विवरण
Dr Viny Kantroo is a Chest, Critical Care & Sleep medicine specialist based in Delhi, boasting over more than 15 years of professional experience. She is currently practising as a full time Senior consultant in Indraprastha Apollo Hospitals New Delhi and Visiting Consultant Apollo Hospitals Noida in the department of Respiratory, Critical Care and Sleep Medicine.
She is recognised for her expertise in various aspects of Chest medicine, which includes EBUS (Convex probe, Radial), Bronchoscopic procedures, pleural effusion management, interstitial lung disease, Covid-19, lung cancer, pneumonia, and intensive care patient management. Dr Kantroo is renowned not only for her medical proficiency but also for her empathy and positive attitude towards patient care. Patients consulting with Dr Viny can be assured of receiving an accurate diagnosis and effective treatment, thanks to her commitment to prompt and comprehensive care.
सारांश
- Respiratory failure is defined as the failure of the lungs or the pump system to adequately oxygenate the body and remove carbon dioxide. While many research articles on the topic exist, a significant portion is related to COVID-19. Respiratory failure can manifest as type 1 (hypoxemic) lung failure due to impaired gas exchange or type 2 (hypercapnic) pump failure resulting from muscle weakness or neurological impairment.
- Non-invasive respiratory support, including high flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV), offers several advantages. These methods can reduce the need for ICU admission, potentially mitigate risks like self-inflicted lung injury, and avoid intubation delays. Careful clinical judgment, caregiver expertise, and resource availability are crucial in determining the appropriate type of non-invasive support.
- NIV has specific goals related to the timing of application. It can prevent impending respiratory failure, provide palliation, avert endotracheal intubation, serve as an alternative when intubation is not desired, or facilitate weaning from invasive ventilation. Indications for NIV vary based on the severity and stage of respiratory failure. Success is more likely in early stages of COPD exacerbations, acute cardiogenic pulmonary edema, and in immunocompromised patients.
- Patient comfort is critical for successful NIV implementation. Mask intolerance is a common reason for failure. Proper mask fitting, management of air leaks, and skin integrity assessment are vital. Different mask types are available, including full face, nasal, nasal pillow, total face, and helmet masks, allowing for individualized fitting.
- NIV improves gas exchange, reduces mortality in specific patient groups (like COPD), decreases ventilator time and hospital stay, and lessens the incidence of ventilator-associated pneumonia. It works by delivering positive pressure to the lungs via a mask, assisting breathing without intubation. Bilevel positive airway pressure (BiPAP) provides two pressure levels: a lower pressure (CPAP/PEEP) during expiration and a higher inspiratory pressure.
- When setting up NIV, it's important to explain the procedure to the patient, begin with low pressures, and gradually increase them based on tidal volume and respiratory distress. Monitoring is key, with frequent reassessment, continuous cardiac and SpO2 monitoring, and arterial blood gas analysis after setting changes. Alarms should be set appropriately and not muted. Humidification is essential to prevent airway damage.
- Predictors of success include improved arterial oxygenation, reduced respiratory rate, and decreased dyspnea. Conversely, stable or worsening oxygenation, unchanged respiratory rate, and the presence of contraindications indicate potential failure. Several technical issues can arise, such as ventilator cycling problems or inadequate chest expansion, requiring adjustments to trigger sensitivity, IPAP/EPAP settings, or airway positioning.
- Integrated strategies to reduce NIV failure include addressing severe hypercapnia or hypoxemia with advanced interventions, optimizing ventilator settings, managing secretions, providing analgesia, and considering underlying comorbidities. Ultimately, the success of NIV depends on careful patient selection, vigilant monitoring, and a proactive approach to addressing potential complications.
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