Predicting Non-Invasive Ventilation Failure in Severe Acute Respiratory Distress Syndrome

Author(s):  
S. Harabaglia ◽  
M.J. Junqueira
2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.


Medicine ◽  
2021 ◽  
Vol 100 (4) ◽  
pp. e24443
Author(s):  
Mohamad Y. Khatib ◽  
Mohamed Z. Peediyakkal ◽  
Moustafa S. Elshafei ◽  
Hani S. Elzeer ◽  
Dore C. Ananthegowda ◽  
...  

2021 ◽  
Author(s):  
Liam Weaver ◽  
Declan G. Bates ◽  
Luigi Camporota

Positive end expiratory pressure (PEEP) is routinely used as part of lung protective ventilation strategies in the treatment of acute respiratory distress syndrome (ARDS). In the case of ARDS arising due to COVID-19 (CARDS), there is some debate as to whether the atypical pathophysiological characteristics of the disease which lead to hypoxaemia could warrant a modified approach to ventilator management, particularly with regards to PEEP settings. Here we review the available evidence for the existence of a unique underlying lung pathophysiology in CARDS, and for the suitability of standard approaches to setting PEEP, in both the invasive and non-invasive ventilation settings. We show how detailed computational models informed by this evidence can shed light on the available data, and help to interpret recent results in the literature.


2020 ◽  
Vol 13 (10) ◽  
pp. e235243
Author(s):  
Syed Muhammad Tahir Nasser ◽  
Madan Narayanan

Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanisms by which proning improves oxygenation as well as the potential risks proning on NIV brings, for which we make specific recommendations.


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