Non-Invasive Ventilation: A Practical Handbook for Understanding the Causes of Treatment Success and Failure


Antonio M. Esquinas, MD, PhD, FCCP, FAARC – Intensive Care Unit Hospital Morales Meseguer, Murcia, Spain; Director International School of Non-Invasive Ventilation; Director International Non Invasive Ventilation Expert of College

Series: Pulmonary and Respiratory Diseases and Disorders
BISAC: MED079000

Non-invasive ventilation (NIV) has shown, in the last two decades, to be an essential ventilatory management modality for treatment of patients with diverse etiologies of acute and chronic respiratory insufficiency, with significant favorable outcomes in terms of improvement in gas exchange, respiratory muscle fatigue, and dyspnea.

NIV is an alternative to invasive mechanical ventilation, with significant improvement in short and long term prognosis. However, despite the abundance of literature supporting the benefits of NIV, there is controversy in regards to the timing of initiation and termination of NIV in the disease process, leading to unsettled issues and constant analysis for both researchers and physicians in clinical practice.

There is scarce literature that describes thorough predictors of success or failure of NIV. There is need to develop tools or models to predict response to NIV, optimize those responses, increase tolerance to NIV technology (mechanical ventilator, interface, or ventilatory mode) that can be translated to increase success rate of NIV.

The book “Non-Invasive Ventilation: A Practical Handbook for Understanding the Causes of Treatment Success and Failure” is the first text published with well-defined objectives that analyze the success and failure response of non-invasive mechanical ventilation.

The table of contents is structured in an order to meet the defined objectives based upon respiratory physiology:
– Breathing patterns
– Respiratory muscular fatigue (inspiratory / expiratory muscle)
– Lung mechanics (compliance and airway resistance)
– Gas exchange (hypercapnic/hypoxemic), and neurologic determinants)

Sections of this book will address different aspects of NIV ranging from perspective pathophysiological benchmarks and clinical studies, to diagnosis and monitoring elements of basic lung – patient – ventilator interaction, including:
– Monitoring lung mechanics (pressure curves, volume (tidal and minute) (lower and high) and leakages (concept / monitoring)), in a broad and profound way
– Illustrating potential determinants and scenarios in non-invasive-ventilation
The aim is to describe a summary of global and practical recommendations of the utility of NIV that will affect the reader’s capability in treating respiratory comorbidities. These include:
– Chronic respiratory diseases like obstructive sleep apnea,
– Obesity hypoventilation syndrome, and
– Cardiac chronic insufficiency.
(Imprint: Nova)

Table of Contents


Chapter 1. Basic Lung-Patient-Ventilator Interaction
(Müge Aydoğdu, MD, Gazi University Medical Faculty Pulmonary Diseases Department and Critical Care Unit, Ankara, Turkey)

Chapter 2. Patient Determinants: NIV Response Breathing Pattern
(Andrea Purro, Humanitas Gradenigo Hospital, Emergency and ICU Department, Turin, Italy)

Chapter 3. Respiratory Muscular Fatigue
(Savino Spadaro, MD, PhD, Francesca Dalla Corte, MD, and Corrado Mollica, MD, Department of Morphology, Surgery and Experimental Medicine, Anesthesia and Intensive Care, University of Ferrara, Italy, and others)

Chapter 4. Lung Mechanics: Compliance and Airway Resistance Implications for Success vs Failure
(Elena Mead, MD, Department of Anesthesia and Critical Care, Memorial Sloan Kettering, New York, NY, US)

Chapter 5. Neurologic Determinants in NIV Response
(Mediha Turktan, MD, and Dilek Ozcengiz, MD, Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey)

Chapter 6. Hemodynamic Conditions
(Stephan Steiner, MD, Department of Cardiology, Pneumology and Intensive Care, St Vincenz Hospital, Limburg/Lahn, Germany)

Chapter 7. pH and PaCO2 Acute Hypercapnic Respiratory Failure
(AylinOzsancak Ugurlu, MD, Baran Balcan, MD, Department of Pulmonary Medicine, Baskent University, Ankara, Turkey, and other)

Chapter 8. Causes and Physiology of Hypoxemic Respiratory Failure
(Antonello Nicolini, Catia Cilloniz, Tommaso Bondavalli and Fulvio Braido, Respiratory Diseases Unit, Hospital of Sestri Levante, Italy, and others)

Chapter 9. Chronic Respiratory Diseases
(Nicola Vargas, Department of Medicine, San Giuseppe Moscati Hospital, Avellino, Italy)

Chapter 10. Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome: Key Implications for NIV Response
(Valerio Saliani, Patrizia Guido, Maria Aliani and Mauro Carone, Respiratory Division, ICS Maugeri S.P.A., Cassano Murge, BA, Italy)

Chapter 11. Chronic Heart Failure
(Laura D Ciobanu, MD, PhD, Internal Medicine Department, University of Medicine and Pharmacy “Grigore T Popa” Iasi, Romania)

Chapter 12. The Role of Severity Index Scores (APACHE II, SAPS II, etc.) in Understanding NIV Response
(Fabrizio Bottino, MD, Emergency Department, Montevarchi, AR, Italy)

Chapter 13. ICU-NIV-Mechanical Ventilators
(Edoardo Piervincenzi, MD, Corrado Mollica, MD, and Mario Mezzapesa, MD, Anesthesia, Resuscitation and Intensive Care Medicine, University of Rome, Italy)

Chapter 14. NIV-BiPAP Turbine Mechanical Ventilators
(Mauro Carone, MD, Capozzolo Alberto, MD, Respiratory Division; ICS Maugeri S.P.A., Cassano Murge, BA, Italy)

Chapter 15. CPAPS- High Flow Oxygen Devices
(Fabio Pastore, MD, Rosalba Romano, MD, Department of Cardiolovacular Medicine, Maria SS. Addolorata” ASL Salerno, Eboli, Italy)

Chapter 16. High Flow Nasal Oxygen
(Dimitrios Lagonidis, MD, Intensive Care Unit, General Hospital of Giannitsa, Giannitsa, Greece)

Chapter 17. Home Non-Invasive Mechanical Ventilators
(Nikolaos Markou, MD, Heleni Stefanatou MD, Maria Kanakaki, MD, Pulmonologist, Intensivist, ICU at Latseion Burn Center, General Hospital of Eleusis ”Thriasion”, Athens, Greece, and others)

Chapter 18. Bi-Level Positive Airway Pressure (BIPAP)
(Alberto Leite, MD, Internal Medicine Department, CUF Porto Hospital, Porto, Portugal)

Chapter 19. Continuous Positive Airway Pressure (CPAP)
(Giuseppe Insalaco, MD and Fabrizio Dal Farra, MD, National Research Council of Italy, Institute of Biomedicine and Molecular Immunology “A. Monroy”, Palermo, Italy, and others)

Chapter 20. Neurally Adjusted Ventilatory Assist (NAVA): Patterns of Response
(Giorgia Spinazzola, MD, Flavia Torrini, MD, Department of Anesthesia and Intensive Care Medicine, Catholic University, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy, and others)

Chapter 21. Monitoring Lung Mechanics and Airflow Curves: Implications for NIV
(Guido Vagheggini, MD, Weaning and Pulmonary Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy)

Chapter 22. Leakage Monitoring
(Emine Aksoy, MD, and Zuhal Karakurt, MD, Health of Science University for Sureyyapaşa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, İstanbul, Turkey)

Chapter 23. Patient-Ventilator Asynchrony
(Catherine M. Albert, Former Education Coordinator, Respiratory Therapy, Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, US)

Chapter 24. Chronic Obstructive Pulmonary Disease
(Annamaria Romano, MD, and Rosalba Romano, MD, Department of Respiratory Medicine, San Giuseppe Moscati Hospital, Avellino, Italy, and others)

Chapter 25. Early Failure in Neuromuscular Diseases
(Alessio Mattei, Giuseppe Tabbia, Luana Focaraccio, Marco Bardessono and
Caterina Bucca, Pneumology Division. Cardio-Thoracic Department, AOU Città della Salute e della Scienza. Presidio Molinette Hospital, Turin, Italy, and others)

Chapter 26. Early Non-Invasive Ventilator Failure in Chest Wall Disorders
(Nilgun Alpay, MD, Dilek Ozcengiz, MD, PhD, Department of Anesthesiology and Reanimation, Dentistry Faculty of Cukurova University, Adana, Turkey, and others)

Chapter 27. Chronic Obstructive Pulmonary Disease (COPD): Late NIV Failure
(Szymon Skoczynski, MD, PhD, Patrycja Rzepka-Wrona, MD, Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland

Chapter 28. Neuromuscular Pulmonary Diseases
(Giuseppe Fiorentino MD, Antonio M. Esquinas MD, PhD, and Anna Annunziata, Respiratory Unit, AO Ospedali dei Colli Monaldi, Naples, Italy, and others)

Chapter 29. Chest Wall Disorders
(Anna Annunziata, MD, and Giuseppe Fiorentino MD, Respiratory Unit, AO Ospedali dei Colli Monaldi, Naples, Italy, and others)

Chapter 30. Acute Hypoxemic Respiratory Failure: Cardiac Pulmonary Edema
(Loredana Tibulloa, MD and Nicola Vargasb, MD, Department of Medicine, “A. Cardarelli” Hospital, Naples, Italy, and others)

Chapter 31. Acute Hypoxemic Respiratory Failure: Non-Cardiac Pulmonary Edema
(Zuhair Salah, MD, Krishna Thandra, MD, and Stephen M. Pastores, MD, Critical Care Medicine Fellow, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, US, and others)

Chapter 32. Patterns of NIV Response in Acute Severe Pneumonia
(Pieter Depuydt, MD, PhD, Associate Professor Intensive Care, Department Intensive Care
Ghent University Hospital, Gent, Belgium)

Chapter 33. Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS)
(Kamil İnci, MD, and Gül Gürsel, MD, Gazi University School of Medicine, Department of Pulmonary Critical Care Medicine’)

Chapter 34. Post-Operative Noninvasive Ventilation
(Samer Alsamman, MD; Amjad N. Kanj, MD, and Ayman O. Soubani, MD, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, US)

Chapter 35. Long-Term Non-Invasive Ventilation-Chronic Obstructive and Restrictive Pulmonary Disorders
Giancarlo Garuti, MD, Alessandro Scarascia, MD, and Gian Piero Bandelli, MD, Pulmonary Medicine Unit, S. Maria Bianca Hospital, Mirandola, MO, Italy, and others)

Chapter 36. Long-Term Mechanical Ventilation: Hospital Readmission, Clinical Implication and Prevention
Birsen Ocakli, MD, and Zühal Karakurt, MD, Health of Science University for Sureyyapaşa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, İstanbul, Turkey, and others)

Chapter 37. Hypercapnic Respiratory Failure
(P.Pierucci, V.Liotino, M. Vulpi, E.Buonamico, M.Dimitri and O. Resta, Department of Respiratory and Sleep Medicine, Policlinico University Hospital in Bari, Italy)

Chapter 38. Summary and Key Determinants from Clinical Studies Concerning Hypoxemic Respiratory Failure: What Can Clinical Trials Offer?
(Serpil Öcal, MD, Department of Intensive Care Unit, Hacettepe University, Ankara, Turkey)

Chapter 39. Models of Hospital NIV Organization (Respiratory Units, ICU, Wards) and Associations with NIV Response
(Sinem Gungor and Zuhal Karakurt, MD, Pulmonary and Critical Care Department, Pulmonology Specialist, Istanbul, Turkey, and others)

Chapter 40. Noninvasive Ventilation: Skills, Education and Training
(Stefano Bambi, PhD, Marco Giani, MD, and Alberto Lucchini, Medical and Surgical Intensive Care Unit, Careggi University Hospital, Florence, Italy, and others)

Chapter 41. Non-Invasive Ventilation Outside the Intensive Care Unit
(Gabriele Valli, MD, PhD; Francesca De Marco, MD; Carlo Ancona, MD, and Maria Pia Ruggieri, MD, Emergency Department, San Giovanni Addolorata Hospital, Rome, Italy)

Chapter 42. Airway Secretions (Cough Assist-High Frequency Chest Wall Oscillation)
(Pedro Rivas, Luis Eduardo Vasconcello and Salvador Llanes, Gabinete Senda, Madrid, Spain, and others)

Chapter 43. Aerosol Therapy Technology: Implications for NIV Response
(Nicola Vargasa, MD, Filomena Micilloa, MD, Department of Medicine, San Giuseppe Moscati Hospital, Avellino, Italy)

Chapter 44. Complementary Pharmacologic Therapy: Drugs That Impact NIV Response
(Franco Aprà MD, Fiammetta Pagnozzi MD, and Andrea Verhovez, MD, High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy)

Chapter 45. Non-Invasive Ventilation: Outcomes, Early and Late Failure
(Guy W. Soo Hoo, MD, Pulmonary, Critical Care and Sleep Section, West Los Angeles VA Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, CA, US)

Chapter 46. New and Current Strategies to Improve NIV Success
(Umberto Vincenzi, Antonio Esquinas, Raffaele Scala, and Umberto Vincenzi, MD, Specialized Medicine Department, Operative Unit of Pneumology and Intermediate Respiratory Intensive Care, “Ospedali Riuniti” Hospital in Foggia, Italy)


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