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Non-invasive Respiratory Support: How to Get It Right in Clinical...
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Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (22 February 2024) | Viewed by 4383

Special Issue Editor

Prof. Dr. Stefano Nava

E-Mail Website
Guest Editor
1. Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
2. Respiratory and Critical Care Unit, St. Orsola University Hospital, Bologna, Italy
Interests: non invasive ventilatory support techniques; respiratory palliative care; weaning from mechanical ventilation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The importance of non-invasive respiratory therapies has been highlighted during the COVID-19 pandemic. The use of this treatment in all areas of the hospital has rapidly increased. Despite the increased use of these technologies within the hospital, there is an increased need to improve education and experience in this field, especially with regard to patients requiring long-term treatment at home.

We recently released one Special Issue titled “Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume I" with a good collection of papers available online, accessed at https://www.mdpi.com/journal/jcm/special_issues/6G6B3S275M. Now we would like to announce the second Special Issue, which aims to collect the latest approaches and findings, as well as discuss current challenges in the provision of respiratory support (non-invasive ventilation with or without oxygen and high flow therapy) with regard to patient selection, initiation, and telemedicine applications. Where applicable, case examples will be presented in addition to real data, aiming to assist the reader with their clinical practice. The focus is on getting it right in patient diagnosis and should include a focus on new modes and strategies of respiratory support, such as autotitration modes and monitoring.

We expect this Special Issue to promote the state of the art in this field, increase the visibility and importance of this area and promote research in areas where there are gaps. Potential topics include, but are not limited to, the following:

  • Domiciliary high flow therapy;
  • Monitoring requirements for home mechanical ventilation;
  • The ventilator, modes, and settings for home mechanical ventilation;
  • What circuit, mask, and filters should be used in home mechanical ventilation;
  • Oxygen distribution with respiratory support devices in the hospital and home;
  • Hospital versus outpatient versus home initiation of ventilatory support.

Prof. Dr. Stefano Nava
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • non-invasive ventilation (NIV)
  • continuous positive airway pressure (CPAP)
  • high flow therapy (HFT)
  • mouthpiece ventilation (MPF)
  • sleep studies
  • mechanical insufflation–exsufflation (MI-E)
  • chronic obstructive pulmonary disease (COPD)
  • neuromuscular disease (NMD)
  • amyotrophic lateral sclerosis (ALS)
  • home mechanical ventilation (HMV)
  • auto-EPAP monitoring
  • weaning

Related Special Issue

Published Papers (5 papers)

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Research

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7 pages, 200 KiB  
Article
Effect of Nasal High Flow (NHF) on Right Heart Function in Stable Patients with Pulmonary Hypertension of Different WHO Classes
by Jens Bräunlich, Hans-Jürgen Seyfarth and Hubert Wirtz
J. Clin. Med. 2024, 13(7), 1862; https://doi.org/10.3390/jcm13071862 - 24 Mar 2024
Viewed by 472
Abstract
Background: Nasal high flow (NHF) has various effects on the respiratory system in acute and chronic conditions. There are initial reports that NHF is also able to influence cardiac function in acute decompensation. This study was designed to clarify whether NHF has an [...] Read more.
Background: Nasal high flow (NHF) has various effects on the respiratory system in acute and chronic conditions. There are initial reports that NHF is also able to influence cardiac function in acute decompensation. This study was designed to clarify whether NHF has an influence on the right heart in stable patients with chronic pulmonary hypertension. Methods: Forty-one stable patients from different pulmonary hypertension (PH) WHO classes were recruited. Most patients were assigned to WHO classes 1 and 3. All received a right heart catheterization and blood gas analysis. Oxygenation was kept constant. The mean pulmonary arterial pressure (mPAP), wedge pressure (PC), cardiac output (CO), diastolic pulmonary gradient (DPG), pulmonary arterial resistance (PVR) and other parameters were determined. The patients then used NHF at 35 L/min for 20 min, after which the right heart catheter measurements were repeated with ongoing NHF therapy. Results: In the entire cohort and in the subgroups, there were no changes in right heart function or cardiac ejection fraction. The blood gases did not change either. Conclusions: Thus, there is no effect of NHF on right heart function in stable patients with PH. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
9 pages, 641 KiB  
Article
A Data-Driven Framework for Clinical Decision Support Systems in Positive Airway Pressure and Oxygen Titration
by Artis Svaža, Dāvis Freimanis, Dana Zariņa, Pavels Osipovs, Svjatoslavs Kistkins, Vitālijs Ankudovičs, Olegs Sabeļnikovs, Valdis Pīrāgs, Yuriy Chizhov and Dmitrijs Bliznuks
J. Clin. Med. 2024, 13(3), 757; https://doi.org/10.3390/jcm13030757 - 28 Jan 2024
Viewed by 719
Abstract
Background: Current obstructive sleep apnea treatment relies on manual PAP titration, but it has limitations. Complex interactions during titration and variations in SpO2 data accuracy pose challenges. Patients with co-occurring chronic hypercapnia may require precise oxygen titration. To address these issues, we [...] Read more.
Background: Current obstructive sleep apnea treatment relies on manual PAP titration, but it has limitations. Complex interactions during titration and variations in SpO2 data accuracy pose challenges. Patients with co-occurring chronic hypercapnia may require precise oxygen titration. To address these issues, we propose a Clinical Decision Support System using Markov decision processes. Methods: This study, compliant with data protection laws, focused on adults with OSA-induced hypoxemia utilizing supplemental oxygen and CPAP/BiPAP therapy. PAP titration, conducted over one night, involved vigilant monitoring of vital signs and physiological parameters. Adjustments to CPAP pressure, potential BiLevel transitions, and supplemental oxygen were precisely guided by patient metrics. Markov decision processes outlined three treatment actions for disorder management, incorporating expert medical insights. Results: In our study involving 14 OSA patients (average age: 63 years, 27% females, BMI 41 kg m−2), significant improvements were observed in key health parameters after manual titration. The initial AHI of 61.8 events per hour significantly decreased to an average of 18.0 events per hour after PAP and oxygen titration (p < 0.0001), indicating a substantial reduction in sleep-disordered breathing severity. Concurrently, SpO2 levels increased significantly from an average of 79.7% before titration to 89.1% after titration (p < 0.0003). Pearson correlation coefficients demonstrated aggravation of hypercapnia in 50% of patients (N = 5) with initial pCO2 < 55 mmHg during the increase in CPAP pressure. However, transitioning to BiPAP exhibited a reduction in pCO2 levels, showcasing its efficacy in addressing hypercapnia. Simultaneously, BiPAP therapy correlated with a substantial increase in SpO2, underscoring its positive impact on oxygenation in OSA patients. Markov Decision Process analysis demonstrated realistic patient behavior during stable night conditions, emphasizing minimal apnea and good toleration to high CPAP pressure. Conclusions: The development of a framework for Markov decision processes of PAP and oxygen titration algorithms holds promise for providing algorithms for improving pCO2 and SpO2 values. While challenges remain, including the need for high-quality data, the potential benefits in terms of patient management and care optimization are substantial, and this approach represents an exciting frontier in the realm of telemedicine and respiratory healthcare. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
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15 pages, 2379 KiB  
Communication
International Survey of the Tools Used for Assessment, Monitoring and Management of Home Mechanical Ventilation Patients
by Michelle Chatwin and Nicholas Hart
J. Clin. Med. 2023, 12(21), 6803; https://doi.org/10.3390/jcm12216803 - 27 Oct 2023
Cited by 1 | Viewed by 1593
Abstract
Background: There are limited data reporting diagnostic practices, compared to clinical guidelines, for patients with chronic respiratory failure requiring home mechanical ventilation (HMV). There are no data detailing the current use of downloaded physiological monitoring data in day-to-day clinical practice during initiation and [...] Read more.
Background: There are limited data reporting diagnostic practices, compared to clinical guidelines, for patients with chronic respiratory failure requiring home mechanical ventilation (HMV). There are no data detailing the current use of downloaded physiological monitoring data in day-to-day clinical practice during initiation and follow up of patients on HMV. This survey reports clinicians’ practices, with a specific focus on the clinical approaches employed to assess, monitor and manage HMV patients. Methods: A web-based international survey was open between 1 January and 31 March 2023. Results: In total, 114 clinicians responded; 84% of the clinicians downloaded the internal physiological ventilator data when initiating and maintaining HMV patients, and 99% of the clinicians followed up with patients within 3 months. Adherence, leak and the apnea-hypopnea index were the three highest rated items. Oxygen saturation was used to support a diagnosis of nocturnal hypoventilation and was preferred over measurements of carbon dioxide. Furthermore, 78% of the clinicians reviewed data for the assessment of patient ventilator asynchrony (PVA), although the confidence reported in identifying certain PVAs was reported as unconfident or extremely unconfident. Conclusions: This survey confirmed that clinical practice varies and often does not follow the current guidelines. Despite PVA being of clinical interest, its clinical relevance was not clear, and further research, education and training are required to improve clinical confidence. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
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12 pages, 927 KiB  
Article
Clinical Outcomes according to Timing to Non Invasive Ventilation Initiation in COPD Patients with Acute Respiratory Failure: A Retrospective Cohort Study
by Lara Pisani, Gabriele Corsi, Marco Carpano, Gilda Giancotti, Maria Laura Vega, Vito Catalanotti and Stefano Nava
J. Clin. Med. 2023, 12(18), 5973; https://doi.org/10.3390/jcm12185973 - 14 Sep 2023
Viewed by 696
Abstract
Nighttime and non-working days are characterized by a shortage of dedicated staff and available resources. Previous studies have highlighted that patients admitted during the weekend had higher mortality than patients admitted on weekdays (“weekend effect”). However, most studies have focused on specific conditions [...] Read more.
Nighttime and non-working days are characterized by a shortage of dedicated staff and available resources. Previous studies have highlighted that patients admitted during the weekend had higher mortality than patients admitted on weekdays (“weekend effect”). However, most studies have focused on specific conditions and controversial results were reported. We conducted an observational, monocentric, retrospective cohort study, based on data collected prospectively to evaluate the impact of the timing of NIV initiation on clinical outcomes in COPD patients with acute respiratory failure (ARF). A total of 266 patients requiring NIV with a time gap between diagnosis of ARF and NIV initiation <48 h were included. Interestingly, 39% of patients were not acidotic (pH = 7.38 ± 0.09 vs. 7.26 ± 0.05, p = 0.003) at the time of NIV initiation. The rate of NIV failure (need for intubation and/or all-cause in-hospital death) was similar among three different scenarios: “daytime” vs. “nighttime”, “working” vs. “non-working days”, “nighttime or non-working days” vs. “working days at daytime”. Patients starting NIV during nighttime had a longer gap to NIV initiation compared to daytime (219 vs. 115 min respectively, p = 0.01), but this did not influence the NIV outcome. These results suggested that in a training center for NIV management, the failure rate did not increase during the “silent” hours. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
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Review

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19 pages, 8452 KiB  
Review
Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders
by Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck
J. Clin. Med. 2024, 13(9), 2643; https://doi.org/10.3390/jcm13092643 - 30 Apr 2024
Viewed by 616
Abstract
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate [...] Read more.
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters. Full article
(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)
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