Noninvaziv Ventilasyondaki Zorluklar: NIV Başarısızlığı ve Komplikasyonlarının Nedenleri Anlamak

Yıl 2025, Cilt: 47 Sayı: 1, 32 - 38, 17.01.2025

Erdem Yalçınkaya , Emel Eryüksel , Sait Karakurt , Hüseyin Arıkan , Sehnaz Olgun , Umut Sabri Kasapoğlu

https://doi.org/10.20515/otd.1498328

Öz

Non-invaziv ventilasyon (NIV), akut solunum yetmezliğinin tedavisinde başarılı bir şekilde kullanılmaktadır. Bu çalışmanın amacı, NIV uygulamasına bağlı gelişen komplikasyonları ve bu komplikasyonların tedavi başarısızlığı üzerindeki etkilerini değerlendirmek olup, özellikle NIV başarısızlığına en sık neden olan komplikasyonu belirlemeye odaklanılmıştır. 1 Ocak 2015 ile 30 Aralık 2017 tarihleri arasında Dahili Yoğun Bakım Ünitesine kabul edilen 99 hastanın (54 erkek, ortalama yaş 66 +/- 8 yıl) verileri üzerine retrospektif bir analiz yapıldı. Bu hastalara, akut solunum yetmezliği nedeniyle NIV uygulandı ve 24 saati aşan süre boyunca yoğun bakım ünitesinde takip edildiler. Hastaların demografik verileri, akut solunum yetmezliği nedenleri ve NIV komplikasyonları kaydedilen verilerden elde edildi. NIV ile ilişkili komplikasyonlar arasında 21 hastada (%21) gelişen rahatsızlık, 18 hastada (%18) hava kaçağı, 16 hastada (%16) cilt erozyonu, 9 hastada (%9) gözlerde iritasyon ve kuruluk, 5 hastada (%5) cilt ülseri, 3 hastada (%3) abdominal gerginlik, 2 hastada (%2) klostrofobi ve 1 hastada (%1) hipotansiyon yer almaktaydı. NIV başarısızlığı ile ilişkili faktörleri değerlendirmek amacıyla yapılan univaryant ve multivaryant analizlerde, NIV kullanımına bağlı rahatsızlık, başarısızlığa en sık katkıda bulunan faktör olarak tespit edilmiştir (p = 0,039). Bu çalışmada, NIV ile ilişkili bir komplikasyon olarak rahatsızlık, başarısızlığın ana faktörü olarak belirlenmiştir. Doğru ekipmanın seçilmesi, uygun ventilatuvar desteğin sağlanması ve titiz izlem, komplikasyonların en aza indirilmesi ve NIV tedavisinin etkinliğinin artırılması için önemlidir.

Anahtar Kelimeler

Non-İnvaziv Ventilasyon, Komplikasyonlar, Rahatsızlık, Tedavi Başarısızlığı

Challenges in Non-Invasive Ventilation: Understanding the Causes of NIV Failure and Complications

Öz

Non-invasive ventilation (NIV) has been successfully used in the treatment of acute respiratory failure. The objective of this study was to evaluate complications arising from NIV and their impact on therapy failure, with a specific focus on identifying the most common NIV-related complication leading to NIV failure. A retrospective analysis was conducted on data from 99 patients (54 males, mean age 66 +/- 8 years) who were admitted to Internal Intensive Care Unit between January 1, 2015, and December 30, 2017. These patients received NIV due to acute respiratory failure and were monitored in the intensive care unit for more than 24 hours. The patients' demographic data, causes of acute respiratory failure, and NIV-related complications were obtained from the recorded data. Complications with NIV included discomfort, which developed in 21 patients (21%); air leakage observed in 18 patients (18%), skin erosion in 16 patients (16%), irritated and dry eyes in 9 patients (9%), skin ulcer in 5 patients (5%), abdominal tension in 3 patients (3%), claustrophobia in 2 patients (2%), and hypotension in 1 patient (1%). Univariate and multivariate analyses conducted to evaluate the factors associated with NIV failure showed that discomfort with NIV was the most common factor contributing to failure (p = 0.039). Discomfort as an NIV-related complication was identified as the main factor of failure. Choosing the right equipment, providing appropriate ventilatory support, and thorough monitoring are key to minimizing complications and maximizing the effectiveness of NIV therapy.

Anahtar Kelimeler

Non-Invasive Ventilation, Complications, Discomfort, Treatment Failure

Kaynakça

• 1. Ramakrishnan, N., et al., Guidelines for noninvasive ventilation in acute respiratory failure. Indian journal of critical care medicine, 2010. 10(2): p. 117-147.
• 2. Chawla, R., et al., ISCCM guidelines for the use of non-invasive ventilation in acute respiratory failure in adult ICUs. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2020. 24(Suppl 1): p. S61.
• 3. Lightowler, J.V., et al., Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. Bmj, 2003. 326(7382): p. 185.
• 4. Masip, J., et al., Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. Jama, 2005. 294(24): p. 3124-3130.
• 5. Osadnik, C.R., et al., Non‐invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2017(7).
• 6. Aliberti, S., et al., A real life evaluation of non invasive ventilation in acute cardiogenic pulmonary edema: a multicenter, perspective, observational study for the ACPE SIMEU study group. BMC emergency medicine, 2018. 18: p. 1-5.
• 7. Brochard, L., et al., Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. New England Journal of Medicine, 1995. 333(13): p. 817-822.
• 8. Çelikel, T., et al., Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest, 1998. 114(6): p. 1636-1642.
• 9. Navarra, S.M., M.T. Congedo, and M.A. Pennisi, Indications for non-invasive ventilation in respiratory failure. Reviews on recent clinical trials, 2020. 15(4): p. 251-257.
• 10. Carlucci, A., et al., Noninvasive versus conventional mechanical ventilation: an epidemiologic survey. American journal of respiratory and critical care medicine, 2001. 163(4): p. 874-880.
• 11. Nava, S. and P. Ceriana, Causes of failure of noninvasive mechanical ventilation. Respiratory care, 2004. 49(3): p. 295-303.
• 12. Ozyilmaz, E., A.O. Ugurlu, and S. Nava, Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC pulmonary medicine, 2014. 14: p. 1-10.
• 13. Kim, T., et al., Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study. Acute and Critical Care, 2020. 35(4): p. 255-262.
• 14. Thille, A.W., et al., Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Critical Care, 2013. 17: p. 1-8.
• 15. Antonelli, M., et al., Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive care medicine, 2001. 27: p. 1718-1728.
• 16. Meduri, G.U., et al., Noninvasive positive pressure ventilation via face mask: first-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest, 1996. 109(1): p. 179-193.
• 17. Carlucci, A., et al., Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive care medicine, 2003. 29: p. 419-425.
• 18. Cammarota, G., R. Simonte, and E. De Robertis, Comfort during non-invasive ventilation. Frontiers in Medicine, 2022. 9: p. 874250.
• 19. Ferrer, M., et al., Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. American journal of respiratory and critical care medicine, 2003. 168(1): p. 70-76.
• 20. Esteban, A., et al., Noninvasive positive-pressure ventilation for respiratory failure after extubation. New England Journal of Medicine, 2004. 350(24): p. 2452-2460.
• 21. Epstein, S.K. and R.L. Ciubotaru, Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. American journal of respiratory and critical care medicine, 1998. 158(2): p. 489-493.
• 22. Carron, M., et al., Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. British journal of anaesthesia, 2013. 110(6): p. 896-914.
• 23. Demoule, A., et al., Benefits and risks of success or failure of noninvasive ventilation. Intensive care medicine, 2006. 32: p. 1756-1765.
• 24. Nava, S. and N. Hill, Non-invasive ventilation in acute respiratory failure. The Lancet, 2009. 374(9685): p. 250-259.
• 25. Cuvelier, A., et al., Cephalic versus oronasal mask for noninvasive ventilation in acute hypercapnic respiratory failure. Intensive care medicine, 2009. 35: p. 519-526.
• 26. Conti, G., et al., Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive care medicine, 2002. 28: p. 1701-1707. 27. Fraticelli, A.T., et al., Physiological effects of different interfaces during noninvasive ventilation for acute respiratory failure. Critical care medicine, 2009. 37(3): p. 939-945.
• 28. Gay, P.C., Complications of noninvasive ventilation in acute care. Respiratory care, 2009. 54(2): p. 246-258.
• 29. Chiumello, D., et al., Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive care medicine, 2003. 29: p. 1671-1679.
• 30. Racca, F., et al., Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. Journal of Applied physiology, 2005. 99(4): p. 1262-1271.
• 31. Grieco, D.L., et al., Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS. Intensive care medicine, 2021. 47: p. 851-866.
• 32. Hill, N.S., Problems, remedies, and strategies to optimize the success of noninvasive ventilation. Noninvasive Positive Pressure Ventilation: Principles and Applications. Hill NS (Ed). Armonk, NY, Futura Publishing, 2001: p. 187-213.
• 33. Tan, D., et al., High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Critical Care, 2020. 24: p. 1-10.
• 34. Carteaux, G., et al., Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study. Chest, 2012. 142(2): p. 367-376.
• 35. Leone, M., et al., Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline. Intensive care medicine, 2020. 46: p. 697-713.
• 36. Cammarota, G., et al., New setting of neurally adjusted ventilatory assist during noninvasive ventilation through a helmet. Anesthesiology, 2016. 125(6): p. 1181-1189.
• 37. Yang, B., L. Gao, and Z. Tong, Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis. Heart & Lung, 2024. 63: p. 42-50.
• 38. Ni, Y.-N., et al., The effect of sedation and/or analgesia as rescue treatment during noninvasive positive pressure ventilation in the patients with Interface intolerance after Extubation. BMC Pulmonary Medicine, 2017. 17: p. 1-9.
• 39. Longrois, D., et al., Sedation in non-invasive ventilation: do we know what to do (and why)? Multidisciplinary respiratory medicine, 2014. 9: p. 1-8.
• 40. Hilbert, G., P. Navalesi, and C. Girault, Is sedation safe and beneficial in patients receiving NIV? Yes. 2015, Springer. p. 1688-1691.