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2010 NIV weaning

WITH VITALSOURCE®
EBOOK

NON-INVASIVE
VENTILATION & WEANING
PRINCIPLES AND PRACTICE

Edited by
Mark Elliott, Stefano Nava
and Bernd Schönhofer


Non-invasive Ventilation and Weaning:
Principles and Practice



Non-invasive Ventilation and
Weaning: Principles and Practice

Edited by


Mark Elliott

MA MB, BChir, MD, FRCP(UK)
Department of Respiratory Medicine,
St James’s University Hospital, Leeds, UK

Stefano Nava MD
Respiratory Intensive Care Unit,
Fondazione S Maugeri, IRCCS, Pavia, Italy
Bernd Schönhofer MD, PhD
Department of Respiratory and Critical Care Medicine,
Klinikum Region Hannover, Oststadt-Heidehaus,
Hannover, Germany


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© 2010 by Taylor & Francis Group, LLC
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Dedication

To our wives Anna Maria, Nicola and Maria



Contents

Preface

xi

Contributors

xiii

Acknowledgements

xix

Abbreviations

xxi

PART I
1

EQUIPMENT AND PRACTICE

Non-invasive ventilation: from the past to the present
Dominique Robert, Barry Make

Section A
2
3
4
5
6
7
8
9

Positive pressure ventilators
Dean R Hess
Negative pressure ventilation
Antonio Corrado, Massimo Gorini
Continuous positive airway pressure
A Craig Davidson
Emerging modes for non-invasive ventilation
Paolo Navalesi, Rosanna Vaschetto, Antonio Messina
Interfaces
Cesare Gregoretti, Davide Chiumello
Quality control of non-invasive ventilation: performance, service, maintenance and infection control of ventilators
Jordi Rigau, Ramon Farré
Humidifiers and drug delivery during non-invasive ventilation
Antonio M Esquinas Rodriguez
How to start a patient on non-invasive ventilation
Raffaele Scala, Martin Latham

Section B
10
11
12
13
14

The equipment

The practice: acute non-invasive ventilation

How to set up an acute non-invasive ventilation service
Alicia K Gerke, Gregory A Schmidt
Monitoring during acute non-invasive ventilation
Eumorfia Kondili, Nektaria Xirouchaki, Dimitris Georgopoulos
Troubleshooting non-invasive ventilation
Nicholas S Hill
Timing of non-invasive ventilation
Stefano Nava, Paolo Navalesi
Why non-invasive ventilation works in acute respiratory failure
Miguel Ferrer, Antoni Torres

1
3

11
13
24
30
36
42
53
61
70

85
87
97
107
118
126


viii

Contents

Section C
15
16
17
18
19

The chronic ventilator service
Jean-François Muir, Antoine Cuvelier
Diagnostic tests in the assessment of patients for home mechanical ventilation
Patrick Murphy, Michael Polkey, Nicholas Hart
Patient and caregiver education
Ole Norregaard, Joan Escarrabill
Discharging the patient on home ventilation
Joan Escarrabill, Ole Norregaard
Telemedicine
Michele Vitacca

PART II

THE DISEASES

Section D
20
21
22
23

25
26
27
28

30
31

33
34
35
36

Cardiac failure

Pathophysiology and modern management of cardiac failure
Martin R Cowie, Paul M Haydock
Acute cardiogenic pulmonary oedema
Alasdair J Gray
Assisted ventilation in chronic congestive cardiac failure
Matthew T Naughton

Section G
32

Hypoxaemic respiratory failure

Pathophysiology of hypoxaemic respiratory failure
Luke Howard
Home oxygen therapy in chronic respiratory failure
Jadwiga A Wedzicha, Christine Mikelsons
Acute oxygen therapy
Mark Elliott
Equipment for oxygen therapy
Daniel Schuermans, Lies Verfaillie
Non-invasive ventilation for hypoxaemic respiratory failure
Massimo Antonelli, Giuseppe Bello

Section F
29

COPD

Pathophysiology of respiratory failure in chronic obstructive pulmonary disease
Paul P Walker, Peter M A Calverley
Treatment of chronic obstructive pulmonary disease: acute and chronic
Borja G Cosio, Roberto Rodríguez-Roisin
Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease
Alexandre Demoule, François Lellouche, Jordi Mancebo, Laurent Brochard
Non-invasive ventilation in chronic obstructive pulmonary disease
Enrico M Clini, Ernesto Crisafulli, Nicolino Ambrosino

Section E
24

The practice: chronic non-invasive ventilation

Neuromuscular disease

Muscle disorders and ventilatory failure
David Hilton-Jones
Pathophysiology of respiratory failure in neuromuscular diseases
Franco Laghi, Hameeda Shaikh, Gokay Gungor
Slowly progressive neuromuscular diseases
Joshua O Benditt, Louis Boitano
Amyotrophic lateral sclerosis
Stephen C Bourke, G John Gibson
Duchenne muscular dystrophy
Anita K Simonds

139
141
151
167
174
184

193
195
197
206
217
228

237
239
245
251
260
268

275
277
289
307

319
321
331
340
351
361


Contents

37

Central sleep apnoea
Patrick Lévy, Jean-Christian Borel, Renaud Tamisier, Bernard Wuyam, Jean-Louis Pépin

Section H
38

Scoliosis
William J M Kinnear

Section I
39
40
41

43
44
45
46
47
48

50
51

53
54
55

57

Special situations

Bronchoscopy during non-invasive ventilation
Massimo Antonelli, Giuseppe Bello
Non-invasive ventilation in pregnancy
John M Shneerson
Tracheostomy
Piero Ceriana, Paolo Pelosi
Non-invasive ventilation in end-of-life care
Laura Evans, Mitchell M Levy

Section M
56

Paediatric ventilatory failure

Equipment and interfaces in children
Brigitte Fauroux, Bruno Louis, Frédéric Lofaso
Chronic non-invasive ventilation for children
Brigitte Fauroux
Non-invasive positive pressure ventilation in children with acute respiratory failure
Giorgio Conti, Marco Piastra, Silvia Pulitanò

Section L
52

Other conditions

Bronchiectasis and adult cystic fibrosis
Irene Permut, Gerard J Criner
Non-invasive ventilation in highly infectious conditions: lessons from severe acute respiratory syndrome
David S C Hui
Cancer patients
Pieter Depuydt, Elie Azoulay, Marcio Soares, Dominique Benoit
Non-invasive ventilation in the elderly
Erwan L’Her
Post-surgery non-invasive ventilation
Samir Jaber, Boris Jung, Gerald Chanques
Trauma
Umberto Lucangelo, Massimo Ferluga
Role of non-invasive respiratory support after spinal cord damage
John W H Watt

Section K
49

Obesity

The endocrinologist and respiratory failure
John P H Wilding
Pathophysiology of respiratory failure in obesity
Francesco Fanfulla
Non-invasive ventilation in acute and chronic respiratory failure due to obesity
Juan F Masa, Isabel Utrabo, Francisco Javier Gómez de Terreros

Section J
42

Chest wall deformity

Prolonged weaning

Epidemiology and cost of weaning failure
William B Hall, Shannon S Carson
Pathophysiology of weaning failure
Eleni Ischaki, Theodoros Vassilakopoulos

ix

368

377
379

389
391
399
408

419
421
427
433
438
446
454
459

467
469
475
483

489
491
496
499
508

513
515
521


x

Contents

58
59
60

Non-invasive ventilation for weaning and extubation failure
Scott K Epstein
Weaning strategies and protocols
Michele Vitacca
Specialized weaning units
Aditi Satti, Gerard J Criner, Bernd Schönhofer

Section N
61
62

Respiratory physiotherapy (including cough assistance techniques and glossopharyngeal breathing)
Miguel R Gonçalves, João Carlos Winck
Rehabilitation
Rik Gosselink, T Troosters, J Segers, C Burtin

Section O
63

65

543
550

557
559
568

Outcome measures

579

Health status and quality of life
Wolfram Windisch

581

Section P
64

The physiotherapist and assisted ventilation

530

The patient experience of non-invasive ventilation

591

Psychological issues for the mechanically ventilated patient
Linda L Bieniek, Daniel F Dilling, Bernd Schönhofer
Reflection on our times with a resident ‘Nippy’ ventilator
Michael and Alyson Lindley

593

Index
PART III

599

601
APPENDICES*

Appendix A Invasive respiratory muscle studies
Patrick Murphy, Michael Polkey, Nicholas Hart
Appendix B Weaning strategies and protocols
Michele Vitacca
Appendix C Exploring the option of a trach
Linda L Bieniek
Appendix D Ventilator guidelines for emotional health
Linda L Bieniek
Appendix E Michael and Alyson Lindley's photo album
*These appendices are available only in the Vitalsource ebook edition.

623
625
632
638
646
657


Preface

We have been privileged to have worked through the
time during which non-invasive ventilation has been
transformed from a niche technique, available in only a
few small specialist centres, to become part of the
mainstream of respiratory and intensive care medicine. It
has been exciting to see how an understanding of basic
physiology has underpinned the application of the
technique and interaction between industry, engineers,
ventilator users and clinicians has lead to innovations and
refinements of the equipment, which has been key to its
the success.
Non-invasive ventilation is a multidisciplinary
endeavour and all the professional groups involved have
brought their own perspectives, disciplines and insights.
Ventilator users and their carers have played their part,
developing ideas and ways around problems, based on their
own experience.
None of this would have happened without the vision
and enthusiasm of a few individuals. At a personal level

we would like to acknowledge the contributions of
Dr Margaret Branthwaite and Prof. Dr. Dieter Köhler, who
have been pioneers, inspired us and influenced our decision
to get involved in this field.
NIV has reached maturity and as such it is sometimes
difficult to see how it can be taken further. However,
presentations at international meetings and publications
in the scientific literature confirm that the prospects for
the future remain healthy, with innovations in equipment,
application and the extension and refinement of the
indications for its use. We are delighted that so many
people who have been influential in the field and for the
emerging leaders for the future, have agreed to contribute
to this book.
Mark Elliott
Stefano Nava
Bernd Schönhofer



Contributors

Nicolino Ambrosino
Chief of Respiratory Section AO Pisana, Cardio-Thoracic Department,
Pulmonary Unit, University Hospital of Pisa, and Pulmonary
Rehabilitation and Weaning Unit, Auxilium Vitae, Volterra, Italy
Massimo Antonelli MD
Professor of Intensive Care and Anesthesiology, and Director,
General Intensive Care Unit, Policlinico Universitario A Gemelli,
Università Cattolica del Sacro Cuore, Rome, Italy
Elie Azoulay MD, PhD
Service de Réanimation Médicale, Groupe de Recherche Respiratoire
en Réanimation Onco-hématologique, Groupe de Recherche Famiréa,
Hôpital Saint Louis, Université Paris, Paris, France
Giuseppe Bello MD
Assistant Professor of Intensive Care and Anesthesiology,
General Intensive Care Unit, Policlinico Universitario A Gemelli,
Università Cattolica del Sacro Cuore, Rome, Italy
Joshua O Benditt MD
Medical Director of Respiratory Care Services, University of
Washington Medical Center, Seattle, Washington, USA
Dominique Benoit MD, PhD
Department of Intensive Care, Ghent University Hospital, Ghent,
Belgium
Linda L Bieniek
Advisory Board Member, International Ventilator Users Network,
and Retired Certified Employee Assistance Professional,
La Grange, Illinois, USA
Louis Boitano MS, RPFT, RRT
Respiratory Care Services, University of Washington
Medical Center, Seattle, WA, USA
Jean-Christian Borel PhD
Hypoxia Pathophysiology Laboratory INSERM ER117, Joseph
Fourier University and Physiology Unit, Rehabilitation and
Physiology Department, CHU, Grenoble, France
Stephen C Bourke MB, BCh (Hons), PhD, FRCP
Consultant Respiratory Physician, Northumbria Healthcare
NHS Foundation Trust, and Newcastle University,
North Tyneside General Hospital, Newcastle-upon-Tyne,
North Shields, UK
Laurent Brochard
Medical ICU, AP-HP, Henri Mondor Teaching Hospital, Créteil,
University Paris EST, France

C Burtin PT, MSc
Respiratory Rehabilitation and Respiratory Division, University
Hospitals, Katholieke Universiteit Leuven, and Faculty of
Kinesiology and Rehabilitation Sciences, Katholieke Universiteit
Leuven, Leuven, Belgium
Peter M A Calverley MB, ChB, FRCP, FRCPEd
Professor of Respiratory Medicine and Rehabilitation, School
of Clinical Sciences, University of Liverpool, and Aintree Chest
Centre, University Hospital Aintree, Liverpool, UK
Shannon S Carson MD
Associate Professor, and Associate Director, Medical Intensive
Care Unit, and Director, Fellowship Training Program, Pulmonary
and Critical Care Medicine, University of North Carolina School of
Medicine, North Carolina, USA
Piero Ceriana
Pneumologia Riabilitativa E Terapia Subintensiva Respiratoria,
IRCCS Fondazione ‘S Maugeri’, Pavia, Italy
Gerald Chanques MD
Assistant Professor of Anesthesiology and Critical Care, Intensive
Care Unit, Anesthesia and Critical Care Department B, Saint Eloi
Teaching Hospital, Montpellier, France
Davide Chiumello MD
U O Anestesia e Rianimazione, Dipartimento di Anestesia,
Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore,
Milan, Italy
Enrico M Clini
Associate Professor, University of Modena, Department of Oncology,
Haematology and Pneumology, University of Modena, Modena, Italy
Giorgio Conti MD
Professor of Intensive Care and Anesthesia, Pediatric Intensive
Care Unit, Catholic University of Rome, Policlinico A Gemelli,
Rome, Italy
Antonio Corrado MD
Director of Respiratory Intensive Care Unit, Azienda Ospedaliera,
Universitaria Careggi, Firenze, Italy
Borja G Cosio MD, PhD
Department of Respiratory Medicine, Hospital Universitario Son
Dureta, Palma de Mallorca, Spain
Martin R Cowie MD, MSc, FRCP, FESC
Professor of Cardiology, National Heart and Lung Institute,
Imperial College, London, UK


xiv

Contributors

Gerard J Criner MD
Professor of Medicine, Chief of Department of Pulmonary and
Critical Care Medicine, Temple University Hospital, Philadelphia,
PA, USA

Miguel Ferrer MD, PhD
Consultant, Respiratory Intensive and Intermediate Care Unit,
Department of Pneumology, Institute of Thorax, Hospital Clinic,
IDIBAPS, University of Barcelona, Spain

Ernesto Crisafulli
Junior Assistant Ospedale Villa Pineta, Pavullo n/F, Ospedale Villa
Pineta, Pulmonary Rehabilitation Unit, Pavullo, Modena, Italy

Dimitris Georgopoulos MD, PhD
Professor of Intensive Care Medicine, Department of Intensive
Care Medicine, University Hospital of Heraklion,
Crete, Greece

Antoine Cuvelier
Professor, Pulmonary and Intensive Care Department, Rouen
University Hospital, Rouen, France
A Craig Davidson MA, MD, FRCP
Consultant in Respiratory and Intensive Care Medicine, and
Director, Lane Fox Respiratory Unit, Guy's and St Thomas’
Hospital, London, UK
Alexandre Demoule
Medical ICU and Pneumology Department, AP-HP,
Pitié-Salpétrière Teaching Hospital, Paris, France
Pieter Depuydt MD, PhD
Department of Intensive Care, Universitair Ziekenhuis Gent,
Gent, Belgium
Dan F Dilling MD
Assistant Professor of Medicine, Loyola University Chicago Stritch
School of Medicine, Maywood, Illinois, USA
Mark Elliott MA MB BChir MD FRCP (UK)
Department of Respiratory Medicine, St James’s University
Hospital, Leeds, UK
Scott K Epstein MD
Dean for Educational Affairs and Professor of Medicine, Tufts
University School of Medicine, Division of Pulmonary, Critical Care
and Sleep Medicine, Tufts Medical Center, Boston, USA
Joan Escarrabill MD
Director, Master Plan for Respiratory Diseases PDMAR (Health
Ministry), Institut d’Estudis de la Salut, Barcelona, Spain
Antonio M Esquinas Rodriguez MD, PhD, FCCP
Intensivist, International Fellow AARC, Intensive Care Unit,
Hospital Morales Meseguer, Murcia, Spain
Laura Evans MD, MSc
Assistant Professor of Medicine, New York University School of
Medicine, Bellevue Hospital, New York, USA
Francesco Fanfulla MD
Head of Sleep Center, Scientific Institutes of Montescano and
Pavia, Salvatore Maugeri Foundation, Pavia, Italy

Alicia K Gerke MD
Associate, Department of Internal Medicine, Division of
Pulmonary, Critical Care, and Occupational Medicine, University
of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
G John Gibson BSc, MD, FRCP, FRCPEd
Emeritus Professor of Respiratory Medicine, Newcastle University,
Newcastle-upon-Tyne, UK
Francisco Javier Gómez de Terreros MD
Member of Respiratory Research Group, Centro de Investigación
Biomédica en Red de Enfermedades Respiratorias, CIBERES,
Ministry of Science and Innovation, Madrid, and Attending of
Intermediate Respiratory Care Unit, San Pedro de Alcantara
Hospital, Cáceres, Spain
Miguel R Gonçalves
Senior Respiratory Physiotherapist, Clinical Specialist in
Noninvasive ventilation, and University Professor of Respiratory
Physiotherapy, Lung Function, Sleep and Ventilation Unit,
Pulmonary Medicine Department, Intensive Care Unit,
Emergency Department, Faculty of Medicine,
University of Porto, University Hospital of S João, Porto, Portugal
Massimo Gorini MD
Unità di Terapia Intensiva Respiratoria, Fisiopatologia Toracica,
Azienda Ospedaliera, Universitaria Careggi, Firenze, Italy
Rik Gosselink PhD, PT
Professor of Rehabilitation Sciences, Dean of Faculty of
Kinesiology and Rehabilitation Sciences, Katholieke Universiteit
Leuven, Leuven, Belgium
Alasdair Gray MB, ChB, MD, FRCS, FCEM
Consultant, Department of Emergency Medicine, Royal Infirmary
of Edinburgh, Edinburgh, UK
Cesare Gregoretti MD
Director of Anaesthesia and Intensive Care Unit, Adelaide
Hospital, Department of Emergency, Adelaide, Turin, Italy

Brigitte Fauroux MD, PhD
Professor of Pediatrics, Paediatric Pulmonary Department and
Research Unit INSERM UMR-S 938, AP-HP, Hôpital d’Enfants
Armand Trousseau, France

Gokay Gungor
Division of Pulmonary and Critical Care Medicine,
Loyola University of Chicago Stritch School of Medicine,
Illinois, USA, and Sureyyapasa Chest Diseases and Thoracic
Surgery Training and Research Hospital, Istanbul, Turkey

Ramon Farré PhD
Biophysics and Bioengineering Unit, School of Medicine,
University of Barcelona, IDIBAPS, Barcelona, Spain

William B Hall MD
Pulmonary and Critical Care Medicine, University of North
Carolina School of Medicine, North Carolina, USA

Massimo Ferluga MD
Department of Perioperative Medicine, Intensive Care and
Emergency, Cattinara Hospital, Trieste University School of
Medicine, Trieste, Italy

Nick Hart MBBS, BSc (Hons), PhD, MRCP
Clinical Research Consultant, NIHR Comprehensive Biomedical
Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and
King’s College London, London, UK


Contributors xv

Paul M Haydock MRCP
Clinical Research Fellow, National Heart and Lung Institute,
Imperial College London, London, UK
Dean R Hess PhD, RRT
Assistant Director of Respiratory Care, Massachusetts General
Hospital, Associate Professor of Anesthesia, Harvard Medical
School, Massachusetts General ALS Clinic, Wang Ambulatory
Care Center, Boston, USA
Nicholas S Hill MD
Professor of Medicine and Chief, Division of Pulmonary Critical
Care and Sleep Medicine, Tufts Medical Center, Boston, USA
David Hilton-Jones
Clinical Director, Oxford Muscle and Nerve and Myasthenia
Centres, Department of Clinical Neurology, John Radcliffe
Hospital, Oxford, UK
Luke Howard MA, DPhil, FRCP
Consultant Chest Physician, Hammersmith Hospital, and National
Pulmonary Hypertension Service, Department of Cardiac Sciences,
Hammersmith Hospital, London, UK
David S C Hui MD, FRACP, FRCP, FHKCP, FHKAM
Professor, Department of Medicine and Therapeutics, Chinese
University of Hong Kong, and Prince of Wales Hospital, Shatin,
Hong Kong
Elini Ischaki MD
Department of Critical Care and Pulmonary Services, Evangelismos
Hospital, University of Athens Medical School, Athens, Greece
Samir Jaber MD, PhD
Professor of Anesthesiology and Critical Care Medicine,
Department of Anesthesiology and Critical Care (DARB), Saint
Eloi University Hospital and Montpellier School of Medicine,
Montpellier, France
Boris Jung MD
Assistant Professor of Anesthesiology and Critical Care,
Intensive Care Unit, Anesthesia and Critical Care Department B,
Saint Eloi Teaching Hospital, Montpellier, France
William J M Kinnear MD FRCP
Consultant Respiratory Physician, Queens Medical Centre,
Nottingham University Hospitals, Nottingham, UK
Eumorfia Kondili MD, PhD
Assistant Professor of Intensive Care Medicine, Department of
Intensive Care Medicine, University Hospital of Heraklion, Crete,
Greece
Franco Laghi MD
Professor of Medicine, Division of Pulmonary and Critical Care
Medicine, Loyola University Medical Center, Hines, Illinois, USA
Martin Latham BSc (Hons), RGN PG Dip
Sleep Service, St James’s University Hospital, Leeds, UK
François Lellouche
Service de Soins Intensifs de Chirurgie Cardiaque, Centre de
Recherche Hôpital Laval, Université Laval, Québec, Canada
Mitchell M Levy MD
Professor of Medicine, Warren Alpert Medical School of Brown
University, Rhode Island Hospital, Providence, USA

Patrick Lévy MD, PhD
Hypoxia Pathophysiology Laboratory INSERM ER117, Joseph
Fourier University and Physiology Unit, Rehabilitation and
Physiology Department, CHU, Grenoble, France
Erwan L’Her MD, PhD
Professeur agrégé sous octroi, Département de Médecine
Familiale et Médecine d’Urgence Université Laval,
Québec, Canada
Michael and Alyson Lindley
Frédéric Lofaso MD, PhD
Professor of Physiology, AP-HP, Hôpital Raymond Poincaré,
Université Versailles, St Quentin en Yvelines, Physiology
Functional Testing and Technological Innovations Centre,
Garches, France
Bruno Louis PhD
INSERM, Université Paris, Faculté de Médecine, Créteil,
Paris, France
Umberto Lucangelo MD
Department of Perioperative Medicine, Intensive Care and
Emergency, Cattinara Hospital, Trieste University School of
Medicine, Trieste, Italy
Barry Make
Co-Director, COPD Program, National Jewish Health, and
Professor of Medicine, University of Colorado-Denver School
of Medicine, National Jewish Medical and Research Center,
Denver, Colorado, USA
Jordi Mancebo
ICU Medicina Intensiva, Hospital Santa Creu i Sant Pau,
Barcelona, Spain
Juan F Masa MD
Head of Respiratory Research Group, Centro de Investigación
Biomédica en Red de Enfermedades Respiratorias; CIBERES,
Ministry of Science and Innovation, Madrid, and
Director of Intermediate Respiratory Care Unit, Head of
Pulmonary Division, San Pedro de Alcantara Hospital,
Cáceres, Spain
Antonio Messina MD
Anesthesia and Intensive Care, University Hospital 'Maggiore
della Carità' Novara, Università del Piemonte Orientale 'Amedeo
Avogadro', Alessandria-Novara-Vercelli, Italy
Christine Mikelsons MCSP, BSc, MSc, PGCHE
Consultant Respiratory Physiotherapist, Royal Free Hospital,
London, UK
Jean-François Muir
Professor and Head, Pulmonary and Respiratory Intensive Care
Department, Rouen University Hospital, Rouen, France
Patrick Murphy MBBS, BSc (Hons), MRCP
Clinical Research Fellow, Lane Fox Respiratory Unit, Guy's and
St Thomas' NHS Trust, King’s College London, London, UK
Matthew T Naughton MD, FRACP
Head, General Respiratory and Sleep Medicine, Department of
Allergy, Immunology and Respiratory Medicine, Alfred Hospital
and Monash University, Melbourne, Victoria, Australia


xvi

Contributors

Stefano Nava MD
Respiratory Intensive Care Unit, Fondazione S Maugeri, IRCCS,
Pavia, Italy
Paolo Navalesi MD
Anesthesia and Intensive Care, University Hospital 'Maggiore
della Carità' Novara, Università del Piemonte Orientale 'Amedeo
Avogadro', Alessandria-Novara-Vercelli, Italy
Ole Norregaard MD
Director, Danish Respiratory Center West, Arhus University
Hospital, Denmark
Paolo Pelosi
Dipartimento Ambiente, Salute E Sicurezza, Universita’ Degli Studi
Dell’insubria, Varese, Italy
Jean-Louis Pépin MD, PhD
Hypoxia Pathophysiology Laboratory INSERM ER117, Joseph
Fourier University and Physiology Unit, Rehabilitation and
Physiology Department, CHU, Grenoble, France
Irene Permut MD
Fellow, Pulmonary and Critical Care, Temple University Hospital,
Philadelphia, Pennsylvania, USA
Marco Piastra MD
Assistant Professor, Pediatric Intensive Care Unit, Catholic
University of Rome, Policlinico A Gemelli, Roma, Italy
Michael Polkey MB ChB, PhD, FRCP
National Heart and Lung Institute, Respiratory Biomedical
Research Unit, Royal Brompton Hospital, London, UK
Silvia Pulitanó MD
Assistant Professor, Pediatric Intensive Care Unit, Catholic
University of Rome, Policlinico A Gemelli, Rome, Italy
Jordi Rigau PhD
Director of Innovation and Technology, Research, Development
and Innovation Department, Sibel Group, Barcelona, Spain
Dominique Robert
Professor of Intensive Care, Claude Bernard University Lyon 1,
and President, ALLP, Lyon, France
Roberto Rodríguez-Roisin MD, FRCPE
Institut del Tòrax (Servei de Pneumologia), Professor of Medicine,
Hospital Clinic, Universitat de Barcelona Villarroel, Barcelona,
Spain
Aditi Satti MD
Assistant Professor of Medicine, Department of Pulmonary and
Critical Care Medicine, Temple University School of Medicine,
Philadelphia, USA
Raffaele Scala MD
Specialist in Respiratory Diseases and Intensive Care Medicine,
Ospedale S. Donato, Arezzo, Italy
Gregory A Schmidt MD
Professor of Medicine, Department of Internal Medicine,
Division of Pulmonary Diseases, Critical Care, and Occupational
Medicine, Director, Critical Care Programs, Department of
Internal Medicine, University of Iowa Hospitals and Clinics, Iowa
City, USA

Bernd Schönhofer MD, PhD
Professor of Medicine, Department of Respiratory and Critical
Care Medicine, Klinikum Region Hannover, Oststadt-Heidehaus,
Hannover, Germany
Daniel Schuermans RN
Lung Function Technician, Biomedical Research Unit,
University Hospital UZBrussel (VUB), Brussels, Belgium
J Segers PT, MSc
Respiratory Rehabilitation and Respiratory Division, University
Hospitals, Katholieke Universiteit Leuven, and Faculty of
Kinesiology and Rehabilitation Sciences Katholieke Universiteit
Leuven, Leuven, Belgium
Hameeda Shaikh MD
Division of Pulmonary and Critical Care Medicine, Loyola University
of Chicago Stritch School of Medicine, and Edward Hines Jr
Veterans Administration Hospital, Hines, Illinois, USA
John M Shneerson MA, DM, FRCP, FCCP
Director, Respiratory Support and Sleep Centre, Papworth
Hospital, Cambridge, UK
Anita K Simonds MD, FRCP
Consultant in Respiratory Medicine, Academic Department
of Sleep and Breathing, Royal Brompton and Harefield NHS
Foundation Trust, London, UK
Marcio Soares MD, PhD
Intensive Care Unit, Instituto Nacional de Câncer,
Rio de Janeiro, Brazil
Renaud Tamisier MD, PhD
Hypoxia Pathophysiology Laboratory INSERM ER117, Joseph
Fourier University and Physiology Unit, Rehabilitation and
Physiology Department, CHU, Grenoble, France
Antoni Torres MD, PhD
Director of Respiratory, Intensive and Intermediate Care Unit,
Department of Pneumology, Institute of Thorax, Hospital Clinic,
IDIPAPS, Professor of Medicine, University of Barcelona, Spain
T Troosters PT, PhD
Respiratory Rehabilitation and Respiratory Division, University
Hospitals, Katholieke Universiteit Leuven, and Faculty of
Kinesiology and Rehabilitation Sciences, Katholieke Universiteit
Leuven, Leuven, Belgium
Isabel Utrabo MD
Attending of Intermediate Respiratory Care Unit, San Pedro de
Alcantara Hospital, Cáceres, Spain
Rosanna Vaschetto MD
Anesthesia and Intensive Care, University Hospital 'Maggiore
della Carità' Novara, Università del Piemonte Orientale 'Amedeo
Avogadro', Alessandria-Novara-Vercelli, Italy
Theodoros Vassilakopoulos MD
Associate Professor, Department of Critical Care and Pulmonary
Services, University of Athens Medical School, Evangelismos
Hospital, Athens, Greece
Lies Verfaillie MD
Respiratory Division University Hospital, UZ Brussel,
Brussels, Belgium


Contributors xvii

Michele Vitacca MD
Respiratory Unit and Weaning Centre, Fondazione Salvatore
Maugeri, IRCCS, Lumezzane, Italy
Paul P Walker BMed Sci (Hons), BM, BS, MD, FRCP
Consultant in Respiratory Medicine, Aintree Chest Centre,
University Hospital Aintree, Liverpool and School of Clinical
Sciences, University of Liverpool, Liverpool, UK
John W H Watt MB ChB, FRCA, MD
Consultant Anaesthetist, North West Regional Spinal Injuries
Centre, Southport Hospital, Southport, England
Jadwiga A Wedzicha MA, MD, FRCP
Professor of Respiratory Medicine, Academic Unit of Respiratory
Medicine, University College London Medical School, University
College London, London, UK
John P H Wilding DM, FRCP
Professor of Medicine and Honorary Consultant Physician,
Head of Diabetes and Endocrinology Clinical Research Unit,
Clinical Sciences Centre, University Hospital Aintree,
Liverpool, UK

João Carlos Winck PhD
Senior University Professor of Pulmonary Medicine, and
Coordinator of the Lung Function, Sleep and Ventilation Unit,
Pulmonary Medicine Department, Faculty of Medicine,
University of Porto, University Hospital of S João, Porto,
Portugal
Wolfram Windisch MD, PhD
Professor of Medicine, Department of Pneumology, University
Hospital Freiburg, Killianstrasse, Freiburg, Germany
Bernard Wuyam MD, PhD
Hypoxia Pathophysiology Laboratory INSERM ER117, Joseph
Fourier University and Physiology unit, Rehabilitation and
Physiology Department, CHU, Grenoble, France
Nektaria Xirouchaki MD, PhD
Department of Intensive Care Medicine, University Hospital of
Heraklion, Crete, Greece



Acknowledgements

For us this book is the culmination of many years of our
own work and indirectly of that of many others.
We are grateful to our parents Derek and Barbara,
Angelo and Mafalda, Bernhard and Regina for the values
they gave us and their support and encouragement
throughout our lives.
Our families have shared in our involvement in this field,
accepting our absences and distractions; our thanks to
Nicola, Ruth, Katherine, Anna Maria, Maria, Felix and Pia.
Much of what we have learnt would not have been
possible without the commitment of our colleagues and of
learning together with them. Thanks to those who work

and have worked in the Sleep and Assisted Ventilation
Service and on the Respiratory Wards at St James’s
University Hospital and Killingbeck Hospital, the
Respiratory Intensive Care Unit of Pavia Fondazione
S. Maugeri, the Respiratory Intensive care units in
Krankenhaus Kloster Grafschaft, Schmallenberg and
Klinikum Oststadt-Heidehaus, Hannover.
Mark Elliott
Stefano Nava
Bernd Schönhofer



Abbreviations

ABG
ACE
ACPE
ADH
AF
AH
AHI
AHRF
ALS
APAP
ARDS
ARF
ASV
ATS
AVAPS
BAL
BiPAP/BPAP
CAP
CHF
CLdyn
CLstat
CNEP
COPD
PEF
CPAP
CRDQ
CRF
CRQ
CRS
CSA
CSAQLI
CSR
CSS
DA-aO2
DMD
DMV
DNI/DNR
ECG
EDS
EF
ELBG
EMG
EMGdi

arterial blood gases
angiotensin-converting enzyme
acute cardiogenic pulmonary oedema
antidiuretic hormone
atrial fibrillation
absolute humidity
apnoea hypopnoea index
acute hypoxaemic respiratory failure
amyotrophic lateral sclerosis
auto-titrating positive airway pressure
acute respiratory distress syndrome
acute respiratory failure
adaptive servo-controlled ventilation
American Thoracic Society
average volume assured pressure support
bronchioalveolar lavage
bi-level positive airway pressure
community-acquired pneumonia
congestive heart failure
dynamic compliance
static compliance
continuous negative external pressure
chronic obstructive pulmonary disease
peak expiratory flow
continuous positive airway pressure
Chronic Respiratory Disease Questionnaire
chronic respiratory failure
Chronic Respiratory Questionnaire
compliance of the respiratory system
central sleep apnoea
Calgary Sleep Apnea Quality of Life Index
Cheyne–Stokes respiration
central apnoea syndrome
alveolar–arterial gradient
Duchenne muscular dystrophy
domiciliary mechanical ventilation
‘do not intubate’ or ‘do not resuscitate’
electrocardiogram
excessive daytime sleepiness
ejection fraction
ear lobe blood gas
electromyography
diaphragm electromyogram

EPAP
ERS
ET
ETI
FEV1
FiO2
FRC
FVC
GOLD
GPB
HDU
HFCWO
HHW
HME
HMEF
HMV
HPS
HRQoL
i:e
ICU
IL-1
IMV
IPAP
IPV
ITP
LABD
LTAC
LTD
LTOT
LV
LVFS
MAC
MDI
MEP
MIE
MIGET
MIP
MND
MSNA
MV
NAVA

expiratory positive airway pressure
European Respiratory Society
expiratory time
endotracheal intubation
forced expiratory volume in 1 second
oxygen inspiratory fraction
functional residual capacity
forced vital capacity
Global Initiative for Chronic Obstructive
Lung Disease
glossopharyngeal breathing
high-dependency unit
high-frequency chest wall oscillation
heated humidifier wire
heat moisture exchange
heat and moisture exchanger/filter
home mechanical ventilation
hepatopulmonary syndrome
health-related quality of life
inspiratory:expiratory ratio
intensive care unit
interleukin 1
intermittent mandatory ventilation
invasive mechanical ventilation
inspiratory positive airway pressure
intrapulmonary percussive ventilation
intrathoracic pressure
long-acting bronchodilator
long-term acute care
long-term dependency
long-term oxygen therapy
left ventricular
left ventricular fractional shortening
mechanically assisted cough
metered dose inhaler
maximal expiratory pressure
mechanical insufflation-exsufflation
multiple inert gas elimination
maximal inspiratory pressure
motor neurone disease
muscle sympathetic nerve activity
minute volume
neurally adjusted ventilatory assistance


xxii

Abbreviations

NAWR
n-CPAP
NIV
NMD
NIPPV
NPSA
NRD
OHS
OSA
PAV
PCF
PCWP
PEEP
PEEPi
PEF
PEFR
PEG
PMV
Poes
PSV
QALY
RAAS
RAW
RCT
RH
RICU
RIP
RMS
RV

nasal airway resistance
non-invasive CPAP
non-invasive ventilation
neuromuscular disease
non-invasive positive pressure ventilation
National Patient Safety Agency
neural respiratory drive
obesity hypoventilation syndrome
obstructive sleep apnoea
proportional-assist ventilation
peak cough flow
pulmonary capillary wedge pressure
positive end-expiratory pressure
intrinsic PEEP
peak expiratory flow
peak expiratory flow rate
percutaneous endoscopic gastrostomy
prolonged mechanical ventilation
oesophageal pressure
pressure support ventilation
quality-adjusted life-year
renin–angiotensin–aldosterone system
respiratory airway
randomized controlled trial
relative humidity
respiratory intensive care unit
respiratory inductance plethysmography
respiratory muscle strength
residual volume

SABA
SABD
SAMA
SAOS
SARS
SBT
SF-36
SGRQ
SIMV
SIP
SM
SMA
SNIP
SNS
SRI
TcCO2
TLC
TMS
TMV
TNF
TV
TwPdi
SPNS
VAP
VDU
VRU
WOB

short-acting inhaled ␤2-agonists
short-acting bronchodilator
short-acting muscarinic antagonist
sleep apnoea obstructive syndrome
severe acute respiratory syndrome
spontaneous breathing trial
Medical Outcome Survey Short Form 36
St George’s Respiratory Questionnaire
synchronized intermittent mandatory
ventilation
Sickness Impact Profile
sniff manoeuvre
spinal muscle atrophy
sniff nasal inspiratory pressure
sympathetic nervous system
severe respiratory insufficiency
transcutaneous carbon dioxide
total lung capacity
transcranial magnetic stimulation
tracheostomy and mechanical ventilation
tumour necrosis factor
tidal volume
twitch transdiaphragmatic pressure
supramaximal phrenic nerve stimulation
ventilator-associated pneumonia
ventilator-dependent unit
ventilator rehabilitation unit
work of breathing


PART

I

EQUIPMENT AND PRACTICE

1

Non-invasive ventilation: from the past
to the present
Dominique Robert, Barry Make

Section A
2
3
4

5

6
7

8

9

Section B
3

The equipment

Positive pressure ventilators
Dean R Hess
Negative pressure ventilation
Antonio Corrado, Massimo Gorini
Continuous positive airway
pressure
A Craig Davidson
Emerging modes for non-invasive
ventilation
Paolo Navalesi, Rosanna Vaschetto,
Antonio Messina
Interfaces
Cesare Gregoretti, Davide Chiumello
Quality control of non-invasive ventilation:
performance, service, maintenance and
infection control of ventilators
Jordi Rigau, Ramon Farré
Humidifiers and drug delivery during
non-invasive ventilation
Antonio M Esquinas Rodriguez
How to start a patient on non-invasive
ventilation
Raffaele Scala, Martin Latham

13
24

30

36

42

10 How to set up an acute non-invasive
ventilation service
Alicia K Gerke, Gregory A Schmidt
11 Monitoring during acute non-invasive
ventilation
Eumorfia Kondili, Nektaria Xirouchaki,
Dimitris Georgopoulos
12 Troubleshooting non-invasive ventilation
Nicholas S Hill
13 Timing of non-invasive ventilation
Stefano Nava, Paolo Navalesi
14 Why non-invasive ventilation works in acute
respiratory failure
Miquel Ferrer, Antoni Torres
Section C

53

61

70

The practice: acute non-invasive
ventilation
87

97

107
118

126

The practice: chronic non-invasive
ventilation

15 The chronic ventilator service
Jean-François Muir, Antoine Cuvelier
16 Diagnostic tests in the assessment of patients
for home mechanical ventilation
Patrick Murphy, Michael Polkey, Nicholas Hart
17 Patient and caregiver education
Ole Norregaard, Joan Escarrabill
18 Discharging the patient on home ventilation
Joan Escarrabill, Ole Norregaard
19 Telemedicine
Michele Vitacca

141

151
167
174
184



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