scholarly journals Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

2020 ◽  
Vol 67 (5) ◽  
pp. 261-270
Author(s):  
C. Cinesi Gómez ◽  
Ó. Peñuelas Rodríguez ◽  
M.l Luján Torné ◽  
C. Egea Santaolalla ◽  
J.F. Masa Jiménez ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Adult Patient ◽  
Respiratory Support ◽  
Non Invasive ◽  
Consensus Recommendations

scholarly journals Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

2020 ◽  
Vol 44 (7) ◽  
pp. 429-438 ◽  
Author(s):  
César Cinesi Gómez ◽  
Óscar Peñuelas Rodríguez ◽  
Manel Luján Torné ◽  
Carlos Egea Santaolalla ◽  
Juan Fernando Masa Jiménez ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Adult Patient ◽  
Respiratory Support ◽  
Non Invasive ◽  
Consensus Recommendations

scholarly journals A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 410
Author(s):  
Ariann Lenihan ◽  
Vannessa Ramos ◽  
Nichole Nemec ◽  
Joseph Lukowski ◽  
Junghyae Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Enteral Nutrition ◽  
Acute Respiratory Failure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Severity Of Illness ◽  
Respiratory Support ◽  
Early Enteral Nutrition ◽  
Non Invasive ◽  
Bilevel Positive Airway Pressure

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.

scholarly journals ERS Clinical Practice Guidelines: high-flow nasal cannula in acute respiratory failure

2021 ◽  
pp. 2101574
Author(s):  
Simon Oczkowski ◽  
Begüm Ergan ◽  
Lieuwe Bos ◽  
Michelle Chatwin ◽  
Miguel Ferrer ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
High Risk ◽  
Acute Respiratory Failure ◽  
Task Force ◽  
Extubation Failure ◽  
Pulmonary Complications ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Non Invasive

BackgroundHigh-flow nasal cannula (HFNC) has become a frequently used non-invasive form of respiratory support in acute settings, however evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).Materials and methodologyThe European Respiratory Society Task Force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The Task Force used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and non-invasive ventilation (NIV) for the management of adults in acute settings with ARF.ResultsThe Task Force developed 8 conditional recommendations, suggesting using: 1) HFNC over COT in hypoxemic ARF, 2) HFNC over NIV in hypoxemic ARF, 3)HFNC over COT during breaks from NIV, 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications, 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications, 6) HFNC over COT in non-surgical patients at low risk of extubation failure, 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV, 8) trialling NIV prior to use of HFNC in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic ARF.ConclusionsHFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of non-invasive respiratory support to provide to patients in different acute settings.

scholarly journals Prolonged Active Prone Positioning in Spontaneously Breathing Non-intubated Patients With COVID-19-Associated Hypoxemic Acute Respiratory Failure With PaO2/FiO2 >150

2021 ◽  
Vol 8 ◽  
Author(s):  
Paola Pierucci ◽  
Nicolino Ambrosino ◽  
Valentina Di Lecce ◽  
Michela Dimitri ◽  
Stefano Battaglia ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Prone Position ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Control Group ◽  
Prone Positioning ◽  
Non Invasive ◽  
Hypoxemic Acute Respiratory Failure ◽  
Spontaneously Breathing

Background: The COVID-19 pandemic has led to new approaches to manage patients outside the ICU, including prone positioning in non-intubated patients.Objectives: To report the use of prolonged active prone positioning in spontaneously breathing patients with COVID-19-associated acute respiratory failure. Spontaneously breathing vs non-invasive respiratory support for COVID19 associated acute respiratory failure.Methods: Patients with PaO2/FiO2 &gt; 150, with lung posterior consolidations as assessed by means of lung ultrasound, and chest x-ray were studied. Under continuous pulse oximetry (SpO2) monitoring, patients maintained active prone position. A PaO2/FiO2 &lt; 150 was considered as treatment failure and patients had to be switched to non-invasive respiratory support. Retrospectively, data of 16 patients undergoing who refused proning and underwent non-invasive respiratory support were used as controls. The primary outcome was the proportion of patients maintaining prolonged prone position and discharged home. Secondary outcomes included improvement in oxygenation, hospital length of stay, and 6-month survival.Results: Three out of 16 (18.7%) patients did not tolerate the procedure. Three more patients showed a worsening in PaO2/FiO2 to &lt;150 and required non-invasive support, two of whom finally needing endotracheal intubation. After 72 h, 10 out of 16 (62.5%) patients improved oxygenation [PaO2/FiO2: from 194.6 (42.1) to 304.7 (79.3.2) (p &lt; 0.001)] and were discharged home. In the control group, three out of 16 failed, required invasive ventilatory support, and died within 1 month in ICU. Thirteen were successful and discharged home.Conclusion: In non-intubated spontaneously breathing COVID-19 patients with PaO2/FiO2 &gt;150, active prolonged prone positioning was feasible and tolerated with significant improvement in oxygenation.

scholarly journals Non-Invasive Ventilation: a Safe and Effective Respiratory Support Method in Hypoxemic Acute Respiratory Failure Due to Pneumonia with or without Acute Respiratory Distress Syndrome

Folia Medica ◽  
2021 ◽  
Vol 63 (3) ◽  
pp. 321-328
Author(s):  
Viktoria Ilieva ◽  
Yordanka Yamakova
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
Safety And Efficacy ◽  
Non Invasive ◽  
Non Invasive Ventilation

Introduction: The benefit of non-invasive ventilation (NIV) in cases of hypercapnic acute respiratory failure (ARF) has already been proven. Still, its safety and efficacy as a respiratory support method for patients with hypoxemic ARF hasn&rsquo;t been studied so well.Aim: The aim of our study was to examine the safety and efficacy of NIV in hypoxemic ARF of primary lung origin.Materials and methods: This was a prospective observational cohort study of patients with hypoxemic ARF due to communityacquired pneumonia with or without acute respiratory distress syndrome (ARDS) treated using NIV. They were divided into four groups: pneumonia without ARDS, mild, moderate, or severe ARDS. Their clinical and ABG parameters were recorded before initiation of NIV, at 1 hour and 24 hours after ventilation onset and at transition to non-intensive NIV or before endotracheal intubation in NIV failure cases.Results: A total of 63 patients were included. NIV trial was successful in 85.71% of them, while 14.29% experienced NIV failure. In the general population, we observed a significant difference in PaO2/FiO2 only before transition to non-intensive NIV in comparison to the value at admission. This trend was seen in the patients with pneumonia without ARDS and moderate ARDS, but not in those with mild and severe ARDS. The clinical parameters showed improvement early in the course of treatment both in the entire study population and all subgroups.Conclusions: NIV is an effective and safe option for respiratory support in patients with severe CAP only when an adequate etiological treatment has been applied.

scholarly journals Failure of non-invasive respiratory support after 6 hours from initiation is associated with ICU mortality

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0251030
Author(s):  
Mitsuaki Nishikimi ◽  
Kazuki Nishida ◽  
Yuichiro Shindo ◽  
Muhammad Shoaib ◽  
Daisuke Kasugai ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Lung Diseases ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Icu Mortality ◽  
Failure Group ◽  
Non Invasive ◽  
Significant Difference

A previous study has shown that late failure (> 48 hours) of high-flow nasal cannula (HFNC) was associated with intensive care unit (ICU) mortality. The aim of this study was to investigate whether failure of non-invasive respiratory support, including HFNC and non-invasive positive pressure ventilation (NPPV), was also associated with the risk of mortality even if it occurs in the earlier phase. We retrospectively analyzed 59 intubated patients for acute respiratory failure due to lung diseases between April 2014 and June 2018. We divided the patients into 2 groups according to the time from starting non-invasive ventilatory support until their intubation: ≤ 6 hours failure and > 6 hours failure group. We evaluated the differences in the ICU mortality between these two groups. The multivariate logistic regression analysis showed the highest mortality in the > 6 hours failure group as compared to the ≤ 6 hours failure group, with a statistically significant difference (p < 0.01). It was also associated with a statistically significant increased 30-day mortality and decreased ventilator weaning rate. The ICU mortality in patients with acute respiratory failure caused by lung diseases was increased if the time until failure of HFNC and NPPV was more than 6 hours.

scholarly journals Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU

2017 ◽  
Vol 16 (3) ◽  
pp. 115-122
Author(s):  
Christopher John Wright ◽  
◽  
Russell Morton Allan ◽  
Stuart A Gillon ◽  
◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Key Management ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
High Dependency Unit ◽  
Non Invasive ◽  
High Dependency ◽  
Threatening Condition ◽  
Life Threatening

Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

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