Riassunto
Questo è decisamente un campo di applicazione emergente. Si sa ormai da tempo che la chirurgia toracica e addominale maggiore possono essere complicate da una ipossia nel periodo post-operatorio. Questa è quasi sempre da mettersi in relazione a un problema di scarsa mobilità diaframmatica, le cui cause potrebbero essere un danno traumatico durante l’operazione, un effetto farmacologico degli anestetici e/o analgesici sul nervo frenico oppure banalmente il dolore intenso che non permette al paziente di espandere a sufficienza il sistema respiratorio (i.e. cassa toracica e addome). La ridotta funzionalità del diaframma è associata a una ridotta compliance polmonare e alla presenza di aree di atelettasia, che sono il fattore di rischio principale per l’insorgenza di polmonite. Questa temibile complicanza nel periodo postoperatorio può portare anche alla morte.
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Letture consigliate
Prevenzione e trattamento delle complicanze chirurgiche
Auriant I, Jallot A, Hervé P et al (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164(7):1231–1235
Joris JL, Sottiaux TM, Chiche JD et al (1997) Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 111(3):665–670
Kutlu CA, Williams EA, Evans TW et al (2000) Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 69(2):376–380
Perrin C, Jullien V, Vénissac N et al (2007) Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 101(7):1572–1578
Pinilla JC, Oleniuk FH, Tan L et al (1990) Use of nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med 18(8):836–840
Squadrone V, Coha M, Cerutti E et al (2005) Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 293(5):589–595
Obesity Hypoventilation Syndrome (OHS)
Nelson JA, Loredo JS, Acosta JA (2008) The Obesity-Hypoventilation Syndrome and Respiratory Failure in the Acute Trauma Patient. J Emerg Med 2008 Aug 30 [epub ahead of print]
Pérez de Llano LA, Golpe R, Ortiz Piquer M et al (2005) Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest 128(2):587–594
Palliazione dei sintomi nel malato terminale
Cuomo A, Delmastro M, Ceriana P et al (2004) Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer. Palliat Med 18(7):602–610
Curtis JR, Cook DJ, Sinuff T et al (2007) Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med 35(3):932–939
Fernandez R, Baigorri F, Artigas A (2007) Noninvasive ventilation in patients with “do-notintubate” orders: medium-term efficacy depends critically on patient selection. Intensive Care Med 33(2):350–354
Levy M, Tanios MA, Nelson D et al (2004) Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation. Crit Care Med 32(10):2002–2007
Nava S, Sturani C, Hartl S et al (2007) End-of-life decision-making in respiratory intermediate care units: a European survey. Eur Respir J 30(1):156–164
Nava S et al (2008) Multicenter randomized study on the use of non-invasive ventilation vs oxygen therapy in reducing respiratory distress in end-stage cancer patients Am J Respir Crit Care Med 177:A767
Prinicipi T, Pantanetti S, Catani F et al (2004) Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med 30(1):147–150
Schettino G, Altobelli N, Kocmarek RM (2005) Noninvasive positive pressure ventilation reverses acute respiratory failure in selected “do-not-intubate” patients. Crit Care Med 33:1976–1982
Asma
Soma T, Hino M, kida K, Kudoh S (2008) A Prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV). Intern Med 47(6):493–501
Soroksky A, Stav D, Shpirer I (2003) A pilot, prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 123(4):1018–1025
Malattie restrittive neuromuscolari o della cassa toracica
Puha J, Kong K, lee KH et al (2005) Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure. Intensive Care Med 31(4):533–339
Vianello A, Bevilacqua M, Arcaro G et al (2000) Non-invasive ventilatory approach to treatment of acute respiratory failure in neuromuscular disorders. A comparison with endotracheal intubation. Intensive Care Med 26(4):384–390
Supporto ventilatorio durante broncoscopia
Antonelli M, Conti G, Rocco M et al (2002) Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest 121(4):1149–1154
Antonelli M, Pennisi MA, Conti G et al (2003) Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet. Intensive Care Med 29(1):126–129
Maitre B, Jaber S, Maggiore SM et al (2000) Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double-blind study using a new device. Am J Respir Crit Care Med 162(3 Pt 1):1063–1067
Natalini G, Cavaliere S, Vitacca M et al (1998) Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy. A controlled randomised trial. Acta Anaesthesiol Scand 42(9):1063–1069
Indicazioni future supportate da studi singoli
Jaber S, Chanques G, Sebbane M et al (2006) Noninvasive positive pressure ventilation in patients with respiratory failure due to severe acute pancreatitis. Respiration 73(2):166–172
O’Brien G, Criner GJ (1999) Mechanical ventilation as a bridge to lung transplantation. J Heart Lung Transplant 18(3):255–265
Smyth A (2006) Update on treatment of pulmonary exacerbations in cystic fibrosis. Curr Opin Pulm Med 12(6):440–444
Xirouchaki N, Kondoudaki E, Anastasaki M (2005) Noninvasive bilevel positive pressure ventilation in patients with blunt thoracic trauma. Respiration 72(5):517–522
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Nava, S., Fanfulla, F. (2010). La ventiloterapia non invasiva nel trattamento dell’insufficienza respiratoria acuta: indicazioni emergenti. In: Ventilazione meccanica non invasiva. Springer, Milano. https://doi.org/10.1007/978-88-470-1548-7_12
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