This book contains twenty-one original papers and one review paper published by internationally recognized experts in the Atmosphere Special Issue "Recent Advances in Urban Ventilation Assessment and ...Flow Modelling", years 2017–2019. The Special Issue includes contributions on recent experimental and modelling works, techniques, and developments mainly tailored to the assessment of urban ventilation on flow and pollutant dispersion in cities. The study of ventilation is of critical importance, as it addresses the capacity with which a built urban structure is capable of replacing the polluted air with ambient fresh air. Here, ventilation is recognized as a transport process that improves local microclimate and air quality and closely relates to the term “breathability”. The efficiency with which street canyon ventilation occurs depends on the complex interaction between the atmospheric boundary layer flow and the local urban morphology.The individual contributions to this Issue are summarized and categorized into four broad topics: (1) outdoor ventilation efficiency and application/development of ventilation indices, (2) relationship between indoor and outdoor ventilation, (3) effects of urban morphology and obstacles to ventilation, and (4) ventilation modelling in realistic urban districts. The results and approaches presented and proposed will be of great interest to experimentalists and modelers, and may constitute a starting point for the improvement of numerical simulations of flow and pollutant dispersion in the urban environment, for the development of simulation tools, and for the implementation of mitigation strategies.
The significance of natural ventilation Porteous, Colin
Building research and information : the international journal of research, development and demonstration,
02/2019, Volume:
47, Issue:
2
Journal Article
Background
Non‐invasive ventilation (NIV) with bi‐level positive airway pressure (BiPAP) is commonly used to treat patients admitted to hospital with acute hypercapnic respiratory failure (AHRF) ...secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Objectives
To compare the efficacy of NIV applied in conjunction with usual care versus usual care involving no mechanical ventilation alone in adults with AHRF due to AECOPD. The aim of this review is to update the evidence base with the goals of supporting clinical practice and providing recommendations for future evaluation and research.
Search methods
We identified trials from the Cochrane Airways Group Specialised Register of trials (CAGR), which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), and PsycINFO, and through handsearching of respiratory journals and meeting s. This update to the original review incorporates the results of database searches up to January 2017.
Selection criteria
All randomised controlled trials that compared usual care plus NIV (BiPAP) versus usual care alone in an acute hospital setting for patients with AECOPD due to AHRF were eligible for inclusion. AHRF was defined by a mean admission pH < 7.35 and mean partial pressure of carbon dioxide (PaCO2) > 45 mmHg (6 kPa). Primary review outcomes were mortality during hospital admission and need for endotracheal intubation. Secondary outcomes included hospital length of stay, treatment intolerance, complications, changes in symptoms, and changes in arterial blood gases.
Data collection and analysis
Two review authors independently applied the selection criteria to determine study eligibility, performed data extraction, and determined risk of bias in accordance with Cochrane guidelines. Review authors undertook meta‐analysis for data that were both clinically and statistically homogenous, and analysed data as both one overall pooled sample and according to two predefined subgroups related to exacerbation severity (admission pH between 7.35 and 7.30 vs below 7.30) and NIV treatment setting (intensive care unit‐based vs ward‐based). We reported results for mortality, need for endotracheal intubation, and hospital length of stay in a 'Summary of findings' table and rated their quality in accordance with GRADE criteria.
Main results
We included in the review 17 randomised controlled trials involving 1264 participants. Available data indicate that mean age at recruitment was 66.8 years (range 57.7 to 70.5 years) and that most participants (65%) were male. Most studies (12/17) were at risk of performance bias, and for most (14/17), the risk of detection bias was uncertain. These risks may have affected subjective patient‐reported outcome measures (e.g. dyspnoea) and secondary review outcomes, respectively.
Use of NIV decreased the risk of mortality by 46% (risk ratio (RR) 0.54, 95% confidence interval (CI) 0.38 to 0.76; N = 12 studies; number needed to treat for an additional beneficial outcome (NNTB) 12, 95% CI 9 to 23) and decreased the risk of needing endotracheal intubation by 65% (RR 0.36, 95% CI 0.28 to 0.46; N = 17 studies; NNTB 5, 95% CI 5 to 6). We graded both outcomes as 'moderate' quality owing to uncertainty regarding risk of bias for several studies. Inspection of the funnel plot related to need for endotracheal intubation raised the possibility of some publication bias pertaining to this outcome. NIV use was also associated with reduced length of hospital stay (mean difference (MD) ‐3.39 days, 95% CI ‐5.93 to ‐0.85; N = 10 studies), reduced incidence of complications (unrelated to NIV) (RR 0.26, 95% CI 0.13 to 0.53; N = 2 studies), and improvement in pH (MD 0.05, 95% CI 0.02 to 0.07; N = 8 studies) and in partial pressure of oxygen (PaO2) (MD 7.47 mmHg, 95% CI 0.78 to 14.16 mmHg; N = 8 studies) at one hour. A trend towards improvement in PaCO2 was observed, but this finding was not statistically significant (MD ‐4.62 mmHg, 95% CI ‐11.05 to 1.80 mmHg; N = 8 studies). Post hoc analysis revealed that this lack of benefit was due to the fact that data from two studies at high risk of bias showed baseline imbalance for this outcome (worse in the NIV group than in the usual care group). Sensitivity analysis revealed that exclusion of these two studies resulted in a statistically significant positive effect of NIV on PaCO2. Treatment intolerance was significantly greater in the NIV group than in the usual care group (risk difference (RD) 0.11, 95% CI 0.04 to 0.17; N = 6 studies). Results of analysis showed a non‐significant trend towards reduction in dyspnoea with NIV compared with usual care (standardised mean difference (SMD) ‐0.16, 95% CI ‐0.34 to 0.02; N = 4 studies). Subgroup analyses revealed no significant between‐group differences.
Authors' conclusions
Data from good quality randomised controlled trials show that NIV is beneficial as a first‐line intervention in conjunction with usual care for reducing the likelihood of mortality and endotracheal intubation in patients admitted with acute hypercapnic respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). The magnitude of benefit for these outcomes appears similar for patients with acidosis of a mild (pH 7.30 to 7.35) versus a more severe nature (pH < 7.30), and when NIV is applied within the intensive care unit (ICU) or ward setting.
Außerklinische Beatmung Schäfer, Harald
MMW Fortschritte der Medizin,
04/2020, Volume:
162, Issue:
7
Journal Article
Peer reviewed
In den letzten Jahren ist eine deutliche und kontinuierliche Zunahme von meist schwerkranken Patienten zu konstatieren, die außerhalb einer Klinik beatmet werden. Diese Patienten stellen eine ...wachsende Herausforderung für alle an der Versorgung Beteiligten dar. In der Regel erfolgt die ärztliche Weiterbetreuung und die Verordnung der benötigten Hilfsmittel durch Hausärzte. In diesem Beitrag lesen Sie, was ein Hausarzt aus dem Bereich der Beatmungsmedizin wissen sollte.
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