scholarly journals Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS

2021 ◽  
Author(s):  
Domenico Luca Grieco ◽  
Salvatore Maurizio Maggiore ◽  
Oriol Roca ◽  
Elena Spinelli ◽  
Bhakti K. Patel ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ventilatory Support ◽  
High Flow ◽  
Line Treatment ◽  
First Line ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
First Line Treatment

Noninvasive Ventilatory Support As First-Line Treatment For COVID-19 Critically Ill Patients With Acute Hypoxemic Respiratory Failure

2020 ◽  
Author(s):  
Luca Salvatore Menga ◽  
Luca Delle Cese ◽  
Filippo Bongiovanni ◽  
Gianmarco Lombardi ◽  
Filippo Luciani ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Endotracheal Intubation ◽  
Ventilatory Support ◽  
Serum Lactate ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Line Treatment ◽  
First Line ◽  
Hypoxemic Respiratory Failure ◽  
First Line Treatment

Abstract Background: Although widely applied, noninvasive ventilatory support (NIVS) efficacy in COVID-19 disease is unknown. Early identification of treatment failure is warranted to avoid delays in endotracheal intubation and protective ventilation. We conducted a study to determine the rate of and factors associated to NIVS failure in critically ill patients with COVID-19 disease, and to compare NIVS failure rate in COVID-19 patients to that of a matched cohort with hypoxemic respiratory failure of other origins. Methods: All consecutive patients receiving first-line treatment NIVS for hypoxemic respiratory failure due to COVID-19 in the ICU of a University Hospital in Italy up to April 20th, 2020, were studied: laboratory data were collected on arrival, 28-day outcome was recorded. After one-to-one propensity score matching based on simplified acute physiology (SAPS) II score, age, PaO2/FiO2 and PaCO2 at arrival, NIVS failure rate in COVID-19 patients was compared to a previously published cohort who received NIVS during hypoxemic respiratory failure from other causes. Results: Eighty-five patients received first-line treatment with NIVS, mainly with helmet noninvasive ventilation and high-flow nasal cannula. Fifty-two patients (61%) needed endotracheal intubation. Independent predictors of NIVS failure were SAPSII score (adjusted hazard ratio 1.039 [1.018-1.061], <0.001), and serum lactate de-hydrogenase at enrolment (adjusted hazard ratio: 1.002 [1.000-1.004], p=0.013): 88% of patients with SAPSII≥33 and serum lactate de-hydrogenase≥405 Units/Liter needed endotracheal intubation vs. 32% of patients with SAPS<33 and lactate de-hydrogenase<405 Units/Liter. In the propensity-matched cohorts (108 patients), COVID-19 patients showed higher risk of NIVS failure than other causes of hypoxemic respiratory failure (59% vs. 35%, p=0.02), with an adjusted hazard ratio of 2 (CI95% [1.1-3.6], p=0.01). Conclusions: COVID-19 patients receiving first-line NIVS are burdened by high risk of needing endotracheal intubation: this appears greater than that of patients affected by hypoxemic respiratory failure of other origins. In order to not delay endotracheal intubation, if logistically sustainable, NIVS use in the intensive care unit should be avoided in severe patients (SAPSII score≥33) with serum lactate de-hydrogenase≥405 Units/Liter.

scholarly journals Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial

2020 ◽  
Vol 6 (4) ◽  
pp. 00114-2020
Author(s):  
Athanasia Papalampidou ◽  
Eleni Bibaki ◽  
Stylianos Boutlas ◽  
Ioannis Pantazopoulos ◽  
Nikolaos Athanasiou ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
High Flow ◽  
Line Treatment ◽  
First Line ◽  
Hypercapnic Respiratory Failure ◽  
Acute Exacerbation Of Copd ◽  
High Flow Oxygen ◽  
Exacerbation Of Copd ◽  
First Line Treatment

BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

scholarly journals Prolonged non-invasive respiratory support in a COVID-19 patient with severe acute hypoxemic respiratory failure

2021 ◽  
Author(s):  
Andrea Lanza ◽  
Maurizio Sommariva ◽  
Sara Mariani ◽  
Gabriela Ferreyra ◽  
Giuliana Enrica Stagni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Low Flow ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
High Dependency ◽  
Non Invasive Ventilation ◽  
Experienced Team

A pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 was declared in 2020. Severe cases were characterized by the development of acute hypoxemic respiratory failure (AHRF) requiring advanced respiratory support. However, intensive care units (ICU) were saturated, and many patients had to be treated out of ICU. This case describes a 75-year-old man affected by AHRF due to Coronavirus Disease 2019 (COVID-19), hospitalized in a high-dependency unit, with PaO2/FiO2 <100 for 28 consecutive days. An experienced team with respiratory physiotherapists was in charge of the noninvasive ventilatory support (NIVS). The patient required permanent NIVS with continuous positive airway pressure, non-invasive ventilation, high flow nasal oxygen and body positioning. He was weaned from NIVS after 37 days and started exercise training afterwards. The patient was discharged at home with low-flow oxygen therapy. This case represents an example of a successful treatment of AHRF with the still controversial noninvasive respiratory support in one patient with COVID-19.

scholarly journals High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029798 ◽  
Author(s):  
Rémi Coudroy ◽  
Jean-Pierre Frat ◽  
Stephan Ehrmann ◽  
Frédéric Pène ◽  
Nicolas Terzi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Mortality Rates ◽  
High Flow ◽  
Immunocompromised Patients ◽  
Invasive Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Non Invasive Ventilation

IntroductionNon-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT02978300

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