BACKGROUND: Preterm infants often require non-invasive breathing support while their lungs and control of respiration are still developing. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is an emerging technology that allows infants to breathe spontaneously while receiving support breaths proportional to their effort. This study describes the first Australian Neonatal Intensive Care Unit (NICU) experience of NIV-NAVA.
METHODS: Retrospective cohort study of infants admitted to a major tertiary NICU between October 2017 and April 2021 supported with NIV-NAVA. Infants were divided into three groups based on the indication to initiate NIV-NAVA (post-extubation; apnoea; escalation). Successful application of NIV-NAVA was based on the need for re-intubation within 48 h of application.
RESULTS: There were 169 NIV-NAVA episodes in 122 infants (82 post-extubation; 21 apnoea; 66 escalation). The median (range) gestational age at birth was 25 + 5 weeks (23 + 1 to 43 + 3 weeks) and median (range) birthweight was 963 g (365-4320 g). At NIV-NAVA application, mean (SD) age was 17 days (18.2), and median (range) weight was 850 g (501-4310 g). Infants did not require intubation within 48 h in 145/169 (85.2%) episodes [72/82 (87.8%) extubation; 21/21 (100%) apnoea; 52/66 (78.8%) escalation).
CONCLUSIONS: NIV-NAVA was successfully integrated for the three main indications (escalation; post-extubation; apnoea). Prospective clinical trials are still required to establish its effectiveness versus other modes of non-invasive support.

UNASSIGNED: NIV (Non-invasive ventilation) and HFNC (High Flow nasal cannula) are being used in patients with acute respiratory failure. HACOR score has been exclusively calculated for patients on NIV, on other hand ROX index is being used for patients on HFNC. This is first study where ROX index has been used in patients on NIV to predict failure.
UNASSIGNED: This study investigates the comparative diagnostic performance of HACOR score and ROX index to predict NIV failure.
UNASSIGNED: We performed a retrospective cohort study of non-invasively ventilated COVID-19 patients admitted between 1st April 2020 to 15th June 2021 to ICU of a tertiary care teaching hospital located in Central India. We assessed factors responsible for NIV failure, and whether these scores HACOR/ROX index have discriminative capacity to predict risk of invasive mechanical ventilation.
UNASSIGNED: Of the 441 patients included in the current study, 179 (40.5%) recovered, while remaining 262 (59.4%) had NIV failure. On multivariable analysis, ROX index > 4.47 was found protective for NIV-failure (OR 0.15 (95% CI 0.03-0.23; p<0.001). Age > 60 years and SOFA score were other significant independent predictors of NIV-failure. The AUC for prediction of failure rises from 0.84 to 0.94 from day 1 to day 3 for ROX index and from 0.79 to 0.92 for HACOR score in the same period, hence ROX score was non-inferior to HACOR score in current study. DeLong\'s test for two correlated ROC curves had insignificant difference expect day-1 (D1: 0.03 to 0.08; p=3.191e-05, D2: -0.002 to 0.02; p = 0.2671, D3: -0.003 to 0.04; p= 0.1065).
UNASSIGNED: ROX score of 4.47 at day-3 consists of good discriminatory capacity to predict NIV failure. Considering its non-inferiority to HACOR score, the ROX score can be used in patients with acute respiratory failure who are on NIV.

High-flow nasal therapy (HFNT) has an increasing role in the management of acute hypoxic respiratory failure. Due to its tolerable interface and ease of use, its role in chronic hypercapnic respiratory failure (CHRF) is emerging. This article examines the literature to date surrounding the short and long-term mechanisms of HFNT in sleep and wakefulness of CHRF patients. It is likely HFNT will have an increasing role in those patients intolerant of non-invasive ventilation.

Telemonitoring in non-invasive ventilation is constantly evolving to enable follow-up of adults and children. Depending on the device and manufacturer, different ventilator variables are displayed on web-based platforms. However, high-granularity measurement is not always available remotely, which precludes breath-by-breath waveforms and precise monitoring of nocturnal gas exchange. Therefore, telemonitoring is mainly useful for monitoring utilization of the device, leaks, and respiratory events. Coordinated relationships between patients, homecare providers, and hospital teams are necessary to transform available data into diagnosis and actions. Telemonitoring is time and cost-consuming. The balance between cost, workload, and clinical benefit should be further evaluated.

Initiation of home non-invasive ventilation (NIV) requires careful consideration of the patient\'s condition, motivation, expectations, wishes, and social circumstances. The decision to start NIV depends on a combination of factors including patient symptoms and objective evidence of nocturnal hypoventilation. A solid understanding of the underlying pathophysiology is key to a systematic and well-balanced clinical approach to titrating NIV. The location where NIV is initiated is not the most relevant issue, provided that it is a comfortable, safe environment in which adequate monitoring can be assured. The majority of patients prefer their own home for treatment initiation.

Neuromuscular diseases (NMDs) comprise a heterogeneous group of conditions characterized by extreme progressive muscle weakness leading to respiratory failure. Noninvasive mechanical ventilation (NIV) has emerged as a cornerstone in the management of respiratory complications associated with NMDs. This review aims to elucidate the role of NMV in respiratory function, improving quality of life, and prolonging survival in individuals with NMD. The physiological basis of respiratory impairment in NMDs, principles of NMV application, evidence supporting its efficacy, patient selection criteria, and potential challenges in its application are discussed.

UNASSIGNED: The functions of eating, drinking, speaking, and breathing demand close coordination of the upper airway musculature which may be challenged by the long-term use of daytime non-invasive ventilation (NIV). This rapid review explores the challenges and practicalities of these interactions in people with neuromuscular disorders.
UNASSIGNED: A search was performed on PubMed (period 2000-2023) using generic terms to refer to eating, drinking, and speaking related to people with neuromuscular disorders on NIV. A narrative approach was used to summarize the available literature.
UNASSIGNED: Our review shows only a small number of studies exist exploring the use of NIV on swallowing and speaking in people with neuromuscular disorders. We summarize study findings and provide practical advice on eating, drinking and speaking with NIV.
UNASSIGNED: By understanding breathing, NIV mechanics and upper airway interactions, it is possible to optimize swallowing and speaking whilst using NIV. There is a lack of specific guidelines, and concerns regarding aspiration warrant further research and guideline development.

The neuromuscular patients may experience the need for respiratory support due to the onset of respiratory failure. Some skills are essential to achieve therapeutic success. In addition to technical knowledge, it is essential to have knowledge relating to individual neuromuscular diseases. The availability of alternative respiratory supports and various interfaces can be a valuable weapon at different moments in the course of the neuromuscular disease. Furthermore, the doctor-patient relationship plays a key role as does taking care of the patient\'s psychological sphere.

UNASSIGNED: Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide and 24% of the patients die within 5 years of diagnosis.
UNASSIGNED: The epidemiology of mortality and the interventions that reduce it are reviewed. The increasing global deaths reflect increases in population sizes, increasing life expectancy and reductions in other causes of death. Strategies to reduce mortality aim to prevent the development of COPD and improve the survival of individuals. Historic changes in mortality give insights: improvements in living conditions and nutrition, and later improvements in air quality led to a large fall in mortality in the early 20th century. The smoking epidemic temporarily reversed this trend.Older age, worse lung function and exacerbations are risk factors for death. Single inhaler triple therapy; smoking cessation; pulmonary rehabilitation; oxygen therapy; noninvasive ventilation; and surgery reduce mortality in selected patients.
UNASSIGNED: The importance of addressing the global burden of mortality from COPD must be recognized. Steps must be taken to reduce it, by reducing exposure to risk factors, assessing individual patients\' risk of death and using treatments that reduce the risk of death. Mortality rates are falling in countries that have adopted a comprehensive approach to COPD prevention and treatment.

UNASSIGNED: Acute systolic heart failure (ASHF) is one of the most serious complications of the acute coronary syndrome (ACS), and increases the likelihood of adverse clinical outcomes. It remains unclear whether the use of non-invasive ventilation (NIV) could improve symptoms and reduce mortality in patients with ASHF derived from ACS.
UNASSIGNED: Data on biological, clinical, and demographic factors, as well as therapy data, were collected from patients with ASHF in the cardiac department. A total of 1257 ACS patients with ASHF were included in the study. Patients were divided into two groups. The control group received standard oxygen therapy. The comparison group consisted of those who underwent NIV as part of their immediate care. During hospitalization and at follow-up, information on both groups was systematically compared.
UNASSIGNED: In comparison with the control group, mean 24-hour urine output was found to be significantly higher in the NIV group. A significant reduction in the duration of symptoms was observed among patients in the NIV group from the time of admission until relief of dyspnea. Heart rate, C-reactive protein, estimated glomerular filtration rate, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was also improved, compared with those in the control group. The NIV group was found to have a higher survival rate. NIV was independently related to all-cause mortality in 1-year follow-up (hazard ratio, 0.674; p = 0.045).
UNASSIGNED: Our study shows that NIV, as compared with standard oxygen therapy, has a beneficial impact on heart rate, metabolic balance, and relief of dyspnea in ACS patients with ASHF which results in reduced intubation rate, duration of in-hospital stay, and 1-year mortality.