Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure

2021 ◽  
Author(s):  
M. Luján ◽  
Ó. Peñuelas ◽  
C. Cinesi Gómez ◽  
A. García-Salido ◽  
J. Moreno Hernando ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Scientific Societies ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Key Points ◽  
High Flow Oxygen

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.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 numberNCT03673631

scholarly journals The impact of non-invasive respiratory support techniques on the lethal outcome frequency in adult with severe respiratory failure caused by the new coronavirus infection

2021 ◽  
Vol 18 (1) ◽  
pp. 47-56
Author(s):  
К. A. Tsygankov ◽  
I. N. Grachev ◽  
Vladimir I. Shatalov ◽  
А. V. Schegolev ◽  
D. A. Аveryanov ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Severe Respiratory Failure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Coronavirus Infection ◽  
Group 2

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

scholarly journals Comparison of hypoxemia, intubation procedure, and complications for non-invasive ventilation against high-flow nasal cannula oxygen therapy for patients with acute hypoxemic respiratory failure: a non-randomized retrospective analysis for effectiveness and safety (NIVaHIC-aHRF)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chao Zhang ◽  
Min Ou
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Severe Hypoxia ◽  
Invasive Ventilation ◽  
Severe Hypoxemia ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Intubation Procedure

Abstract Background Optimization of preoxygenation procedure can help to secure the method of intubation by reducing the risks of severe hypoxemia and other problems. There is confusion for efficacy of non-invasive ventilation compared to high-flow oxygen therapy regarding occurrence of severe hypoxemia during the intubation procedure. The purpose of the study was to compare the difference between noninvasive ventilation and high flow oxygen therapy to prevent desaturation during laryngoscopy. Methods Patients underwent high-flow nasal cannula oxygen therapy (HCO cohort, n = 161) or non-invasive ventilation procedure (NIV cohort, n = 154) for oxygenation and ventilation due to acute hypoxemic respiratory failure in the intensive care unit. Data before preoxygenation, preoxygenation, intubation, laryngoscopy, and complications of patients due to tracheal intubation were retrospectively collected and analyzed. Results There was no difference between both cohorts for the demographical and clinical conditions of the patients before preoxygenation (p > 0.05 for all parameters), numbers of patients with severe hypoxia during the intubation procedure (35 vs. 45, p = 0.303), the time duration of laryngoscopy (p = 0.847), number of laryngoscopies attempts (p = 0.804), and immediate and late complications during the intubation procedure. The values of pulse oximetry were reported higher for patients of NIV cohort than those of HCO cohort during preoxygenation. Fewer numbers of patients were reported with severe hypoxia among patients of the NIV cohort than those of the HCO cohort (24 vs., 40, p = 0.042) who have moderate-to-severe hypoxemia (partial pressure of arterial oxygen to fraction of inspired oxygen ratio ≤ 200 mmHg) before preoxygenation. The most common complications were hypertension, pulmonary aspiration, and increased 30-day mortality. Conclusions When compared, there was no difference between non-invasive ventilation technique and high-flow oxygen therapy to minimize severe hypoxia prior to laryngoscopy and endotracheal intubation in patients with acute respiratory failure.

scholarly journals High-flow oxygen therapy versus non-invasive ventilation: a randomised physiological cross-over study of alveolar recruitment in acute respiratory failure

2021 ◽  
pp. 00373-2021
Author(s):  
Elise Artaud-Macari ◽  
Michael Bubenheim ◽  
Gurvan Le Bouar ◽  
Dorothée Carpentier ◽  
Steven Grangé ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Alveolar Recruitment ◽  
Patient Comfort ◽  
Invasive Ventilation ◽  
Lung Volumes ◽  
Non Invasive ◽  
Non Invasive Ventilation

High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).A prospective randomised cross-over physiological study was conducted in patients with hypoxemic ARF due to pneumonia. They received alternately HFNC, NIV and FM.Sixteen patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95%CI: (857; 2646)) and 826 (95%CI: (399.5; 2361)) respectively. Global and regional TV increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher SpO2/ FiO2 ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1) but was lower with NIV (p=0.001).This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxemic ARF. In contrast with HFNC, NIV increased lung volumes which may contribute to overdistension and its potentially deleterious effect in these patients.

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