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Ramsay, Michelle Clare. "Patient-ventilator interaction in domiciliary non-invasive ventilation." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/patientventilator-interaction-in-domiciliary-noninvasive-ventilation(9b60bd3e-84b6-4605-96a8-22b4546b1e90).html.
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Introduction: Patient-ventilator asynchrony (PVA) can adversely affect the initiation of home mechanical ventilation (HMV). The aim was to quantify the prevalence of PVA during HMV and determine the relationships between PVA and adherence to therapy, respiratory muscle loading, nocturnal gas exchange, health-related quality of life measures and sleep quality. Method: A pilot randomised control trial was conducted to compare a physiological led set-up of HMV, using neural respiratory drive to optimise ventilator set-up, to an expert led set-up. Type and frequency of PVA were measured by surface parasternal muscle electromyography, thoraco-abdominal plethysmography and mask pressure during initiation of HMV and 3 months post therapy. Severe PVA was defined as affecting ≥10% of breaths. Results: 40 patients (25 male) were enrolled with an age of 58±17years and a body mass index(BMI) of 33±10kg/m2. Underlying diagnoses were neuromuscular ± chest wall disease (NMD-CWD,n=11), obesity-related chronic respiratory failure (ORRF,n=13) and chronic obstructive pulmonary disease (COPD, n=16). Overall, PVA affected 25.6(16.4-35.7)% breaths at initiation of HMV, with ineffective efforts as the predominant type of PVA affecting 10.9(4.6-23.7)% breaths. No difference was observed in the frequency of PVA between physician led and physiological led set-up of HMV at initiation or 3 months(28.4(17.4-37.6)%vs 25.6(14.0-30.4)%;p=0.6 and 22.4(13.3-37.1)%vs23.3(15.2-41.5)%;p=0.7,respectively). No correlations were observed between PVA and ventilator adherence(rs=0.02,p=0.90), nocturnal oxygen saturations(rs =0.04,p=0.85), nocturnal carbon dioxide levels(rs=0.15,p=0.41), respiratory muscle unloading(rs=0.06,p= 0.76), patient perception of ventilator synchronisation(rs=0.03,p=0.9) at 3 months of HMV therapy. 10 patients (7 male) underwent polysomnography assessment of sleep quality. No further correlations were observed between PVA during sleep and sleep efficiency (rs=-0.6,p=0.1), wake after sleep onset(rs=0.5,p= 0.2) or total sleep time(rs=-0.4,p= 0.3) at 3 months of HMV therapy. Conclusion: Severe PVA was identified in the majority of patients irrespective of pathophysiological disease. This was not associated with inappropriate delivery of effective ventilation. These data suggest that elimination of PVA may not be required to successfully set-up HMV.
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Tuggey, Justin Mark. "Non-invasive ventilation in chronic respiratory failure." Thesis, University of Leeds, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427749.
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Moran, Fidelma. "Non-invasive ventilation in non cystic fibrosis bronchiectasis." Thesis, University of Ulster, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.445062.
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Ward, Sarah Anne. "Impact of non-invasive ventilation on congenital neuromuscular disease." Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415338.
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Cheema, Baljit Kaur. "Non-invasive ventilation during paediatric retrieval: a systematised review." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27880.
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Background: In hospital critical-care and emergency settings, non-Invasive ventilation (NIV) is increasingly used in neonatal and paediatric patients as an alternative to invasive positive pressure ventilation (IPPV). Critically ill children and babies may need transfer to higher levels of care, but the emergency transport setting is lagging behind the hospital sector in terms of availability of NIV. Aim and objectives: The goal of this study was to assess the evidence on the safety and effectiveness of NIV in children during transportation. Safety outcome measures were intubation or escalation of ventilation mode (during and soon after transport) and adverse event (AE) occurrence during transport. Effectiveness outcome measures related to improvement in clinical parameters during transfer. Methods: A systematised review of the literature was conducted, based on searches of MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials (CENTRAL), African Index Medicus, Web of Science Citation Index and the World Health Organisation Trials Registry (ICTRP). Two reviewers independently reviewed all identified studies for eligibility, with an initial screening round followed by a full-text review of potentially relevant articles. The quality of studies meeting inclusion criteria was evaluated using an adapted quality assessment tool developed for this study. Results: A total of 1287 records were identified; of these, 12 studies met inclusion criteria. Following quality assessment, eight studies were included and four studies were excluded. There were no randomised controlled trials, quasi-randomised controlled trials or non-randomised studies of intervention, to answer the research question. The included studies were all observational in design: seven studies (n= 708) evaluated in-transport use of continuous positive airway pressure (CPAP) and one study (n=150) reported on use of high-flow nasal cannula (HFNC) in children during transport. During transport on NIV, 3/858 (0.4%) patients required either intubation (1/708; 0.1%; CPAP studies) or escalation of mode of ventilation (2/150; 1%; HFNC study). In the 24 hours following transfer, 63/650 (13%) of children transferred on NIV, were intubated. The odds of intubation within 24 hours were significantly higher for CPAP transfer 60/500 (12%) compared with HFNC 3/150(2%): OR (95% CI) 6.68 (2.40 - 18.63), p=0.00003. Adverse events, where reported, were found to occur in 2-4% of NIV transports, with use of BVM in 8/334 (2%), desaturation episodes in 9/290 (3%), apnoea in 11/290(4%) and administration of CPR in 0/290 (0%) cases being described. There was insufficient reporting of change in vital signs or clinical condition during transport for meaningful analysis. Conclusion: This study is the first systematised review indicating that NIV use in children during transport is likely to be safe. From the low-reliability evidence available, it was calculated that NIV use in children during transport would result in a 0.4% rate of intubation or escalation during transport and an in-transport adverse event rate of 2-4%. There was insufficient evidence to comment on clinical effectiveness of NIV during transfer. Following NIV transfer, 13% of patients were intubated within 24 hours, with significantly higher odds of intubation in children transported on CPAP compared with HFNC. Recommendations: Further research is needed in order to make firm recommendations regarding the safety and effectiveness of NIV during transport of children. A recommended minimum data set, for the standardised reporting of observational studies of paediatric NIV use during transport, is suggested. It is recommended that transport databases and registries are expanded to include NIV details as well as information regarding the presence or absence of pre-specified adverse events during transport.
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Bourke, Stephen C. "Sleep, breathing and non-invasive ventilation in motor neurone disease." Thesis, University of Newcastle Upon Tyne, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433126.
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Rabarimanantsoa-Jamous, Herinaina. "Qualité des interactions patient-ventilateur en ventilation non invasive nocturne." Rouen, 2008. http://www.theses.fr/2008ROUES044.
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La ventilation non invasive est un moyen de traitement usuel et efficace pour soulager l’insuffisance respiratoire hypercapnique. Elle est réalisée à l’aide d’un ventilateur insufflant de l’air dans les voies respiratoires par l’intermédiaire d’un masque apposé au visage du patient : elle permet ainsi de pallier à un manque d’oxygénation et à une augmentation du taux de CO2 dans le sang. Cependant, sa réussite qui dépend surtout de l’amélioration de facteurs cliniques (normalisation des gaz du sang) est fortement liée à des facteurs dynamiques tels que la qualité des interactions patient-ventilateur : il importe ainsi que l’effort inspiratoire du patient soit suffisant pour déclencher le ventilateur et que le ventilateur réponde de manière synchrone et adéquate au cycle respiratoire du patient. Puisque la majorité des patients est ventilée la nuit, l’objectif principal de cette thèse est donc de caractériser les interactions complexes entre le patient et le ventilateur au cours du sommeil. Pour cela, des techniques d’analyse issues de la théorie des systèmes dynamiques non linéaires (portrait de phase, entropie de Shannon, dynamique symbolique) et des statistiques (comparaison de moyennes, distributions, matrices de Markov) ont été développées et validées afin d’apprécier objectivement la qualité des interactions patient-ventilateur au cours du sommeil et leurs conséquences sur la qualité du sommeil. A partir d’une étude clinique incluant quarante et un insuffisants respiratoires, des interactions patient-ventilateur non optimales et/ou des fuites au niveau du masque sont observées chez la moitié des patients. Une relation entre asynchronismes et présence de micro-éveils et d’éveils intra-sommeil est montrée et prouve que les asynchronismes contribuent à une fragmentation du sommeilNon invasive ventilation (NIV) is an usual and efficient treatment to relieve hypercapnic respiratory failure. A ventilator is connected to patient’s face through a mask and insufflates some air into the respiratory airways. However, the success of NIV mainly depends on blood gases normalisation as well as on a good synchronisation between patient’s inspiratory efforts and ventilator’s responses. The ventilator must trigger or be adequately stop the pressurisation according to patient’s inspiration or expiration. Furthermore, since patients are mostly ventilated during their sleep, the main objective of this thesis was to characterize and to quantify patient-ventilator interactions during sleep. For that purpose, techniques borrowed from non linear dynamic systems theory (phase portrait, Shannon entropy, symbolic dynamics) and from statistics (distributions, Markov matrix) were developed and validated in order to objectively appreciate the quality of patient-ventilator interactions during sleep and to evaluate their consequences on sleep quality. From a clinical study including forty one patients with respiratory failure, patient-ventilator interactions were found non optimal in about half of patients who also present major leaks. A privileged relation was found between asynchronies and the presence of micro-arousals and awakenings. These results prove that asynchronies contribute to sleep disruption
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Borel, Jean-Christian. "Effets cliniques, biologiques et aspects techniques de la ventilation non invasive." Grenoble 1, 2008. http://www.theses.fr/2008GRE10250.
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L'hypoventilation alvéolaire chronique est considérée comme un marqueur d'évolution péjorative de différentes pathologies respiratoires. Cependant, son rôle physiopathologique dans différentes dysfonctions systémiques n'a pas été étudié de manière convaincante. Cette thèse avait pour but d'investiguer les conséquences de l'hypoventilation alvéolaire modérée au cours de l'insuffisance respiratoire chronique restrictive et les effets de son traitement par ventilation non-invasive. Nous avons montré que des patients affectés d'un syndrome obésité-hypoventilation (SOH) avaient une fonction endothéliale plus sévèrement altérée et une inflammation systémique plus importante que les patients obèses simples. La PaCO2 était corrélée à la dysfonction endothéliale (Borel et coll, manuscrit en préparation). Nous avons observé que la proportion d'hypoventilation en sommeil paradoxal, chez les sujets SOH, était associée à une réponse ventilatoire au CO2 abaissée et une somnolence diurne excessive. Pour la première fois, nous avons constaté que la ventilation non invasive nocturne améliorait la vigilance diurne objective (Chouri-Pontarollo et coll, Chest 2007). Nous menons actuellement la première étude randomisée du traitement des patients porteurs d'un SOH par VNI versus observation pendant un mois. L'analyse intermédiaire montrait qu'un mois de VNI nocturne chez les patients SOH améliorait la PaCO2 diurne, la capacité pulmonaire totale, la structure du sommeil, cependant aucun paramètre cardiovasculaire et métabolique n'était modifié. Chez des patients insuffisants respiratoires chroniques pariéto-restrictifs, la VNI utilisée au cours d'un exercice aigu, augmentait la ventilation et améliorait la tolérance à l'effort (Borel et coll, Resp Med 2008). Chez ces mêmes patients, un réentrainement à l'effort sous VNI n'apportait pas de bénéfices additionnels par rapport à un réentrainement en ventilation spontanée sauf chez les patients les plus sévères. Ces derniers, amélioraient leur périmètre de marche et leur qualité de vie. Leur fatigue en particulier était améliorée s'ils s'étaient réentraînés sous VNI (Borel et coll, Am Journal of physical med and rehab, 2008, soumis). Enfin, nous avons analysé l'impact des fuites intentionnelles des masques de VNI sur la performance des appareils de VNI bi-pressionnels. L'augmentation des fuites intentionnelles diminuait les capacités des appareils à atteindre et maintenir la pression de consigne. Ceci pouvait conduire à une diminution du volume délivré au patient, en particulier pour des fuites intentionnelles supérieures à 40 L. Min-1 à 14 cm H2O de pression (Borel et al, Chest, sous presse). Conclusion : L'hypoventilation alvéolaire chronique peut-être considéré comme un déterminant physiopathologique de la dysfonction endothéliale, de l'inflammation, de la somnolence, et de l'intolérance à l'effort. La VNI, utilisée au cours des efforts, permet d'améliorer les capacités d'exercice et la qualité de vie des patients insuffisants respiratoires restrictifs les plus sévères. Malgré les limites technologiques des appareils de VNI bi-pressionnels utilisés actuellement, la VNI corrige l'hypoventilation alvéolaire des patients SOH, cependant les effets sur l'inflammation, la dysfonction endothéliale restent incertains à cours et long terme chez ces sujets obèsesChronic alveolar hypoventilation is considered as a pejorative factor of several respiratory diseases outcomes. However, its pathophysiological impact has not been studied in a convincing way. This thesis aimed to assess moderate alveolar hypoventilation consequences during restrictive chronic respiratory failure and the effects of its treatment by non-invasive ventilation (NIV). We have shown that Obesity Hypoventilation Syndrome patients (OHS) had more severely impaired endothelial function and higher systemic low-grade inflammation than simple obese patients. Arterial PaCO2 was correlated with endothelial dysfunction (Borel et al, manuscript in preparation). We have also reported that in OHS, the proportion of REM-sleep time spent in hypoventilation was related to lowered CO2 ventilatory response and to excessive diurnal sleepiness. Non-invasive ventilation improved objective diurnal vigilance (Chouri-Pontarollo et al Chest 2007). Currently, we are conducting the first randomized NIV versus observation during one month study in OHS. The intermediate analysis showed that one month of nocturnal NIV led to a diurnal PaCO2, an improvement of sleep structure and an increase of total lung capacity. However, neither cardiovascular nor metabolic parameters were modified. When NIV was used during exercise, in patients with chronic thoracic restrictive respiratory failure, minute ventilation and exercise tolerance were improved (Borel et al, Resp Med 2008). In these patients, long term training with NIV had no additional benefits as to training in spontaneous breathing, except for the most severe of them. For those later patients, training with NIV lead to a larger improvement in six minutes walking distance and in quality of live, particularly in their fatigue. We also focused on the impact of intentional leak levels of different masks on the performance of ventilators designed for bi-level positive pressure ventilation. Increase of intentional leaks significantly impaired the capacity of ventilators to attain and maintain preset inspiratory pressure and could decrease tidal volume. These significant effects occurred mainly for intentional leaks above 40 l/min (for an inspiratory pressure of 14 cmH2O) (Borel et al, Chest 2008 in press). Conclusion: Chronic alveolar hypoventilation may be considered as one of the patho-physiological factors of endothelial dysfunction, inflammation, sleepiness and exercise intolerance. In spite of technological limitations of bi-level pressure machines currently used, nocturnal NIV corrects alveolar hypoventilation in OHS patients; however its short term and long term impacts on inflammation and endothelial dysfunction remain uncertain. During respiratory rehabilitation program, using NIV during exercise improves exercise capacities and quality of life for the most severe restrictive respiratory failure patients
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Kelly, Julia Louise. "Autotitrating non-invasive ventilation (NIV) in patients with hypercapnic ventilatory failure." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/32008.
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Non-invasive ventilation (NIV) is an evidenced based treatment of alveolar hypoventilation in patients with hypercapnic respiratory failure (HRF). Volume assured pressure support (VAPS) is a new mode of NIV that aims to maintain alveolar ventilation (VA) by autotitration of the pressure support (PS) delivered to a patient in response to changes in respiratory physiology. The overall aim of this thesis was to investigate the use of VAPS ventilation in patients with chronic HRF during wakefulness and sleep, specifically in the detection and treatment of acute exacerbations. Specific aims were to: a) determine if VA was maintained during VAPS ventilation in patients, with obstructive and restrictive pathologies, specifically during during exacerbations, and sleep (Chapters 3 and 4). b) determine the mechanism(s) of presumed maintenance of VA (Chapters 3 and 4). c) determine whether changes in the ventilator-measured respiratory parameters can be used to identify or predict exacerbations (Chapter 3). d) determine if VAPS can be used clinically to treat ventilatory failure as effectively as standard PS NIV in acute hypercapnic exacerbations of chronic respiratory disease, and in patients naive to NIV therapy (Chapters 5 and 6). I have concluded that VAPS ventilation provides an alternative ventilatory mode to standard PS ventilation, and can effectively maintain VA during sleep, and during exacerbations, when lung characteristics are changing. The mechanism of VA maintenance is likely to be the integration of complex patient-ventilator interactions, with large variability between patients, independent of diagnosis. Further studies of patient-ventilator interaction and its impact on the target ventilation may be aided by measuring respiratory drive or diaphragm work. Changes in ventilator-measured parameters were not predictive of impending exacerbation. Clustering may help to understand the physiological characteristics of exacerbations and individual ventilatory responses, and also to determine whether an autotitrating iVAPS improves outcomes of exacerbations, including survival.
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Edwards, Mark. "An experimental investigation of non-invasive ventilation for chronic obstructive pulmonary disease." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417240.
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Carteaux, Guillaume. "Optimisation des interactions patient-ventilateur en ventilation assistée : intérêt des nouveaux algorithmes de ventilation." Thesis, Paris Est, 2015. http://www.theses.fr/2015PESC0027/document.
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En ventilation assistée, les interactions patient-ventilateur, qui sont associés au pronostic, dépendent pour partie des algorithmes de ventilation. Objectifs : Caractériser l'intérêt potentiel des nouveaux algorithmes de ventilation dans l'optimisation des interactions patient-ventilateur : 1) en ventilation invasive, deux modes et leurs algorithmes nous ont semblé novateurs et nous avons cherché à personnaliser l'assistance du ventilateur en fonction de l'effort respiratoire du patient au cours de ces modes proportionnels : ventilation assistée proportionnelle (PAV+) et ventilation assistée neurale (NAVA) ; 2) en ventilation non-invasive (VNI) nous avons évalué si les algorithmes VNI des ventilateurs de réanimation et des ventilateurs dédiés à la VNI diminuaient l'incidence des asynchronies patient-ventilateur. Méthodes : 1) En PAV+ nous avons décrit un moyen de recalculer le pic de pression musculaire réalisée par le patient à chaque inspiration à partir du gain réglé et de la pression des voies aériennes monitorée par le respirateur. Nous avons alors évalué la faisabilité clinique d'ajuster l'assistance en ciblant un intervalle jugé normal de pression musculaire. 2) Nous avons comparé une titration de l'assistance en NAVA et en aide inspiratoire (AI) en se basant sur les indices d'effort respiratoire. 3 et 4) En VNI, nous avons évalué l'incidence des asynchronies patient-ventilateur avec et sans l'utilisation d'algorithmes VNI : sur banc d'essai au cours de conditions expérimentales reproduisant la présence de fuites autour de l'interface ; en clinique chez des patients de réanimation. Résultats : En PAV+, ajuster le gain dans le but de cibler un effort respiratoire normal était faisable, simple et souvent suffisant pour ventiler les patients depuis le sevrage de la ventilation mécanique jusqu'à l'extubation. En NAVA, l'analyse des indices d'effort respiratoire a permis de préciser les bornes d'utilisation et de comparer les interactions patient-ventilateur avec l'AI dans des intervalles d'assistance semblables. En VNI, nos données pointaient l'hétérogénéité des algorithmes VNI sur les ventilateurs de réanimation et retrouvaient une meilleure synchronisation patient-ventilateur avec l'utilisation de ventilateurs dédiés à la VNI pour des qualités de pressurisation par ailleurs identiques. Conclusions : En ventilation invasive, personnaliser l'assistance des modes proportionnels optimise les interactions patient-ventilateur et il est possible de cibler une zone d'effort respiratoire normale en PAV+. En VNI, les ventilateurs dédiés améliorent la synchronisation patient-ventilateur plus encore que les algorithmes VNI sur les ventilateurs de réanimation, dont l'efficacité varie grandement selon le ventilateur considéréDuring assisted mechanical ventilation, patient-ventilator interactions, which are associated with outcome, partly depend on ventilation algorithms.Objectives: : 1) during invasive mechanical ventilation, two modes offered real innovations and we wanted to assess whether the assistance could be customized depending on the patient's respiratory effort during proportional ventilatory modes: proportional assist ventilation with load-adjustable gain factors (PAV+) and neurally adjusted ventilator assist (NAVA); 2) during noninvasive ventilation (NIV): to assess whether NIV algorithms implemented on ICU and dedicated NIV ventilators decrease the incidence of patient-ventilator asynchrony.Methods: 1) In PAV+ we described a way to calculate the muscle pressure value from the values of both the gain adjusted by the clinician and the airway pressure. We then assessed the clinical feasibility of adjusting the gain with the goal of maintaining the muscle pressure within a normal range. 2) We compared titration of assistance between neurally adjusted ventilator assist (NAVA) and pressure support ventilation (PSV) based on respiratory effort indices. During NIV, we assessed the incidence of patient-ventilator asynchrony with and without the use of NIV algorithms: 1) using a bench model; 2) and in the clinical settings.Results: During PAV+, adjusting the gain with the goal of targeting a normal range of respiratory effort was feasible, simple, and most often sufficient to ventilate patients from the onset of partial ventilatory support until extubation. During NAVA, the analysis of respiratory effort indices allowed us to precise the boundaries within which the NAVA level should be adjusted and to compare patient-ventilator interactions with PSV within similar ranges of assistance. During NIV, our data stressed the heterogeneity of NIV algorithms implemented on ICU ventilators. We therefore reported that dedicated NIV ventilators allowed better patient-ventilator synchronization than ICU ventilators, even with their NIV algorithms engaged.Conclusions: During invasive mechanical ventilation, customizing the assistance during proportional ventilatory modes with the goal of targeting a normal range of respiratory effort optimizes patient-ventilator interactions and is feasible with PAV+. During NIV, dedicated NIV ventilators allow better patient-ventilator synchrony than ICU ventilators, even with their NIV algorithm engaged. ICU ventilators' NIV algorithms efficiency is however highly variable among ventilators
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Papin, Olivier Chollet Sylvaine. "Tolérance et efficacité de la ventilation non invasive à domicile chez 44 patients âgés de 75 ans et plus." [S.l.] : [s.n.], 2005. http://theses.univ-nantes.fr/thesemed/MEDpapin.pdf.
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Amorim, Raquel Margarida da Cruz. "O Desmame Precoce da Pessoa submetida a Ventilação Mecânica Invasiva: O Impacto das Intervenções de Enfermagem de Reabilitação." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/29374.
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Mestrado em Enfermagem, Área de especialização: Enfermagem de ReabilitaçãoA Ventilação Mecânica Invasiva é reconhecida como processo terapêutico adjuvante à pessoa acometida de insuficiência respiratória. Em correlação com os seus benefícios, existe a probabilidade de ocorrência de complicações a nível respiratório e motor. Neste contexto, é realçada a importância de realizar um desmame ventilatório precoce. A eficácia e eficiência do desmame ventilatório, requerem do Enfermeiro Especialista em Enfermagem de Reabilitação as competências para elaborar, desenvolver e implementar um plano de intervenção individual, baseado numa avaliação criteriosa do doente. Este relatório surge no decurso da análise ao processo de aquisição e sedimentação de competências comuns do Enfermeiro Especialista, específicas em Enfermagem de Reabilitação, bem como a obtenção de competências de mestre. Este processo foi realizado através das várias fases do plano de intervenção aplicado ao doente submetido a Ventilação Mecânica Invasiva, com o objetivo de desenvolver competências científicas, técnicas e humanas especializadas, ao longo do processo de desmame ventilatório.
Mechanical Invasive Ventilation is recognized as an adjuvant therapeutic process for the person suffering from respiratory failure. In correlation with its benefits, there is a probability of respiratory and motor complications. In this context, the importance of early weaning is emphasized. The efficacy and efficiency of ventilatory weaning require the Nurse Specialist in Rehabilitation Nursing the skills to design, develop and implement an individual intervention plan, based on a careful evaluation of the patient. This report arises during the analysis of the process of acquisition and solidification of common competences of the Specialist Nurse, specific in Rehabilitation Nursing, as well as the acquisition of master's competences. This process was carried out through the various phases of the intervention plan applied to the patient submitted to Mechanical Invasive Ventilation, with the objective of developing specialized scientific, technical and human skills throughout the ventilatory weaning process.
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Nickol, Annabel Henrietta. "Mechanism of action of nocturnal non-invasive ventilation in chronic hypercapnic respiratory failure." Thesis, Imperial College London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411971.
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Piggin, Lucy Helen. "The experience of non-invasive ventilation in motor neurone disease : a qualitative exploration." Thesis, University of Liverpool, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569269.
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Motor neurone disease (MND) is a fatal neuromuscular illness defined by progressive muscle weakness and wastage. Death typically occurs within 2-3 years from symptom onset and is most often attributable to respiratory complications. Weakness in the respiratory muscles increases the risk of mortality and is also a significant predictor of quality of life in MND, which makes management of respiratory aspects of the condition a vital component of care. The first signs of respiratory insufficiency are typically related to the onset of nocturnal hypoventilation, which can disturb sleep and lead to waking headaches, somnolence, fatigue, impaired concentration, cognitive impairment, reduced appetite, and low mood. The primary means of managing these symptoms is through the use of non-invasive ventilation (NIV). There is a vast quantitative research base charting the impact of NIV. It is known to decrease the number of arousals from sleep, reduce somnolence/fatigue, eliminate waking-headaches, improve cognitive functioning, and may also exert a positive impact on emotional/social functioning in some patients. NIV can also benefit daytime respiratory performance, improving self-rated dyspnoea and slowing the rate of respiratory decline as the illness progresses. Crucially, NIV also affords selected MND patients a significant survival advantage. Existing research offers limited insight into the lived experience of respiratory impairment and NIV use; it is unknown how patients themselves feel about using a ventilator or how they receive the positive clinical outcomes associated with the treatment. This thesis presents a body of qualitative research using interpretative phenomenological analysis (IPA) to explore MND patients' experiences of respiratory impairment and NIV use. The first study, a small cross- sectional enquiry (11=5), reports the experiences of patients already established on the ventilator. This study found complex emotional •and psychological responses to NIV, including reluctance to initiate, fear of dependence and threats to control. Respiratory masks were also found to have a significant negative impact on identity and self-esteem. However, patients felt that the positive physical effects of NIV made this experience acceptable. This cross-sectional study was a preparative step for a subsequent longitudinal study, recruiting patients (11=26) and carers (n=26) prior to ventilation and interviewing them over time as they started using NIV. Two data sets are reported: 'pre-ventilation' and 'post-ventilation' analysis. Pre-ventilation analysis also explored the lived experience of respiratory impairment and treatment decision-making. This longitudinal study found that referral into a respiratory service was an emotionally stressful event for patients; most had been unaware of the prospect of respiratory impairment and were vulnerable to anxiety. Patients seemed to lack insight into their own respiratory status, which appeared to be attributable to both a lack of understanding of respiratory aspects of the condition and difficulties in making sense of respiratory changes within the wider physical context of the illness. Most patients responded negatively to the idea of ventilation, seeing it both as a 'defeat' and as an ominous sign of illness progression, yet they were also comforted by the idea that there was 'help' available to prevent suffering. Patients typically elected not to think about NIV ahead of time, which appeared to be part of a wider 'one day at a time' approach to MND. Patients who went on to trial NIV (11= 12) reported markedly different responses to initiation and variable degrees of involvement in treatment decision-making. Many patients did not feel that intervention was needed. Positive physiological! clinical outcomes did not necessary lead to positive psychological and emotional responses to the treatment and did not ensure that the experience of using a ventilator was a positive one. There were a number of practical and psychological challenges that determined tolerance and compliance with the treatment; however, the same challenges were often perceived differently by different patients. It was not possible to predict 'success' on NIV based on clinical or demographic variables alone. Patients' experiences of NIV were best understood in the individual context of each patient and in light of their personal illness experiences. These findings make a significant contribution to the established research base, providing an alternative perspective to substantiate the quantitative evidence. It is intended that the research presented in this thesis will be of direct practical utility, helping clinicians who are supporting MND patients to ensure that patients' experiences of respiratory care and NIV use are as positive as they can be.
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Lyall, Rebecca Ann. "Respiratory muscle function and non-invasive positive pressure ventilation in motor neurone disease." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417858.
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Nierat, Marie-Cecile. "induction non-invasive d'une plasticité de la commande ventilatoire chez l'humain sain." Phd thesis, Université Pierre et Marie Curie - Paris VI, 2014. http://tel.archives-ouvertes.fr/tel-01021262.
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La commande de la ventilation chez l'humain est capable d'adaptation persistante qui repose sur des mécanismes de type LTP. Différentes techniques permettant l'induction de plasticité sont couramment utilisées mais leur application au contrôle ventilatoire n'a fait l'objet que de très peu de travaux.L'objectif de cette thèse est (1) examiner la possibilité d'induire des mécanismes de type LTP par la rTMS et la tsDCS en deux sites de la commande ventilatoire destinée au diaphragme, l'AMS et les métamères C3-C5 ; (2) évaluer les conséquences sur le profil ventilatoire en ventilation de repos et lorsque la ventilation est artificiellement contrainte. Nous avons examiné les effets d'un conditionnement inhibiteur appliqué par rTMS en regard de l'AMS sur l'excitabilité corticophrénique. Nous avons observé la présence d'une diminution persistante de cette excitabilité et en avons tiré la proposition qu'en ventilation de repos l'AMS augmente l'excitabilité de la commande ventilatoire à l'éveil. Nous avons alors considéré les conséquences de la rTMS sur la ventilation expérimentalement contrainte. Les modifications du profil ventilatoire induites par la rTMS sont en faveur d'une participation de l'AMS à la production ou au traitement de la copie d'efférence. Dans une 3ème étude, nous avons examiné les effets de la tsDCS au niveau C3-C5 sur l'excitabilité corticophrénique et sur le profil ventilatoire. L'augmentation de cette excitabilité et du volume courant nous a conduit à suggérer la possibilité d'induire une plasticité respiratoire au niveau spinal.L'ensemble de ces résultats nous permet d'envisager des perspectives thérapeutiques à l'utilisation de la rTMS et de la tsDCS.
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Lellouche, François Brochard Laurent. "Optimisation de l'humidification des gaz au cours de la ventilation mécanique." Créteil : Université de Paris-Val-de-Marne, 2008. http://doxa.scd.univ-paris12.fr:80/theses/th0405445.pdf.
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Lellouche, François. "Optimisation de l'humidification des gaz au cours de la ventilation mécanique." Paris 12, 2007. http://www.theses.fr/2007PA120053.
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L'humidification des voies aériennes au cours de la ventilation mécanique peut se faire avec différents systèmes : les humidificateurs chauffants (HC), les filtres humidificateurs (FH) et les filtres "actifs". Leurs avantages et inconvénients sont précisés dans ce travail. Les performances hygrométriques de ces systèmes on été testées sur banc, sur sujets sains et sur patient au cours de la ventilation invasive et non invasive (VNI) avec la méthode psychométrique et ont été comparées aux données de la littérature. Nous avons montré que les HC avec fils chauffants ont des performances altérées lorsque la température d'entrée de chambre (influencée par la température ambiante et celle de sortie de ventilateur) est élevée. Les FH sont très influencés par la température des patients, leurs performances sont très diminuées en cas d'hypothermie. Au cours de la VNI, nous avons montré que les HC sont particulièrement sensibles à la température d'entrée de chambre, que les FH ont une perte significative de leur efficacité en cas de fuites et qu'en l'absence d'humidification, les gaz moteurs influencent l'humidité délivrée aux patients. Nous avons aussi étudié l'impact de l'espace mort des différents systèmes au cours de la VNI. L'espace mort additionnel des FH entraîne une augmentation du travail respiratoire, de la ventilation minute et une diminution de la ventilation alvéolaire en comparaison avec les HC. Pourtant, il n'a pas été démontré de différence sur le taux d'intubation au cours de la VNI entre ces deux systèmes. L'ensemble de ces données nous a permis de formuler des recommandations pour l'humidification des voies aériennes au cours de la ventilation mécaniqueThe airways humidification during mechanical ventilation can be performed with different systems : heated humidifiers (HH), heat and moisture exchangers (HME) and "active" HME. Their advantages and disadvantages are outlined in this work. Hygrometric performances of these systems have been tested on bench, on healthy subjects and on patients during invasive as well as non-invasive ventilation (NIV) with the psychometric method and were compared with data from the literature. We showed that heated wire HH have altered performance when the inlet chamber temperature (influenced by both the ambient and the outlet ventilator temperatures) is high. The HME are strongly influenced by patient's core temperature, their performances are reduced in the case of hypothermia. During NIV, we showed that the HH are particulary sensitiveto the inlet chamber temperature, that the HME have a sifnificant loss of their effectiveness in the event of leaks and that in the absence of humidification, gas characteristics influence humidity delivered to the patients. We also studied the impact of the dead space of these systems during NIV. HME's additional dead space leads to increased work of breathing, minute ventilation and a decrease in alveolar ventilation compared with the HH. However, it has not been demonstrated any difference on the rate of intubation during NIV between these two systems. Taken together, these data allowed us to make recommendations for the airways humidification during mechanical ventilation
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Reminiac, François. "Aérosolthérapie et dispositifs de haut débit nasal humidifié." Thesis, Tours, 2017. http://www.theses.fr/2017TOUR3302.
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L’aérosolthérapie est une modalité thérapeutique complexe souvent prescrite dans les services de réanimation et de surveillance continue, les services d’urgences et les unités de soins intensifs, notamment chez les patients obstructifs, ce qui fait des bronchodilatateurs la classe médicamenteuse la plus prescrite par voie aérosolisée. Les patients de ces unités de soins aiguë nécessitent aussi fréquemment un support ventilatoire parmi lesquels le haut débit nasal humidifié se montre être une modalité prometteuse en raison de ses effets physiologiques, y compris chez les patients obstructifs. La question de l’administration d’aérosols de médicaments et notamment de bronchodilatateurs chez des patients soumis au haut débit nasal est donc posée. L’administration d’aérosols médicamenteux au cours du haut débit nasal directement dans le circuit de ce support ventilatoire pourrait être une méthode simple, efficace, voire même bénéfiqueAerosol therapy is a complex method of drug delivery frequently used in intensive care units, step down units and emergency departments, especially in obstructive patients which makes bronchodilators the most prescribed drug class in critical care. Critically ill patients often require ventilatory support, including nasal high flow therapy which showed promising clinical benefits. Given the physiologic effects of nasal high flow therapy, its implementation may be beneficial for obstructive patients. Consequently, the question of aerosol administration, especially bronchodilators, in patients undergoing nasal high flow arises. Aerosol administration during nasal high flow therapy directly in the high flow circuit could be a simple, efficient and possibly beneficial method. However, technical and physiological issues may jeopardize efficacy of this combined administration
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Huang, Li [Verfasser]. "Non-invasive intermittent mandatory ventilation in preterm infants with respiratory distress syndrome immediately after extubation: a controlled study on synchronized non-invasive mechanical ventilation and review of the literature / Li Huang." Ulm : Universität Ulm. Medizinische Fakultät, 2014. http://d-nb.info/106043718X/34.
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Lorber, Julien Leconte Philippe. "Enquête observationnelle prospective concernant l'utilisation de la ventilation non invasive au service d'accueil et urgence du CHU de Nantes à propos de 49 cas /." [S.l.] : [s.n.], 2005. http://theses.univ-nantes.fr/thesemed/MEDlorber.pdf.
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Hilbert, Gilles. "Optimisation et évaluation physiopathologique des techniques de ventilation non invasive et de sevrage ventilatoire." Bordeaux 2, 2002. http://www.theses.fr/2002BOR28932.
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L'insuffisance respiratoire aigue (IRA) des patients broncho-pneumopathes chroniques obstructifs (BPCO)est un motif fréquent d'hospitalisation en réanimation. Un risque élevé de fatigue des muscles respiratoires est présent chez les patients BPCO qui font partie des malades les plus difficiles à sevrer du respirateur. Très étudiée dans le sevrage, l'Aide Inspiratoire (AI) permet de diminuer le travail effectué par les muscles respiratoires en prenant à sa charge une partie de ce travail. L'échec d'extubation, défini par la nécessité de réintubation avant la 48-72° heure après l'extubation, est responsable d'une augmentation de morbidité et de mortalité. C'est également dans la décompensation aigue des patients BPCO que les bénéfices majeurs de la ventilation non-invasive (VNI) ont surtout été démontrés. Chez les patients immunodéprimés avec IRA, le recours à la ventilation mécanique est associé à une mortalité élevée ; ainsi, éviter l'intubation pourrait être un objectif majeur dans cette pathologie. Cependant, l'expérience de la VNI dans l'IRA hypoxémiante reste encore relativement pauvre comparée à̧ la prise en charge des BPCO. Nos travaux de recherche clinique concernent le niveau d'AI "optimal" pour débuter le sevrage établi par le monitorage de l'analyse spectrale de l'électromyogramme diaphragmatique enregistré à l'aide d'une électrode de surface placée dans l'oesophage, l'évaluation de la VNI chez des patients BPCO avec insuffisance respiratoire hypercapnique post extubation et l'intérêt du monitorage de la pression mesurée 0,1 seconde après le début d'un effort inspiratoire (P0. 1) dans cette situation. Nous avons également évalué le mode BiPAP (Bi Level Positive Airway Pressure) et démontré l'intérêt des mesures précoces de pH dans la décompensation aigue de BPCO traitée par VNI, le mode Ventilation Spontanée en Pression Pösitive Continue puis le mode Ventilation Spontanée-AI-Pression Expiratoire Positive, dans l'IRA de patients immunodéprimés. Dans cette dernière situation, nous avons également montré l'intérêt d'établir le diagnostic de l'IRA, et d'utiliser un masque laryngé pour la réalisation d'une fibroscopie bronchique avec lavage broncho-alvéolaire chez les patients avec un rapport PaO2/FiO2 < 125Acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) is a frequent reason for admission in intensive care unit. COPD patients present with a high risk of muscular respiratory failure and may prove difficult to wean. Highly studies in the weaning of COPD patients, Pressure Support (PS) allows to reduce the work assumed by the respiratory muscles by taking in charage part of this work. Extubation failure, defined as the need to perform re-intubation in a delay of 48-72 hours post extubation, is responsible of an increase in morbidity and mortality. It has been demonstrated that non invasive ventilation (NIV) can reverse acute respiratory failure in a significant portion of patients with exacerbation of COPD. In immunosuppressed patients with ARF, mechanical ventilation is associated with a significant risk of death. Consequently, avoiding intubation should be an important objective in the management of respiratory failure in these high-risk patients. Nevertheless, compared with the management of COPD patients, data on the efficacy of NIV in patients with hypoxemic ARF are very limited. Our studies concern the "optimal" PS level for weaning onset, established by the monitoring of spectral analysis of diaphragmatic electromyography recorded using a bipolar esophageal electrode, the evaluation of NIV in COPD patients with postextubation hypercapnic respiratory insufficiency, and the value of monitoring airway occlusion pressure at 0. 1 sec (P0. 1) in this condition. We have also studied the Bi Level Positive Airway Pressure mode and demonstrated that rapid improvement in the blood pH was crucial for successful NIV in patients with exacerbation of COPD, the Continuous Positive Airway Pressure mode, then the Spontaneous Ventilation-PS-Positive End Expiratory Pressure mode in immunosuppressed patients with ARF. In this last condition, we have also demonstrated the value of the establishment of a positive diagnosis of ARF, and the feasibility and safety of the laryngeal mask airway-supported fibreoptic bronchoscopy with bronchoalveolar lavage in patients with PaO2/FiO2<125
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Danaga, Aline Roberta [UNESP]. "Papel dos índices de pressões inspiratórias e de respiração rápida e superficial na predição da reintubação em terapia intensiva." Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/88571.
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A ventilação mecânica invasiva é recurso fundamental em unidades de terapia intensiva. Sua aplicação ocorre em quase metade dos pacientes dessas unidades. Entretanto, a VMI associa-se a várias complicações, especialmente quando utilizada por período prolongado. Desse modo, preconiza-se que a interrupção do suporte ventilatório seja realizada assim que possível. A intempestividade em realizar tanto o desmame como a extubação pode gerar graves conseqüências ao paciente, incluindo a necessidade de reintubação. Esta, por sua vez, está relacionada à elevada incidência de pneumonia hospitalar, o que leva ao maior tempo de ventilação mecânica, de permanência na terapia intensiva, aumento no custo hospitalar e da mortalidade. Visto que tanto a ventilação mecânica prolongada como sua retirada prematura podem ser prejudiciais, faz-se necessário o reconhecimento do momento ideal do desmame e extubação. Vários índices fisiológicos foram propostos com o intuito de identificar os pacientes capazes de reassumir a ventilação espontânea. Poucos ofereceram poder preditivo satisfatório e o índice de respiração rápida e superficial parece ser o mais útil devido sua simplicidade e confiabilidade. No entanto, o melhor ponto de corte dos índices fisiológicos raramente foi estabelecido por curva ROC, evidenciando a necessidade de novos estudos. Neste trabalho, foram revisados os estudos que demonstraram a importância da utilização de protocolos de desmame e extubação e avaliaram o papel preditivo dos índices propostos.
Invasive mechanical ventilation is crucial in intensive care units and its application becomes necessary in almost half of the patients. However it has been associated to several complications especially under prolonged use. Therefore it is reccomended that the discontinuation of ventilator support must be attemped as soon as possible. The premature weaning or extubation also can gerate negative consequences to the patient, including the need of reintubation. This is most related to higher incidence of nosocomial pneumonia, increased IMV use and ICU length of stay, hospital costs and elevated mortality rates. Because of both, prolonged IMV and it’s premature discontinuation can be harmful, it is necessary to recognize the optimal moment for weaning and extubation. Many physiological indexes were proposed to distinguish patients ready to breath spontaneously, but fewness demonstrated satisfatory predictive power. Rapid shallow breathing index seems to be the most useful parameter because of its simplicity and reliability. However, in rare studies the best threshold for these indexes was established by ROC curve, making evident the need of further investigations. The present study reviewed articles that demonstrated importance of weaning and extubation protocols utilization and that assessed the predictive role of physiological indexes.
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Labeix, Pierre. "Effet de l'assistance ventilatoire pendant l'exercice sur la fatigue et l'endurance musculaire des membres inférieurs chez le patient atteint de Broncho-Pneumopathie Chronique Obstructive." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSES046.
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Parmi les traitements recommandés dans la Broncho pneumopathie Chronique obstructive, la réhabilitation respiratoire a montré une efficacité indéniable pour diminuer la dyspnée et améliorer la qualité de vie. Pourtant, les patients les plus sévères n'ont pas la possibilité de réaliser un effort suffisant pour induire une adaptation physiologique. L'ajout d'une ventilation non invasive (VNI) pendant les efforts, permet d’augmenter l’endurance à l’exercice, de diminuer la dyspnée. Son utilisation au cours d'une réhabilitation respiratoire permet une augmentation de la charge d'entrainement. Cependant la sélection des patients pouvant bénéficier le plus de la VNI à l’exercice reste empirique.La question est donc de discriminer les patients qui s'améliorent le plus lors d'un effort avec la VNI en utilisant un test simple, réalisable en pratique courante et de chercher un lien potentiel entre efficacité de la VNI et augmentation de la charge de travail pendant la réhabilitation.Dans une première étude, à l'aide du test simple de maintien d’une extension du genou contre résistance réalisé après un exercice de pédalage, nous avons montré que l'application d'une VNI au cours de l'effort permettait de diminuer la fatigue musculaire du quadriceps. Nous avons également trouvé qu'un tiers des patients ne présentaient pas d'amélioration de la fatigue musculaire avec VNI, suggérant que ce test pouvait servir à discriminer les patients pouvant bénéficier de l'entrainement avec VNI.Dans une deuxième étude, nous avons entrainé avec une VNI, des patients BPCO sévères présentant une limitation ventilatoire à l'effort afin de montrer un lien entre charge d'entrainement et efficacité de la VNI pour améliorer l’endurance du quadriceps. Nous avons confirmé les premiers résultats de la première étude et montré que l'entrainement avec VNI permettait d'augmenter la durée des efforts avec ou sans aide inspiratoire et que l'effet de prévention de la fatigue post-exercice avec VNI persistait après entraînement. Nous n'avons pas retrouvé de relation entre efficacité de la VNI et charge d'entrainement.Nos travaux suggèrent que la diminution du travail respiratoire avec VNI à l’exercice a un effet sur la performance des muscles périphériques et que cet effet persiste après réhabilitation respiratoireAmong the treatments recommended in Chronic Obstructive Pulmonary Disease (COPD), respiratory rehabilitation has shown undeniable effectiveness in reducing dyspnea and improving quality of life. However, the most severe patients do not have the possibility to make sufficient effort to induce physiological adaptation. The addition of noninvasive ventilation (NIV) during efforts, allows increasing exercise endurance and decreasing dyspnea. Its use during respiratory rehabilitation allows an increase of the training load. However, the selection of patients who can benefit the most from NIV during exercise remains empirical.The question is therefore to discriminate the patients who improve the most during an effort with NIV using a simple test achievable in current practice and to seek after a relationship between the NIV-induced prevention of post-exercise quadriceps fatigue and the training load during the PR program with the adjunct of noninvasive ventilation.In a first study, using a simple test of knee extension maintenance against resistance carried out after a cycling exercise, we showed that the application of NIV during exercise reduced quadriceps muscle fatigue. We also found that one third of the patients did not show an improvement in muscle fatigue with NIV, suggesting that this test could be used to discriminate between patients who could benefit from NIV training.In a second study, we trained severe COPD patients with ventilatory effort limitation with NIV to show a link between training load and the effectiveness of NIV in improving quadriceps endurance. We confirmed the initial results of the first study and showed that training with NIV increased the duration of effort with or without inspiratory support and that the prevention effect of post-exercise fatigue with NIV persisted after training. We did not find a relationship between NIV effectiveness and training load.Our work suggests that the decrease in respiratory work with NIV during exercise has an effect on peripheral muscle performance and that this effect persists after respiratory rehabilitation
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Jaber, Samir. "Optimisation des modalités d'assistances ventilatoires non-invasives chez le patient en insuffisance respiratoire aigue͏̈." Montpellier 1, 2002. http://www.theses.fr/2002MON1T011.
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La prise en charge de l'insuffisance respiratoire aigue (ira) utilise classiquement une sonde introduite dans la trachee comme interface patient-respirateur. Cependant, cette procedure "invasive" peut entrainer des complications (pneumopathies, inconfort, sedation. . . ). Pour tenter de pallier ces inconvenients, les cliniciens ont developpe des techniques d'assistance ventilatoire "non-invasives" (vni) qui consistent a utiliser comme interface patient-respirateur un masque nasal ou facial. Dans ce travail, nous avons premierement analyse les principes d'utilisation, les benefices cliniques et les limites de ces techniques de vni. Deuxiemement, nous avons evalue de nouveaux moyens pouvant ameliorer l'efficacite de la technique et d'autres situations d'utilisation. [. . . ] nous avons montre que chez les patients hypoxemiques, l'utilisation d'une pression positive constante diminuait les alterations des echanges gazeux au cours de la fibroscopie bronchique et diminuait la frequence des aggravations respiratoires secondaires a ce geste. Enfin, les benefices potentiels de l'application de la vni au cours de l'ira dans les suites operatoires sont presentes.
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Balfour, Liezl. "Development of a clinical pathway for non-invasive ventilation in a private hospital in Gauteng." Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/30377.
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Despite the advantages of using NIV, healthcare professionals are not in agreement about precisely when to commence NIV (Elliott, Confalonieri& Nava 2002:1159; Lightowler, Wedzicha, Elliott&Ram 2003: [4]; Garpestad &Hill 2006:147), which adds to the underutilisation of NIV. The aim of this study was to collaboratively develop a clinical pathway for NIV. Two main objectives were identified, namely (i) to identify the components of a clinical pathway for NIV, and (ii) to develop a clinical pathway for NIV that can be implemented in the CCU. The research design utilised for this study was qualitative, contextual, explorative and descriptive in nature. The study consisted of three phases, namely Phase 1: Components of the clinical pathway, Phase 2: Literature control, and Phase 3: Development of the clinical pathway. The objectives of the study were met, and a clinical pathway for NIV was developed.Dissertation (MCur)--University of Pretoria, 2011.
Nursing Science
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Naeck, Roomila. "Evaluation de l'adaptation à la ventilation non invasive chez des patients atteints d'insuffisance respiratoire chronique." Rouen, 2011. http://www.theses.fr/2011ROUES042.
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L’objectif est d’étudier les influences de la ventilation non invasive (VNI) sur l’organisme d’un patient atteint d’une insuffisance respiratoire chronique. A partir des signaux de polysomnographie (PSG), examen de référence permettant d’analyser les mécanismes d’interactions patient-ventilateur, l’efficacité de la VNI a pu être appréciée. 1) Etude rétrospective : des synoptiques permettant une visualisation globale des événements au cours de la nuit par la représentation simultanée des variables enregistrées lors de la PSG ont été construits. Puis, les relations entre les différents asynchronismes patient-ventilateur et les fuites non intentionnelles ont été quantifiées. Quatre types de profil ventilatoire ont été mis en évidence. 2) Etude prospective : adaptation à la VNI. Trois PSG ont été réalisées : une en ventilation spontanée (J1), une la nuit de la mise en place de la VNI (J2) et une après 15 jours de VNI (J15). Une analyse individuelle a été effectuée par l’interprétation des synoptiques, et une analyse globale a été effectuée par une approche statistique. Une entropie de Shannon, calculée à partir de diagrammes de proche-retour, a été utilisée pour estimer la qualité du sommeil. La mise en place de la VNI se traduit par une amélioration des paramètres ventilatoires, une amélioration voire une restauration du temps passé en sommeil paradoxal, et une diminution de la fragmentation du sommeil par la correction des apnées obstructives. Sous VNI, la variabilité cardiaque, estimée à partir d’une entropie de Shannon calculée sur la base d’une dynamique symbolique, diminue significativement. Peu d’effets des asynchronismes sur la qualité de la ventilation ont été notésThe aim of this work is to study the impact that the noninvasive ventilation (NIV) has on the organism of a patient having chronic respiratory failure. To do so, two studies based on polysomnography (PSG) were carried out. 1) Retrospective study: synoptics were made which allowed us to have a global visualization of the events occuring during the night, by the simultaneous representation of the recording variables during the PSG. We were then able to quantify the connections between the various patient-ventilator asynchronisms and the non-intentional leaks. Four different patient-ventilator types of interactions could be highlighted. 2) Prospective study: how patients can adapt themselves to NIV. Three PSG were performed: one was made under spontaneous breathing (J1), one was made during the second night after NIV initiation (J2) and the third one was made 15 days later (J15). An individual analysis could then be carried out, based on the interpretation of the synoptics of each patient, and a global analysis was performed as well through a statistic approach. A Shannon entropy calculated on recurrence plot, was also used to estimate the quality of sleep. During the initiation of long-term noninvasive ventilation, ventilatory parameters (oxymetry and capnography) were improved, patients showed a progressive increase of the time spent in REM sleep and the sleep fragmentation was reduced thanks to a correction of obstructive sleep apneas. Under noninvasive ventilation, cardiac variability, estimated with a Shannon entropy based on a symbolic dynamic, was significantly reduced. Only a few effects of the asynchronisms on ventilation quality were noticed in this study
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Georges, Marjolaine. "Effets extra-ventilatoires de la ventilation non-invasive au cours de la sclérose latérale amyotrophique." Thesis, Paris 6, 2015. http://www.theses.fr/2015PA066350/document.
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La sclérose latérale amyotrophique (SLA) est une maladie neurodégénérative. Une insuffisance diaphragmatique apparaît quand les neurones phréniques sont atteints. La ventilation non-invasive (VNI) est un traitement efficace. Une hyperactivité des muscles inspiratoires extradiaphragmatiques (MIED) est fréquente. C'est un phénomène compensateur vital pour assurer une ventilation correcte mais ses conséquences extraventilatoires restent inconnues. La VNI, mettant au repos les MIED, pourrait avoir d'autres effets bénéfiques que la correction des échanges gazeux. Dans la partie 1, la dépense énergétique (DE) diminue de 7% sous VNI. Dans la partie 2, les tests d'endurance (VMM et PiMAX répétés) ne sont pas adaptés aux patients SLA avec faiblesse diaphragmatique. Une série de 10 SNIP est réussie par 90% d'eux. La réalisation de SNIP répétés suffit à induire une fatigue aux caractéristiques évocatrices de fatigue centrale : la pression chute alors que la vitesse de relaxation normalisée est conservée. La fatigue n'est pas corrélée à la sévérité de la SLA ou à l'utilisation de la VNI. Dans la partie 3, 57% des patients SLA ont un potentiel préinspiratoire (PPI) en ventilation spontanée (VS), réponse corticale au déséquilibre charge-capacité. L'activité corticale préinspiratoire influence l'activité des MIED et la perception de la dyspnée. La VNI inhibe quasi-complètement le PPI. La VNI réduit la DE en soulageant le travail respiratoire imposé aux MIED pour compenser la faiblesse diaphragmatique. Cette contribution métabolique plaide en faveur d'une initiation précoce de la VNI. Juger du moment pour initier la VNI est délicat. La présence d’un PPI en VS peut guider la décisionAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Respiratory failure (RF) develops when phrenic neurons are involved. Noninvasive ventilation (NIV) is the only treatment for diaphragm weakness. Patients with ALS-related RF often exhibit strong activity of inspiratory neck muscles (INM) as a compensatory mechanism to maintain adequate ventilation.In chapter 1 of thesis, resting energy expenditure (REE) is lower under NIV (median decrease of 7%). Chapter 2 confirms that standard tests to measure respiratory muscle endurance (maximal voluntary ventilation and repeated maximal inspiratory pressures) are not adapted to ALS patients with diaphragm involvement while 90 % of them complete a series of 10 maximal sniff pressures (SNIP). This test is sufficient to initiate fatigue in ALS patients with a progressive decrease in sniff amplitude and preserved maximal relaxation rate. These results suggest that central fatigue contribute to RF in ALS. Different tests of respiratory muscle endurance were not linked to ALS severity or NIV use. Chapter 3 shows that 57 % of ALS patients with RF exhibit respiratory-related cortical activity during spontaneous breathing. Pre-inspiratory potentials (PIP) almost disappear on NIV. Presence of PIP interferes with dyspnea and INM activity.NIV can reduce REE probably by alleviating the ventilator burden imposed on INM to compensate ALS-related RF. This positive contribution to a better nutritional equilibrium supports the hypothesis that starting NIV early in the course of ALS could be beneficial. To determine the good timing to initiate NIV stay difficult. Recording PIP could provide a useful tool
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McFeeters, Melanie. "The lived experiences of hospital for parents of children commenced on invasive long-term ventilation." Thesis, De Montfort University, 2016. http://hdl.handle.net/2086/13059.
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Recent years have seen a significant increase in the number of ventilator-dependent children being discharged from the hospital. There is a wealth of literature describing the issues surrounding the complex discharge process required for these children however there has been limited exploration of the experiences of parents during their child’s admission to hospital. Interpretive phenomenology based on Heideggerian research philosophy was used to explore the lived experiences of hospital for parents of children commenced on invasive long-term ventilation (I-LTV). Purposive sampling was utilised to select parents of children who had been cared for at one NHS hospital trust. Eight in-depth, unstructured qualitative interviews involving sixteen parents (eight couples) were conducted over a six month period during 2014 to gather data about the parent’s recollections of the time spent with their child in hospital. Most children were cared for on both the paediatric intensive care (PIC) and high dependency units (HDU) with the majority having been discharged from hospital at the time of the interviews. All interviews were transcribed verbatim, and analysed using a modified van Manen (1990) approach. Thematic analysis provided an insight in to the lived world of the parents caring for their technology-dependent child, with two over-arching concepts of uncertainty and transitions characterising the parents’ journeys. The findings revealed multiple transitions in a world of complexity and uncertainty with four main themes emerging from the data; 1) Going in to the Unknown, 2) This wasn’t what we wanted, 3) Safer at Home, and 4) Clawing every little bit back. Parents were required to develop coping strategies to deal with the transitions and uncertainties experienced and establish new roles and identities as they became experts in caring for their technology-dependent child. As a result of the findings a new framework combining the concepts of uncertainty and transitions was derived identifying areas for consideration including: health-illness, psycho-social, situational and developmental transitions together with existential, biographical, environmental, relational and temporal uncertainties. Strategies for facilitating coping and adaptation towards healthier outcomes were identified and a strong argument emerged for the development of more effective management of transitions and uncertainty delivered within an environment more conducive to family-centred care.
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Horsley, Alex. "Non-invasive assessment of ventilation maldistribution in lung disease using multiple breath inert gas washouts." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/4512.
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Clinical research in cystic fibrosis (CF) requires study endpoints that are sensitive to airways disease, repeatable and non-invasive. Despite significant advances in the treatment of CF, lung function assessments continue to rely on the forced expiratory volume in 1 second (FEV1). Although simple to perform, it lacks sensitivity, is difficult for younger subjects, and changes over time. An alternative method of assessing lung physiology is to derive measures of ventilation heterogeneity from inert gas washout tests. In early lung disease, measures of gas mixing appear to be more sensitive than spirometry. In addition, since only tidal breathing is required, they are more physiological and are more straightforward for younger subjects. Widespread use has been impaired by the lack of a robust and cost effective gas analyser technology. The work presented in this thesis concerns the adaptation, validation and then use of a novel gas analyser (Innocor) in a clinical system for the performance of multiple breath washouts. Lung clearance index (LCI), a simple measure of ventilation heterogeneity, has been calculated from washouts in 52 adults with CF and 50 healthy controls. LCI was more sensitive to disease than FEV1 in CF, being elevated in 11 of the 12 CF patients with normal spirometry. In healthy subjects, LCI has been shown to be repeatable and reproducible, with a narrow range of normal that is stable over a wide age range. In a separate study of 19 patients, LCI has also been shown to improve with treatment of an exacerbation in CF. Correlation with changes in other biochemical (serum CRP, peripheral blood white cell count, sputum IL-8, sputum neutrophil) clinical (symptom score) or structural (computed tomography) markers was poor. Short term change in LCI has also been demonstrated in CF patients in response to chest physiotherapy, although there was considerable heterogeneity of response in terms of both LCI and volume of lung ventilated by tidal breathing (as measured by washout functional residual capacity). In addition to LCI, multiple breath phase III slope analysis has been performed on washouts of CF patients and healthy controls, and this has been compared to other measures of lung physiology. Proposed measures of convective and diffusive gas mixing have been shown to be unreliable in CF. These studies have also been the first to demonstrate multi-centre use of washout tests as endpoints. The technology described here offers the possibility of a simple and reliable system for performing multiple breath washouts, though at present it is not available commercially. The studies have added to the understanding of the utility and reliability of washout tests, as well as some of their limitations. It is hoped that in future LCI will be an important clinical endpoint in therapeutic intervention studies in CF, and that it will also offer new ways to follow changes in lung physiology in other diseases.
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Girou, Emmanuelle Brun-Buisson Christian. "Prévention des infections liées aux soins en réanimation." Créteil : Université de Paris-Val-de-Marne, 2007. http://doxa.scd.univ-paris12.fr:8080/theses-npd/th0394932.pdf.
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Thèse de doctorat : Sciences de la vie : Paris 12 : 2003.Version électronique uniquement consultable au sein de l'Université Paris 12 (Intranet). Titre provenant de l'écran-titre. Bibliogr. : 135 réf.
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Jacoupy-Essouri, Sandrine Fauroux Brigitte. "Insuffisance respiratoire aiguë hypercapnique de l'enfant bases physiopathologiques et implications pour la ventilation mécanique noninvasive /." Créteil : Université de Paris-Val-de-Marne, 2007. http://doxa.scd.univ-paris12.fr:8080/theses-npd/th0367739.pdf.
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Edner, Malin, and Nina Danielsson. "Att vårdas lätt sederad eller vaken under invasiv ventilation : En systematisk litteraturstudie som belyser intensivvårdspatientens upplevelse." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-85771.
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Bakgrund De flesta patienter som läggs in på en intensivvårdsavdelning för invasiv ventilation får sedering någon gång under vårdtillfället. Dagens forskning visar att det finns stora fördelar för patienten att vårdas lätt sederad eller vaken vid invasiv ventilation. Dagens sederingspraxis har gått mot att hålla patienten mer vaken. Invasiva metoder används inom intensivvård vilket kan upplevas som smärtsamt eller obehagligt. Även den högteknologiska vårdmiljön är speciell vilket kan bidra till obehag för patienten. Vårdpersonal beskriver att det tar mer tid i anspråk att vårda en patient som är vaken eller lätt sederad samtidigt som de upplever fördelar med att ha en mer vaken patient. Det finns då möjlighet att kommunicera och interagera med patienten i större utsträckning. Det framkommer även att vårdpersonal ser en utmaning i att vårda lätt sederade eller vakna patienter där de bland annat är oroliga för patientens trygghet och välbefinnande. Syfte Beskriva intensivvårdspatienters upplevelse av att vårdas lätt sederade eller vakna vid invasiv ventilation på en intensivvårdsavdelning. Metod En systematisk litteraturstudie har använts som metod. Kvalitativa artiklar har analyserats med hjälp av Bettany-Saltikov och McSherrys (2016) nio steg. Resultat De tre huvudkategorier som framkom under analysen var upplevelsen av fysiskt och psykiskt lidande, upplevelsen av att kommunicera och upplevelsen av sammanhang eller avsaknad av sammanhang. Slutsats Patienternas upplevelse av att vårdas lätt sederade eller vakna var både obehaglig och smärtsam. Många av patienterna föredrog trots detta att vårdas vakna eller lätt sederade. Dels för att ha kontroll men även för att kunna kommunicera och interagera. Däremot så framkom att just upplevelsen av kommunikation kunde vara mycket frustrerande då framförallt intubation var ett stort hinder för att kunna kommunicera.Background Most patients admitted to an intensive care unit for invasive ventilation get sedation at some point during the stay. Today's research shows that there are great advantages for the patient to be cared for ligthly sedated or consious during invasive ventilation. Today's sedation practice has moved towards keeping the patient more awake. Invasive procedures are used in the intensive care, which can be experienced as painful or unpleasant. The high-tech care environment is also special, which can contribute to the discomfort of the patient. Nurses describe that it takes more time to care for patients who are awake or lightly sedated. They also experienced advantages of having a more alert patient, such as the possibility of communicating and interacting with the patient. Healthcare professionals also see a challenge in caring for easily sedated or conscious patients, where they are worried about the patient’s safety and well-being. Purpose Describe intensive care patients' experience of being cared for lightly sedated or consious during invasive ventilation in an intensive care unit. Method A systematic literature review has been used as a method. Qualitative articles have been analyzed with the help of Bettany-Saltikov and McSherrys (2016) nine steps. Results The three main categories that emerged during the analysis were the experience of physical and psychological suffering, the experience of communication and the experience of context or lack of context. Conclusion The patients' experience of being cared for lightly sedated or awake was both unpleasant and painful. Many of the patients nevertheless preferred to be cared for awake or lightly sedated. Partly to have control but also to be able to communicate and interact. On the other hand, it emerged that the experience of communication could be frustrating, as intubation was a major obstacle to communicating.
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Marjanovic, Nicolas. "Approche globale du support ventilatoire en médecine d'urgence." Thesis, Poitiers, 2020. http://theses.univ-poitiers.fr/64158/2020-Marjanovic-Nicolas-These.
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L’insuffisance respiratoire aiguë est un motif fréquent de consultation dans un service d’urgences. Le traitement de première intention repose sur l’oxygénothérapie conventionnelle. En cas d’échec ou d’emblée en cas d’urgence vitale immédiate, le recours à un support ventilatoire devient nécessaire. Les supports ventilatoires englobent l’oxygénothérapie à haut-débit nasal humidifiée (OHD) et la ventilation mécanique qui peut être invasive ou non-invasive. Les données concernant l’intérêt du support ventilatoire en médecine d’urgence sont issues pour l’essentiel de travaux conduits en réanimation, et une approche globale de leur place en médecine d’urgence n’a jamais été réalisé.L’objectif de ce travail est de proposer une évaluation globale du support ventilatoire en médecine d’urgence, en analysant l’intérêt de l’OHD, d’introduction récente aux urgences, et la pratique aux urgences de la ventilation mécanique non-invasive et invasive.Nous avons dans un premier temps évalué les effets cliniques et gazométriques de l’OHD au cours de l’insuffisance respiratoire aiguë hypoxémique de novo, puis au cours de l’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP cardiogénique, aux travers de deux études prospectives. Puis, nous avons réalisé une compilation des données de l’ensemble des études prospectives réalisés aux urgences pour déterminé si la mise en place précoce de l’OHD au cours des détresses respiratoires aiguës sans cause spécifique était susceptible d’améliorer le devenir des patients. Nous avons constaté qu’une mise en place précoce de l’OHD, dès l’admission du patient aux urgences, était associée à une amélioration des paramètres cliniques et gazométriques en cas d’insuffisance respiratoire aiguë de novo comparativement à l’oxygénothérapie conventionnelle, et de manière similaire à la ventilation non-invasive en cas d’insuffisance respiratoire aiguë hypercapnique secondaire à un OAP. En revanche, au cours des détresses respiratoires aiguës admises aux urgences, quelle qu’en soit la cause, l’OHD n’a pas été associé à une diminution au recours à la ventilation mécanique, ni à une diminution de la mortalité.Parallèlement, nous avons réalisé une évaluation des pratiques de la ventilation mécanique aux urgences, en analysant, indépendamment de l’indication de la ventilation mécanique, trois déterminants susceptibles d’influer le pronostic des patients. Nous avons dans un premier temps conduit un banc d’essai de l’ensemble des ventilateurs mécaniques de médecine d’urgence commercialisés en Europe et en Amérique du Nord pour évaluer leur performance et leur utilisabilité aux travers de deux études. Puis, nous avons réalisé une évaluation des pratiques de la ventilation mécanique, et mesuré l’association entre les paramètres réglés (notamment la ventilation à faible volume) et le pronostic du patient. Nous avons mis en évidence que les ventilateurs de médecine d’urgence récents ont une performance technique proche des ventilateurs de réanimation en raison des évolutions technologiques et de l’émergence des ventilateurs à turbine. L’augmentation de leurs performances et de leur complexité n’a pas été associée à une dégradation de leur utilisabilité. Enfin, dans les 6 services d’urgences participants, la majorité des patients ont bénéficié d’une ventilation mécanique à faible volume courant (entre 6 et 8 mL/kg de poids idéal théorique), répondant ainsi aux recommandations des sociétés savantes. En revanche, une ventilation à faible volume courant n’a pas été associée à une diminution de l’incidence du syndrome de détresse respiratoire aigu ou une diminution du taux de mortalité.Ces études permettent une évaluation globale du support ventilatoire aux urgences, intégrant la ventilation mécanique invasive et non-invasive, par son approche clinique et technologique, et un traitement émergent, l’OHD, par son impact clinique, gazométrique et pronostique aux urgencesAcute respiratory failure is a common complaint of patients visiting the Emergency Department and conventional oxygen therapy is its first-line treatment. Ventilatory support is required when nasal oxygen therapy is not enough or as a first-line treatment in the most severe cases. Ventilatory supports include high-flow and humidified nasal cannula oxygen (HNFO) and mechanical ventilation. Data assessing their values in Emergency Departments (EDs) mainly come from research conducted in Intensive Care Units. In addition, a comprehensive approach of their application and their results in Emergency Departments has never been conducted.The aim of this research is to provide a comprehensive assessment of ventilatory supports in EDs by assessing the place of HFNO, introducing recently in this setting, and the practice of noninvasive and invasive mechanical ventilation in EDs. We assessed first the clinical and biological impact of HFNO in patients admitting to an ED for de novo acute hypoxemic respiratory failure, then in patients admitting for acute hypercapnic respiratory failure secondary to acute heart failure, through two prospective studies. In addition, we provided a matching of data issued from all prospective trials conducted in the EDs. We aimed to determine if early application of HFNO in patients with acute respiratory failure improves outcome. We found HFNO applied early was associated with an improvement in clinical and biological patterns in patients admitted for de novo acute hypoxemic respiratory failure, and similarly in patients admitted for acute hypercapnic respiratory failure due to acute heart failure. However, HFNO was not associated with a reduction of mechanical ventilation requirements or in mortality. In addition, we assessed mechanical ventilation in the ED by analysing three determinants that may influence patient’s outcome. First, we conducted a large bench test assessing performance and usability of all emergency ventilators marketed in Europe or North America and assessing through two distinct studies. Then, we assessed the mechanical ventilation practice in six French EDs and measured the association between mechanical ventilation settings and patients’ outcome. Performance of recent emergency ventilator were closes to ICU ventilators due to high technological improvements in the last decades. These improvements were associated with an increase of their complexity without impairment of their usability. Finally, in six French EDs, most of the patients were treated with a low tidal volume (between 6 and 8 mL/kg of predicted body weight) as recommend by scientific societies. However, a low tidal volume strategy was not associated with a reduction in the acute respiratory distress incidence as well as in mortality. These studies provided a comprehensive assessment of the ventilator support in the ED, including invasive and noninvasive ventilation, through a clinical and technological approach, and an emerging treatment, HFNO, by its clinical, biological and prognostic impact
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Oscroft, Nicholas Stephen. "The effects of long-term non-invasive positive pressure ventilation in hypercapnic chronic obstructive pulmonary disease." Thesis, University of London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542958.
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Hui, Chi-hoi, and 許志海. "Nurse-led non-invasive mechanical ventilation guideline for acute pulmonary oedema patients in acute medical wards." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658190X.
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Berkius, Johan. "Intensive care in chronic obstructive pulmonary disease : treatment with non-invasive ventilation and long-term outcome." Doctoral thesis, Linköpings universitet, Avdelningen för kardiovaskulär medicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-100738.
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Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. When we began this project our knowledge about the outcome of COPD patients admitted to the ICU in Sweden was scarce. Aims: To investigate the characteristics, survival and health-related quality of life (HRQL) of COPD patients admitted to Swedish ICUs. To investigate how ICU personnel decide whether to use invasive or non-invasive ventilatory treatment (NIV) of the newly admitted COPD patient in need of ventilatory support. To investigate outcome according to mode of ventilation. Material and methods: Detailed data, including HRQL during recovery, from COPD patients admitted to ICUs that participated in the Swedish intensive care registry were analysed. A questionnaire was distributed to personnel in 6 of the participating ICUs in order to define factors deemed important in making the choice between invasive and non-invasive ventilation immediately after admission. The answers were analysed. Results: The proportion of COPD patients admitted to Swedish ICUs in need of ventilatory support is 1.3-1.6 % of all admissions. The patients are around 70 years-old and are severely ill on admission, with high respiratory rates and most have life-threatening disturbances in their acid-base balance and blood gases. There are more women than men. The short- and long-term mortality is high despite intensive care treatment. The majority of patients are treated with NIV. The length of stay on the ICU is shorter when NIV is used. The choice between NIV and invasive ventilation in these patients may be irrational. It is guided by current guidelines, but other non-patient-related factors seem to influence this decision. NIV seems to be preferable to invasive ventilation at admission, not only according to short-term benefits but also to long-term survival. Failure of NIV followed by invasive ventilation does not have a poorer prognosis than directly employing invasive ventilation. The health-related quality of life of COPD patients after treatment on Swedish ICUs is lower than in the general population. However it does not decline between 6 and 24 months after ICU discharge. After 24 months the HRQL is quite similar to that of COPD patients not treated on the ICU. Conclusions: COPD patients in need of ventilatory support admitted to Swedish ICUs are severely ill on admission, and their short- and long-term mortality is high despite ICU care and ventilatory treatment. Non-invasive ventilation should be the first line treatment on admission. NIV has short- and long-term benefits compared to invasive ventilation, without increasing mortality risk in case of failure. After discharge from the ICU and recovery, the HRQL of COPD patients is lower than in the general population, but comparable to COPD patients not treated on the ICU.
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Liljeroth, Jennifer, and Lisa Tannerfalk. "Lätt sederade patienter under invasiv ventilation : En strukturerad litteraturstudie om patientupplevelser." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-81751.
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Bakgrund: Tidigare forskning visar att invasiv ventilation varit obehagligt för patienterna, därav har de varit djupt sederade. Rutinerna har ändrats och numera är patienterna ofta lätt sederade under invasiv ventilation på IVA. Lätt sedering har visats ge positiva fysiologiska effekter. Därför är det av stor vikt att belysa patienternas upplevelser av att vara lätt sederade under invasiv ventilation. Syfte: Syftet var att beskriva lätt sederade patienters upplevelser under invasiv ventilation på IVA. Metod: En strukturerad litteraturstudie med systematisk datainsamling har genomförts. 13 resultatartiklar inkluderades efter kvalitetsgranskning. Det kvalitativa innehållet analyserades med hjälp av dataextraktion. Resultat: Följande tre huvudkategorier, med subkategorier, utgjorde resultatet: Upplevelser av sitt tillstånd, Upplevelser av att bli sedd och hörd och Upplevelser av längtan. Patienterna hade både positiva och negativa upplevelser av att vara lätt sederade. Upplevelser av maktlöshet och förlorad värdighet var centralt i resultatet. Majoriteten av patienterna ville trots allt vara lätt sederade. Flera förbättringsområden framkom ur resultatet baserat på patienternas upplevelser. Slutsats: Resultatet kan ge ökad kunskap hos IVA-sjuksköterskan för att förbättra patienternas vårdupplevelse genom förbättringsarbeten inom verksamheten. Patienternas vårdvistelse kan underlättas med hjälp av hälsofrämjande åtgärder med minskad risk för vårdlidande. Sjuksköterske-patient ratio 1:1 tror författarna kan ge ökad patientfokuserad vård. Litteraturstudien har kartlagt befintlig forskning och även förslag på vidare forskning inom ämnet.Background: Earlier research show that invasive ventilation has been uncomfortable for the patients. Therefore the patients have been deeply sedated. Routines have changed and the patients are nowadays often lightly sedated during invasive ventilation in the ICU. Light sedation results in positive physical effects. It's important to illuminate the patients' experiences by light sedation during invasive ventilation. Aim: The aim of the study was to describe lightly sedated patients experiences during invasive ventilation in the ICU. Method: A structured literature study with systematic data collection was implemented. 13 articles was included after quality control. The qualitative content were analyzed with data extraction. Result: The result were constituted by the following three main categories with subcategories: Experiences of the condition, Experiences of being seen and heard, and Experiences by yearning. The patients expressed both positive and negative experiences associated with light sedation. Experiences of powerlessness and lost dignity were central parts of the result. Nevertheless, the majority of patients wanted to be lightly sedated. Several areas of improvement emerged from the result based on the patients' experiences. Conclusion: The result can provide the ICU-nurse with increased knowledge about the patients experiences of care during improvement within the intensive care. Patients hospital stay could be facilitated by health-promoted actions and reduced risk of suffering in care. The authors believe that nurse-patient ratio 1:1 can provide increased patient-focused care. The literature study has also illustrated the existing research and ideas for further research.
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Cantin, Danny. "Effet inhibiteur de la ventilation nasale à pression positive intermittente sur les reflux gastro-oesophagiens chez l'agneau nouveau-né." Mémoire, Université de Sherbrooke, 2015. http://hdl.handle.net/11143/6719.
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Résumé : Introduction : La ventilation nasale, de plus en plus utilisée chez le nourrisson, peut insuffler de l’air dans l’estomac et causer des reflux gastro-œsophagiens (RGO). Parmi les modes de ventilation nasale, l’aide inspiratoire (AIn) devrait entrainer un plus grand nombre de RGO que le neuro-asservissement de la ventilation assistée (NAVAn), où l’insufflation d’air est plus «physiologique». L’objectif principal de l’étude est de comparer le nombre de RGO en NAVAn et en AIn dans notre modèle ovin d’étude du RGO néonatal et de ventilation nasale.
Méthodes : Une polysomnographie avec pH-impédancemétrie œsophagienne de 6 h a été effectuée chez 10 agneaux nouveau-nés. L’enregistrement a été répété trois jours consécutifs (une condition par jour) en respiration spontanée, AIn (15/4 cmH[indice inférieur 2]O) et NAVAn (15/4 cmH[indice inférieur 2]O) dans un ordre randomisé.
Résultats : Comparé à la respiration spontanée [13 (23)], le nombre de RGO en 6 h a diminué fortement et de façon similaire en AIn [1 (3)] et en NAVAn [2 (2)] (p < 0,05), même pour des RGO faiblement acides et proximaux. De plus, le nombre d’insufflations d’air n’était pas différent entre l’AIn et la NAVAn.
Conclusion : L’AIn et la NAVAn inhibent de façon équivalente les RGO chez l’agneau, incluant les RGO faiblement acides et proximaux, si la pression inspiratoire n’est pas trop élevée et malgré le fait que de l’air soit insufflé dans l’œsophage. Ce résultat est identique à celui obtenu avec l’application d’une pression positive continue nasale (6 cmH[indice inférieur 2]O). Il est possible que la pression positive appliquée lors de la ventilation diminue les relaxations transitoires du sphincter inférieur de l’œsophage, mais des études en manométrie œsophagienne sont nécessaires pour comprendre les mécanismes en jeu. // Abstract : Introduction: Nasal ventilation, increasingly used in infants, can blow air in the stomach and cause gastroesophageal reflux (GER). Among the nasal ventilation modes, pressure support ventilation (nPSV) should lead to a greater number of GER than neurally-adjusted ventilatory assist (nNAVA), where the air delivery is more "physiological". The main objective of the study is to compare the number of GER in nNAVA and nPSV in our unique sheep model of neonatal GER and nasal ventilation.
Methods: A 6h polysomnographic recording with esophageal pH-impedance was
performed in 10 newborn lambs. The recording was repeated for three consecutive days
(one condition per day) for spontaneous breathing, nPSV (15/4 cmH[subscript 2]O) and nNAVA (15/4 cm H[subscript 2]O) in a randomized order.
Results: Compared with spontaneous breathing [13 (23)], the number of GER in 6h
strongly and similarly decreased in nPSV [1 (3)] and nNAVA [2 (2)] (p < 0.05), even
proximal and weakly acidic GER. In addition, the number of air insufflations was not
different between nPSV and nNAVA.
Conclusion: nPSV and nNAVA both inhibit GER in lambs, including weakly acidic and
proximal GER, if the inspiratory pressure is not too high and despite the fact that air is
blown into the esophagus. This result is identical to the one obtained with the application of a nasal continuous positive airway pressure (6 cmH[subscript 2]O). It is posssible that the applied
positive pressure decreases transient relaxations of the lower esophageal sphincter, but
esophageal manometry studies are needed to understand the mechanisms involved.
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Jacoupy-Essouri, Sandrine. "Insuffisance respiratoire aiguë hypercapnique de l’enfant : bases physiopathologiques et implications pour la ventilation mécanique noninvasive." Paris 12, 2007. http://www.theses.fr/2007PA120034.
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La ventilation noninvasive (VNI) a de nombreuses indications potentielles en pédiatrie mais elle reste sous-utilisée en raison des difficultés techniques. Il y a par ailleurs un manque crucial de données physiologiques et d’études cliniques. L’objet de ce travail est d’évaluer les conséquences physiologiques de détresses respiratoires fréquentes en pédiatrie et de préciser les bénéfices de la VNI. Sur une population de 10 jeunes nourrissons présentant une obstruction sévère des voies aériennes supérieures, nous avons constaté une augmentation très importante du travail respiratoire en ventilation spontanée. La VNI permet une réduction de ce travail et une amélioration des échanges gazeux. Cette étude a mit en évidence les problèmes d’interaction du patient avec son ventilateur lors d’une VNI à 2 niveaux de pressions. Le problème du réglage des paramètres de ventilation a fait l’objet d’un travail sur des patients atteints de mucoviscidose chez lesquels la VNI a démontré son efficacité. Nous avons montré que, quel que soit le mode de réglage, clinique ou physiologique, la VNI s’accompagne d’une amélioration significative du travail respiratoire. Chez 13 enfants présentant une insuffisance respiratoire aiguë hypercapnique nécessitant une ventilation assistée, la VNI diminue significativement le travail respiratoire de ces patients et améliore la ventilation alvéolaire et les échanges gazeux. Un réglage clinique, basé sur des paramètres noninvasifs, s’est avéré être aussi efficace qu’un réglage invasif basé sur l’enregistrement des pressions oesophagienne et transdiaphragmatique. Des résultats préliminaires sur 6 nourrissons atteints de bronchiolite sévère montrent qu’une pression positive continue administrée de manière noninvasive permet de diminuer le travail respiratoire et d’améliorer la ventilation alvéolaire. En conclusion, ces études physiologiques permettent de mieux comprendre la physiopathologie de l’insuffisance respiratoire aiguë et la place de la VNINoninvasive ventilation (NIV) has numerous potential indications in childhood. The aim of the present work was to analyse the physiological consequences of some common causes of respiratory failure in children and to evaluate the benefit of NIV. We analysed the work of breathing in 10 infants, mean age 8 months, presenting with severe upper airway obstruction due to structural abnomalities of the upper airway. Their work of breathing was dramatically increased and decreased significantly with NIV, which translated in an improvement of breathing pattern and gas exchange. In 13 children hospitalised in the pediatric intensive care unit (PICU) for an acute hypercapnic respiratory failure, NIV was associated with a reduction in the work of breathing and an improvement of alveolar ventilation and gas exchange. Moreover, a clinical setting of NIV was as efficient as a physiological setting. A preliminary study on 6 infants hospitalised in the PICU for severe bronchiolitis, NIV decreased the work of breathing and improved alveolar ventilation. In conclusion, the measurement of the work of breathing in various causes of respiratory failure in children improves our understanding of the pathophysiology of respiratory failure and the benefit of NIV
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Girou, Emmanuelle. "Prévention des infections liées aux soins en réanimation." Paris 12, 2003. https://athena.u-pec.fr/primo-explore/search?query=any,exact,990003949320204611&vid=upec.
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Les services de réanimation rassemblent les malades les plus à risque de complications infectieuses en raison de leur extrême gravité et de leur exposition à de nombreux dispositifs invasifs. Une partie de ces infections nosocomiales, notamment celle liées aux soins est probablement évitable en mettant au point des mesures de prévention efficaces. Cette thèse présente les travaux que nous avons menés dans ce domaine ; la première partie étant consacrée à la prévention des pneumopathies acquises sous ventilation mécanique (PAVM) et la deuxième à la prévention de la transmission croisée manuportée. Nous avons montré que le recours à la ventilation non invasive en remplacement de la ventilation invasive conventionnelle était associé à une diminution significative non seulement des PAVM, mais également d’autres types d’infections. En revanche, le drainage continu des sécrétions sous-glottiques combiné à la position demi-assise ne semblait pas avoir d’effet sur la colonisation oro-trachéale des malades intubés et ventilés, étape physiopathologique préalable au développement des PAVM. Nous avons également montré que l’utilisation de la friction hydro-alcoolique, un usage raisonné des gants de soins et le dépistage ciblé des staphylocoques dorés multirésistants devaient être proposées pour limiter la transmission croisée manuportée en réanimationPatients hospitalized in intensive care units are at high-risk of acquiring infections because of their high severity and high exposure to invasive devices. One part of these infections may probably be avoided using effective measures, especially the part associated with care activities. This thesis presents the studies we conducted in this field with a first part focusing on the prevention of ventilator-associated pneumonia (VAP) and a second part discussing the prevention of cross transmission via hands. For VAP prevention, the use of noninvasive ventilation was associated with a significant reduction of VAP and other sites of infection whereas, in another study, the use of subglottic secretions drainage and semi-recumbent position had no effect on tracheal colonization, which normally precedes lung infection. We also demonstrated that the use of alcoholic hand-rubs, the rational use of gloves and, the screening of multiresistant Staphylococcus aureus on admission might help limiting cross transmission of microorganisms in intensive care units
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Nobre, Joana Filipa de Gandarinho e. "Ventilação não-invasiva em pacientes com Esclerose Lateral Amiotrófica." Bachelor's thesis, [s.n.], 2012. http://hdl.handle.net/10284/3437.
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Vincent, Alexandre. "Etude et conception de capteurs à ultrasons pour l'évaluation non invasive de la ventilation pulmonaire chez l'homme." Grenoble 2 : ANRT, 1987. http://catalogue.bnf.fr/ark:/12148/cb37610625k.
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Fort, Pierre-Arnaud. "Ventilation non invasive : de l'expérience hospitalière à la prise en charge pré-hospitalière de l'insuffisance respiratoire aigue͏̈." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M096.
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Vincent, Alexandre. "Étude et conception de capteurs à ultrasons pour l'évaluation non invasive de la ventilation pulmonaire chez l'homme." Paris 11, 1987. http://www.theses.fr/1987PA112045.
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This work includes three parts : The design of new sensors using ultrasonic propagation and allowing different motion measurements of the human ventilatory system. -The choice of suitable composite variables allowing the determination of pulmonary volumes with enough accurary by a pattern of breathing box. The automatisation of the clinic data processing, got in parallel from a direct spirometer, from perimetric and surfacic sensors and from new ultrasonic sensors. A method of efficient volume-motion coefficients is obtained from these data. The first part originality is linked to the choice of the resonant frequency of the ultrasonic wave resulting from a compromise between a some rather short wave length in order to keep a good resolution, which is long enough to properly cross the ventilatory system. We have also shown the propagation of a compression wave guided by skindeep tissus. This wave allows us to measure cords or fractions of thoracic or abdominal perimeters. The geometrie pattern explicits respective assignments of two partially independant compartments during breathing, and lets understanding of the influence of the ventilatory system geometrie changes of volume-motion coefficients. Finally, we show that ventilatory motions include not only transversal and sagittal dilatations of compartments, but also a lengthening of the whole ventilatory system which importance is stretched by the necessity of a third variable measured with the ultrasonic sensor. Ln conclusion, this work represents a technological contribution on new sensors and a methodologie one in the calibration field. Lt allows us to look forward at an extension of using non-invasive measurement of ventilation to monitor breathing during long periods. KEY WOBQS: Breathing functional tests, non-invasive measurement of ventilation, volume-motion coefficients, ventilatory system modelling, ultrasonic wave guided by interfaces, biologie tissueCe travail comprend trois parties: La conception de nouveaux capteurs utilisant la propagation des ultrasons et permettant la mesure statique et dynamique des différentes dimensions du système ventilatoire chez l'homme; le choix des variables composites pertinentes permettant de déterminer les volumes pulmonaires avec une précision suffisante grâce à une modélisation du caisson respiratoire; l'automatisation du traitement des données cliniques obtenues en parallèle à partir d'une spirométrie directe, de capteurs périmétriques, surfaciques et des nouveaux capteurs à ultrasons. Dans la première partie nous avons choisi la fréquence de résonance de l'onde ultrasonore en faisant un compromis entre une longueur d'onde assez courte pour garder une bonne résolution et assez longue pour satisfaire la profondeur de pénétration qui permet à l'onde de traverser le parenchyme pulmonaire. Nous avons montré également la propagation d'une onde de volume guidée par les tissus superficiels qui permet de mesurer des cordes ou fractions de périmètre thoracique ou abdominal. Le modèle géométrique précise les rôles respectifs des deux compartiments dans la respiration et permet de mieux comprendre l'influence des changements de géométrie du système ventilatoire sur les coefficients de calibration. Nous montrons enfin que les mouvements ventilatoires ne comportent pas seulement des dilatations transversales et sagittales des compartiments, mais également un allongement de l'ensemble du système ventilatoire; allongement dont l'importance est mis en évidence par la nécessité d'une troisième variable mesurée par le capteur à ultrasons. En conclusion ce travail représente un apport technologique sur de nouveaux capteurs et un apport méthodologique dans l'épreuve de calibration. Il permet d'envisager l'extension du domaine d'utilisation des Mesures Non Invasives de la Ventilation (MNIV) aux mesures au long cours
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Fresnel, Emeline. "Etude comparative des performances des ventilateurs de domicile et analyse des interactions patient-ventilateur en ventilation non invasive." Rouen, 2015. http://www.theses.fr/2015ROUES048.
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La ventilation non invasive constitue une modalité de traitement de l’insuffisance respiratoire chronique suffisamment prescrite pour motiver des études sur banc d’essai afin d’évaluer et de comparer les performances des ventilateurs. Pour que les évaluations soient fiables et reproductibles, nous avons revisité de nombreux aspects des études sur poumon mécanique et développé une procédure paramétrique de tests des ventilateurs. Nous avons commencé par modéliser un effort inspiratoire physiologique qui, lorsqu’il gouverne trois modèles pulmonaires physiopathologiques distincts, permet de simuler une cohorte réaliste de patients. L’élaboration de cette procédure a nécessité la définition d’une terminologie claire et motivée, ainsi que l’uniformisation des conditions de tests des ventilateurs. Il a ainsi été rendu possible de caractériser la synchronisabilité des ventilateurs, définie comme leur capacité à se synchroniser aux différents modèles pulmonaires testés. Ces performances dépendent à la fois de la mécanique et de la dynamique pulmonaires. La création de fiches techniques et d’outils de comparaison des ventilateurs, mis à la disposition des praticiens sur un site dédié, devrait faciliter le choix d’un dispositif d’assistance ventilatoire adapté à chaque patient. Ce travail s’appuie en outre sur un modèle dynamique d’interactions patient-ventilateur ayant permis de dresser une revue des asynchronismes mais également d’en comprendre les mécanismes sous-jacents. La mise en relation des résultats théoriques et expérimentaux offre une perspective d’identification des stratégies de fonctionnement des ventilateurs et d’optimisation des interactions patient-ventilateurNoninvasive ventilation can be defined as a modality of treatment for chronic respiratory failure. Nowadays, it is sufficiently often prescribed to motivate test bench studies whose objectives are to evaluate and compare ventilators performances. To provide reliable and reproducible assessments, we revisited many aspects of test bench studies and developed a parametric procedure for testing ventilators. We initially focused our attention on the modeling of a physiological inspiratory effort which, when driving three pathophysiological lung models, allows to simulate a realistic cohort of patients. The development of this procedure required to introduce a clear and motivated terminology, as well as to unify the parameter settings of the ventilators. It was then possible to characterize the ventilators synchronizability, defined as the ability of the device to synchronize with the different pulmonary models it was connected to. These performances depend on the mechanics and dynamics of the lung model. Providing the practitioners with reports and tools for comparing ventilators on a dedicated website should facilitate the choice of a ventilatory assistance device adapted to each patient. This works was also devoted to the use of a dynamical model for the patient-ventilator system which allowed us not only to review most of the asynchrony events observed in clinics but also to explain their underlying mechanisms. Linking theoretical and experimental results offers us a perspective for identifying the ventilators operating strategies, a required step to improve patient-ventilator interactions
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Camilo, Helena Isabel Picareta Lopes. "Cuidar do doente crítico submetido a ventilação não invasiva no Serviço de Urgência." Master's thesis, Universidade de Évora, 2018. http://hdl.handle.net/10174/23273.
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A realização do estágio no SU permitiu não só desenvolver um projeto de intervenção com objetivo de uniformizar as intervenções de enfermagem ao doente crítico com necessidade de ventilação não invasiva, demonstrando a importância das mesmas, mas também desenvolver e adquirir competências comuns e especificas do enfermeiro especialista, através de um conjunto de atividades que foram planeadas e concretizadas ao longo deste período. A pertinência do tema escolhido para desenvolver o projeto está relacionada com o impacto das doenças respiratórias saúde, sociedade e economia, quer pela taxa de mortalidade ou morbilidade associada. Neste sentido, a ventilação não invasiva surge como um tratamento seguro e eficaz, sendo cada vez mais aplicada com bons resultados. Contudo, o sucesso da sua utilização depende também de uma equipa de enfermagem treinada e qualificada, que consiga prevenir, tratar e vigiar possíveis complicações inerentes ao procedimento em doentes críticos. A formação da equipa de enfermagem, permite melhorar e desenvolver as suas capacidades técnicas, de forma a que consigam perceber e antecipar complicações no tratamento do doente crítico submetido ventilação não invasiva, uma vez que estão mais sensíveis às suas necessidades; ABSTRACT:
Taking care of critically ill patient undergoing noninvasive ventilation in the emergency department
The accomplishment of the internship in the emergency service allowed not only to develop an intervention project with the aim of standardizing the nursing interventions to the critical patient with need for non-invasive ventilation, demonstrating the importance of these, but also developing and acquiring common and specific skills of the specialist nurse, through a set of activities that were planned and accomplished during this period. The pertinence of the theme chosen to develop the project is related to the impact of respiratory, health, society and economy diseases, either by the associated mortality rate or morbidity. In this sense, non-invasive ventilation appears as a safe and effective treatment, being increasingly applied with good results. However, the success of its use also depends on a trained and qualified nursing team that is able to prevent, treat and monitor possible complications inherent to the procedure in critically ill patients. The training of the nursing team allows them to improve and develop their technical capacities so that they can perceive and anticipate complications in the treatment of critical patients undergoing non-invasive ventilation since they are more sensitive to their needs.
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Roos, Kerstin. "Omvårdnadsdokumentation för patienter med kronisk obstruktiv lungsjukdom som behandlas med Non-invasiv ventilation : en journalgranskning." Thesis, Högskolan Kristianstad, Sektionen för hälsa och samhälle, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-13934.
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Bakgrund: Patienter med kronisk obstruktiv sjukdom (KOL) som behandlas med Non-invasiv ventilation (NIV) har risk för trycksår och malnutrition. Observation och övervakning av patienterna är viktigt för att kunna följa behandlingsförloppet och tidigt upptäcka en eventuell försämring samt förebygga komplikationer. Dokumentation av given omvårdnad måste kunna följas för att utvärdera och säkerställa kraven på en god och säker vård. Syfte: Syftet med studien var att granska omvårdnadsdokumentationen för patienter med KOL som behandlats med NIV på en medicinsk akutvårdsavdelning. Metod: Studien genomfördes som en retrospektiv systematisk journalgranskning i 75 journaler med en granskningsmall. Resultat: Omvårdnadsprocessens steg fanns inte dokumenterad i sin fullständighet för trycksår eller nutrition i någon journal. Dokumentationen av omvårdnadsprocessen för trycksår var oberoende av antal vårddygn, kön och ålder men beroende av antal dygn med NIV. För nutrition var dokumentationen av omvårdnadsprocessen beroende av antal NIV- och vårddygn men oberoende av kön och ålder. Dokumentationen för omvårdnad och behandling med NIV var utspridd i journalen under olika rubriker. Slutsats: Studiens resultat visade att det fanns brister i omvårdnadsdokumentationen.
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Baolorphet, Phetphirun, and Neselius Henrik Ekhult. "Sjuksköterskors erfarenheter av non-invasiv ventilatorbehandling : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3328.
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Non invasiv ventilatorbehandling, NIV, är en behandlingsmetod för patienter med akut respiratorisk svikt. Både ventilatoriska och hypoxiska tillstånd kan behandlas med denna metod som blivit vanligare inom akutsjukvården de senaste decennierna. Det ställs stora krav på sjuksköterskan att arbeta både patientsäkert och personcentrerat inom akutsjukvården. Krav om behandlingsmetod, effekt och omvårdnadsåtgärder vid biverkningar leder till att sjuksköterskan kan arbeta självständigt och effektivt. För att kunna minska patientlidande och vårdskador som kan leda till höga kostnader för hälso- och sjukvården krävs att kunskapen om NIV-behandling följer normen för aktuell evidens samt riktlinjer. Syftet med studien var att belysa sjuksköterskors erfarenheter av att genomföra non invasiv ventilatorbehandling av patienter med akut respiratorisk svikt. Litteraturöversikt valdes som metod. Datainsamlingen genomfördes i databaserna CINAHL, PubMed och PsycINFO samt manuell sökning med hjälp av sökord som bedömds besvara studiens syfte. Sökningarna genererade 16 vetenskapliga originalartiklar av både kvantitativ och kvalitativ design, publicerade år 2008 – 2018, som inkluderades i studien. Artiklarna analyserades med en integrerad analys. Tre huvudteman framkom i analysen: fördelning vid riskbedömning och ansvar, samverka i interprofessionellt team och faktorer som påverkar omvårdnad vid NIV-behandling. Alla teman hade i sin tur två till fyra underkategorier. Samarbete och kommunikation var ett av de mest framträdande teman som framkom i studien. Slutsatsen av sjuksköterskors erfarenheter av att genomföra NIV-behandling involverar flera olika faktorer. Såsom kunskapen om behandlingen, interaktion med patienten och samarbete samt kommunikation med läkaren som var otillräckliga för att genomföra och upprätthålla en högkvalitativ vård för patienten. För att kunna bedriva en god vård krävs att sjuksköterskan erhålls kunskap, utbildning och träning samt får stöd och återkoppling för sitt arbete. Stödet kan erhållas från både kollegor och organisationsledningen för att kunna skapa förutsättningar för ökat samarbete. Genom att tillse personal och arbeta för goda arbetsförhållanden.Non-invasive ventilation treatment, NIV, is a treatment method for patients with acute respiratory failure. Both ventilatory and hypoxic conditions can be treated with this method, which has become more common in emergency care in recent decades. There are great demands on the nurse to work both patient-safe and person-centered in emergency care. Requirements for treatment method, effect and nursing measures in case of side effects lead to the nurse being able to work independently and efficiently. In order to reduce patient suffering and healthcare injuries that can lead to high costs for health and medical care, knowledge of NIV treatment must comply with the norm for current evidence and guidelines. The aim of this study was to highlight nurses' experiences of carry out non-invasive ventilator treatment to patients with acute respiratory failure. A literature review was chosen as a method. The data collection was carried out in the databases CINAHL, PubMed and PsycINFO as well as manual search using keywords that were judged to respond to the purpose of the study. The searches generated 16 original scientific articles of both quantitative and qualitative design, published year 2008 – 2018, which were included in the study. The articles were analyzed with integrated analysis. Three main themes emerged from the analysis: distribution of risk assessment and responsibility, collaborate in interprofessional teams and factors that affect nursing in NIV treatment. The themes in turn had two to four subcategories. Cooperation and communication were one of the most prominent themes that emerged in this study. The conclusion of the nurse's experience of carrying out NIV treatment is lined with several different factors. Such as the knowledge of the treatment, interaction with the patient and collaboration as well as communication with the doctor who were insufficient to carry out and maintain a high-quality care for the patient. In order to be able to carry out good care, the nurse must receive knowledge, education and training, and receive support and feedback for their work effort. The support can also be obtained from colleague and the organization management in order to be able to create the conditions for increased cooperation by ensuring staff and work for good working conditions.