolerated
- Day 2: 16 hours
- Day 3: 12 hours
- Inspiratory pressure was increased by 5 cm H20 as needed up to 20 H20 as tolerated.
Heart failure
Noninvasive ventilation may help treat respiratory insufficiency due to heart failure, but the optimal mode of noninvasive ventilation is not clear. A systematic review found that CPAP may be better than bilevel PAP.[10] However, in a more recent randomized controlled trial of respiratory insufficiency due to heart failure, neither CPAP or bilevel PAP reduced mortality as compared to standard oxygen therapy; however, both of the noninvasive methods provided similar symptomatic and metabolic improvement.[4] In this trial CPAP was started at 5 cm of water and increased as needed to 15 cm of water. Bilevel PAP was started at an inspiratory positive airway pressure of 8 cm of water and an expiratory positive airway pressure of 4 cm of water and was increased as needed to an inspiratory pressure of 20 cm of water and expiratory pressure of 10 cm of water.[4]
References
- ↑ Anonymous (2024), Artificial respiration (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Talmor D, Sarge T, Malhotra A, et al (November 2008). "Mechanical ventilation guided by esophageal pressure in acute lung injury". N. Engl. J. Med. 359 (20): 2095–104. DOI:10.1056/NEJMoa0708638. PMID 19001507. Research Blogging.
- ↑ Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM (June 2008). "I-gel insertion by novices in manikins and patients". Anaesthesia. DOI:10.1111/j.1365-2044.2008.05542.x. PMID 18557971. Research Blogging.
- ↑ 4.0 4.1 4.2 Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J (July 2008). "Noninvasive ventilation in acute cardiogenic pulmonary edema". N. Engl. J. Med. 359 (2): 142–51. DOI:10.1056/NEJMoa0707992. PMID 18614781. Research Blogging.
- ↑ Ram FS, Picot J, Lightowler J, Wedzicha JA (2004). "Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease.". Cochrane Database Syst Rev (3): CD004104. DOI:10.1002/14651858.CD004104.pub3. PMID 15266518. Research Blogging. Review in: Evid Based Nurs. 2005 Jan;8(1):22
- ↑ Hess DR (July 2004). "The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature". Respir Care 49 (7): 810–29. PMID 15222912. [e]
- ↑ 7.0 7.1 Plant PK, Owen JL, Elliott MW (2000). "Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.". Lancet 355 (9219): 1931-5. PMID 10859037.
- ↑ Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A et al. (1995). "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.". N Engl J Med 333 (13): 817-22. PMID 7651472.
- ↑ Keenan SP, Sinuff T, Cook DJ, Hill NS (June 2003). "Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature". Ann. Intern. Med. 138 (11): 861–70. PMID 12779296. [e]
- ↑ Pang D, Keenan SP, Cook DJ, Sibbald WJ (October 1998). "The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review". Chest 114 (4): 1185–92. PMID 9792593. [e]