Evidence - pt monitoring and NIV

Question 1

What is the evidence for Assessment and monitoring in ICU?

Answer 1

Holm,

• review of 4 patients to explore ICU experience with being conscious during ETT intubation and MV
• 3 themes: Tube in throat, to be conscious but feeling doped, Time is dragging on
• no sedation protocol may cause physical and existential character - patients seem positive to being conscious
• Clinical implications: Nurses need to further accommodate patient’s needs

Question 2

Peppard et al, 2000 looked into NIV effects of OSA. What did they find?

Answer 2

• aim: to check effects of OSA on developing HT.
• no sleep apneoa - risk is 1 to develop HT
  -Mild sleep apnoea (5-14.9 events/hr) - twice as likely to develop HT
• 15 events/ hr - three times as likely
  Clinical implications: sleep apnoea have highers risk of developing HT

Question 3

What did Marin et al, 2005 find about the effects of OSA on stroke

Answer 3

• aim: to check effects of OSA on fatal vs non fatal (stroke, heart attack)
• severe OSAH> Mild OSAH> severe OSAH and CPAP > snorers
• CI: Pt’s with severe OSAH higher mortalisty risk compared to others

Question 4

Describe what Johanasoon et al, 2004 found about weight and sleep apnoea

Answer 4

• found that with weight loss comes decreased sleep apnoea

Question 5

Kryger, 2005 looked into use of splints vs CPAP for sleep apnoea. What did they find?

Answer 5

• over a month for mild, mod or severe sleep apnoea
• 65% choose splint - more comfortable
• not much difference with Mild and mod apnoea
• CPAP more effective for severe
• CI: CPAP more effect vs splint for severe sleep Apnoea

Question 6

Describe what Doug McEvoy et al, 2016 found about SPS for preventation of CV events

Answer 6

• in OSA pateints
  found:
• adherence/ usage defined as good when > 4 hours a night
• average CPAP usage = 3.3 +/- 2.3 hrs
• 42% CPAP group had good adherence
• Residual AHI = 3.7/ hr in users
• no objective leak stats, no data on masks used
• 47% SPAP group still snoring at end of study
  -17.5% of partners of CPAP uses noted breathing pasus 1-2 times per week
  Clinical implications:
• risk of serious CV not less in users
• less sleepiness, improved health related QoL
• improved mood and increase attendance in work ( by 0.3 days!)

Question 7

What did Ram et al, 2004 find in regards to NIV use

Answer 7

• looked into NIV plu usual medical care vs usual medical care with COPD
• decreased mortality, decreased need for intubation, decreased in complications, decreased hospital stay
• rapid improvement in pH in the 1st hour

Question 8

What did Kennan et al, 2002 find in regards to NIV in post extubation failure?

Answer 8

• 81 patients who developed respiratory distress within 48 hours
• no difference in rates of reintubation, hospital ortality or length of stay

Question 9

Describe what Estaban et al, 2004 found about NIV in post extubation failure

Answer 9

• 221 patients
• no difference in need for reintubation
• rate of death in ICU higher in NIV group
• longer period to reintubation in NIV group

Question 10

What did Holland, 2003 and Fauroux, 2007 find in regards to NIV used as treatment for chronic sputum

Answer 10

• addition of +ve pressure during ACBT/ FET treatment can potentially: preserve or improve respiratory muscle strength, improve expiratory muscle streangth, improve oxygen saturation
• reduce dyspnoea, well tolerated and usually preferred due to fatigue reduction